肾上腺髓样脂肪瘤CT与MRI表现及误诊分析  

CT and MRI features of adrenal myelolipoma and misdiagnostic analysis

作　　者：李小双[1,3] 周浩 崔文静 陈晓 刘永康 王晨曦[2] 王中秋 

机构地区：[1]南京中医药大学附属医院江苏省中医院放射科,江苏南京210029 [2]南京中医药大学附属医院江苏省中医院病理科,江苏南京210029 [3]蚌埠医学院研究生部

出　　处：《实用放射学杂志》2016年第6期888-891,共4页Journal of Practical Radiology

摘　　要：目的 分析肾上腺髓样脂肪瘤（AML）CT、MRI表现及误诊情况。方法 回顾分析经手术病理证实的32例AML，27例（32个肿块）行CT检查，6例（7个肿块）行MRI检查，其中1例同时行CT及MRI检查（1个肿块）。分析肿块的形态、大小、包膜、边界、CT密度、MR信号及强化程度。结果 28例单发，4例多发；37个肿块（97.4%）境界清晰，35个（92.1%）有包膜，29个（76.3%）呈圆形或椭圆形，9个（23.7%）呈分叶状或不规则形。肿块平均直径6.63（1.07~16.98）cm。22个（22/32, 68.8%）肿块以脂肪低密度为主，7个（7/32, 21.9%）呈混杂密度，3个（9.3%）呈等、稍高密度；9个（9/32，28.1%）肿块有钙化，1个（1/32，3.1%）伴出血。7个肿块在T1WI均含高信号区域，且这些区域在脂肪抑制序列上信号明显降低。增强后病灶内软组织轻度强化24例，中度强化2例，脂肪成分均无强化。24例表现较为典型,术前均正确诊断。8例表现不典型,为多发、瘤体过小、乏脂肪、形态不规则及瘤内出血，其中3例误诊，1例漏诊。结论 肾上腺区单发圆形或椭圆形、境界清晰、有包膜、内含不等量脂肪成分且增强后呈轻、中度强化的肿块为典型AML表现；少数不典型AML易漏诊、误诊。Objective To explore the imaging features of adrenal myelolipoma（AML） and misdiagnostic analysis. Methods 32 cases with pathologically confirmed AML were analyzed retrospectively. 27 patients（32 masses） underwent CT examination, and 6 patients （7 masses） MRI examination. One patient underwent both CT and MRI examination. The morphology, pseudocapsule, boundary, density and MRI signal of the lesions were analyzed. Results 28 eases were unilateral, 4 cases were multi-foci. 37 （97.4%） tumors had clear boundaries, 35 （ 92. 1% ） tumors had pseudocapsule, 29 （ 76. 3 % ） tumors were round or oval shaped, 9 （ 23. 7 % ） tumors were lobulated or irregular shaped. The average diameter of the tumors was 6.63（1.07-16.98） cm. In CT scan, 22（22/32, 68.8 % ） tumors showed fat dominated low density,7 （ 7/32,21.9 % ） tumors showed fat density mixed with soft tissue density, 3 （ 9.3 % ） tumors showed iso-or hyperdensity. Calcification and hemorrhage were observed in 9 （9/32,28.1% ） and one （1/32,3.1 % ） mass, respectively. Seven masses contained the areas that showed high signal intensity on T1WI , which were suppressed on fat saturation images. CT or MRI enhancement showed that soft tissues of masses were mildly enhanced in 24 masses, and moderately enhanced in 2 masses, but the fat contents were not enhanced. 24 cases with the typical appearance were correctly diagnosed. Three masses were misdiagnosed and one mass was miss diagnosed in the other eight cases which were showed atypical （eatures, including multi-loci, small sizes,with minima[ fat or irregular shape ,or big sizes with hemorrhage. Conclusion Round or oval shaped,with el.ear boundaries and pseudocapsule,containing fat tissue density or signal with no or mildly enhancement are the typical features of adrenal myelolipoma. It is often misdiagnosed or miss-diagnosed for some AML with atypical features.

关 键 词：肾上腺髓样脂肪瘤 计算机体层成像 磁共振成像 

分 类 号：R736.6[医药卫生—肿瘤] R814.42[医药卫生—临床医学]