肾上腺髓质脂肪瘤CT和MRI表现与其病理特点分析  

Analysis of CT and MRI manifestations of adrenal myelolipoma with its pathological feature

作　　者：李丹菲 杨钦[2] 陈自谦[3] 杨艳秋 汪丽 王烈[2] 张再重[2] 

机构地区：[1]福建医科大学福总临床医学院,福建福州350000 [2]南京军区福州总医院普外科,福建福州350025 [3]南京军区福州总医院影像科,福建福州350025

出　　处：《医学影像学杂志》2017年第11期2154-2159,共6页Journal of Medical Imaging

摘　　要：目的分析肾上腺髓质脂肪瘤的CT及MRI特征,提高诊断的准确率,为患者治疗方案的选择及为手术风险的预判提供影像依据。方法回顾性分析了17例经手术病理证实的AML患者的CT(含CTA)或MRI资料,其中男性8例(47.0%),女性9例(53.0%),观察病灶的影像学特征、平扫和增强特点及血供情况。结果病灶多呈椭圆形或类圆形,边界清楚,CT平扫密度欠均匀,可见脂肪成分及增生的肾上腺成分,增强扫描肾上腺成分强化,脂肪成分无强化,可见钙化。CTA显示病灶血供来自肾动脉或腹主动脉分支。MRI病灶T1WI、T2WI均以混杂高信号为主,病灶高信号部分在T2WI脂肪抑制序列呈低信号,DWI呈稍高信号,同/反相位序列同相位呈高信号,反相位呈低信号,说明病灶以脂肪成分为主,肾上腺成分T1WI、T2WI、T2WI脂肪抑制、DWI均呈等信号,增强扫描肾上腺成分强化,脂肪成分未见明显强化。光镜下病灶均由大片成熟脂肪组织、造血细胞岛及边缘增生的肾上腺组织三种成分构成。结论肾上腺髓质脂肪瘤具有一定的CT及MRI特征,只有将CT(含CTA)、MRI技术结合起来,才能在最大程度上降低其误诊率,提高诊断准确性。Objective To analyze the CT and MRI features of adrenal myelolipoma, to improve the accuracy of diagnosis, and to provide imaging evidence for the choice of treatment plan and the preoperative judgment of surgical risk. Methods CT （ inclu- ding CTA） or MRI data of 17 patients with AML confirmed by operation and pathology were analyzed retrospectively, including 8 cases of male （47%） , 9 cases of female （53%）. The imaging features, plain scan , enhancement characteristics and blood sup- ply vessels of the lesions were observed. Results Lesions were oval or round, clear boundary. Lesions were inhomogeueous den- sity in CT plain imiging, which were component of visible fat and adrenal hyperplasia. Enhanced scanning showed adrenal compo- nent enhancement but fat composition no enhancement. CTA showed that the blood supply of the lesion was from the renal artery or the abdominal aorta. Lesions were mainly mixed high signal on T~ WI and T2WI of MRI. The high signal portion of the lesions showed low signal on the TzWI fat suppression sequence, while slightly high signal on DWI, high signal on in-phase and low sig- nal on opposed-phase of in-phase opposed-phase T~ WI sequences , indicating that the lesion is rich in fat composition. Adrenal gland composition was equal signal on T~ WI, T2WI, TzWI fat suppression and DWI sequence. Enhanced scanning showed adre- nal component enhancement but fat composition rio enhancement. Lesions were composed of large tracts of mature adipose tissue, hematopoietic cell island and the edge of the adrenal tissue under light microscope. Conclusion Adrenal Myelolipoma has certain CT and MRI features, only the CT （including CTA）, MRI technology combined to the greatest extent can reduce the misdiagnosis rate and improve the accuracy of diagnosis.

关 键 词：肾上腺肿瘤 髓质脂肪瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R736.6[医药卫生—肿瘤]