黄色肉芽肿性肾盂肾炎误诊漏诊18例CT和正电子发射计算机断层显像CT表现及原因  

Investigations on CT and PET-CT manifestations and causes of 18 cases with xanthogranulomatous pyelonephritis misdiagnosed or of missed diagnosis

作　　者：蒙秋华[1] 陈娇香[2] 张文浩[1] 叶丽芳[1] 李新春[1] 曾庆思[1] 

机构地区：[1]广州医科大学附属第一医院放射科,510080 [2]中山大学第一附属医院胸外科

出　　处：《实用医学影像杂志》2015年第5期431-433,共3页Journal of Practical Medical Imaging

摘　　要：目的探讨黄色肉芽肿性肾盂肾炎(XGPN)误诊漏诊的影像学特点及原因,以更好提高其诊断准确性。方法回顾性分析18例经手术病理证实的误诊漏诊XGPN CT及正电子发射计算机断层显像(PET)-CT的征象,并复习文献加以分析。结果 XGPN的病肾多合并结石和肾周累及,12例弥漫型XGPN的CT平扫表现为肾盂扩张积水或伴肾盂肾盏旁囊性病变,3例局限型XGPN的CT表现为肾实质或肾包膜下囊性或囊实性占位,增强后呈实性结节增强或环形强化,3例局限型XGPN的PET-CT表现为肾内低、等密度灶伴糖代谢增高。结论XGPN常表现为肾结石、肾积水的基础上,容易合并肾周累及的肾内、肾盂、肾盏旁囊性或囊实性结节,呈环状或不均匀结节状强化,病灶可呈放射性异常浓聚。单纯CT平扫容易漏诊弥漫型XGPN,CT表现不典型时局灶型XGPN容易误诊为恶性肿瘤。Objective To evaluate the imaging features of Xanthogranulomatous Pyelonephritis （XGPN） and misdiagnosis cause in order to improve diagnostic accuracy of XGPN. Methods Eighteen cases with XGPN misdiag- nosed or missed diagnosed by CT and PET-CT were proved by operation and pathology ,then the results were analyzed retrospectively and the literature was reviewed. Results XGPN were often associated with renal calculus and exten- sive infilitation to the perirenal or pararenal space. Twelve cases of diffuse type showed as hydronephrosis or hy- dronephrosis with parenchymal cystic on plain CT scan. Three cases of focal type showed as renal parenchyma or re- nal subcapsular cystic nodules or cystic nodules with solid, and on enhacement CT scan the nodules were showed as solid and ring-shaped enhancement. Another 3 cases of focal type presented as a renal parenchymal low or isodensity lesion with increased glucose metabolism on PET-CT. Conclusion On the basic of renal calculus and hydronephrosis ,XGPN often appeared as renal parenchyma cystic or cystic with solid nodules which were with circular enhancement or asymmetrical enhancement of radioactive concentration, The lesions were often associated with renal pelvis or the perirenal or pararenal space. XGPN of diffuse type is easy to misdiagnose on plain CT scan and focal XGPN is easily misdiagnosed as malignant tumors.

关 键 词：肾盂肾炎 黄肉芽肿性 体层摄影术 螺旋计算机 泡沫细胞 

分 类 号：R692.7[医药卫生—泌尿科学]