肾平滑肌瘤六例的影像学表现  

Imaging features of renal leiomyoma： report of 6 cases

作　　者：丛振杰 殷薇薇[3] 姜茂竹 龚静山 林志军 张光辉 

机构地区：[1]烟台山医院南院放射科,山东省烟台市264025 [2]烟台山医院南院肿瘤科,山东省烟台市264025 [3]温州医科大学附属第一医院放射科 [4]深圳市人民医院影像科

出　　处：《中华解剖与临床杂志》2018年第1期33-38,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨肾平滑肌瘤的影像学表现特征,以提高对该病的诊断水平,从而选择更合理的治疗方案.方法 回顾性分析2005年1月—2016年12月4所医院经手术病理确诊的6例肾平滑肌瘤患者的影像学资料,其中男5例、女1例,年龄26~77岁.6例患者均行CT平扫及增强扫描;MRI平扫2例,其中1例同时行增强检查.结果 6例共发现7个平滑肌瘤病灶,肿瘤最大径2.5~7 cm,平均5.3 cm;其中5个位于右肾,2个位于左肾;5个位于肾脏边缘,1个位于肾实质内,1个位于肾盂.肿瘤呈圆形和椭圆形各3个,呈分叶状1个.CT平扫5个病灶呈高密度,2个呈等密度;1个病灶密度不均,肿块内见坏死、囊变,其它6个密度均匀.CT增强扫描7个病灶均表现出渐进性延迟强化的特点,其中6个呈均匀强化,1个强化不均.MRI平扫2例共检出3个病灶：2个信号均匀,其中1个呈T1 WI低信号、T2 WI略高信号,1个呈T1 WI等信号、T2 WI明显低信号;1个信号不均,T1 WI、T2 WI均呈高低混杂信号,T2 WI上病灶周围可见低信号肿瘤包膜;2个瘤体内见斑点状钙化.MRI增强检查1个病灶呈均匀延迟强化.结论 肾平滑肌瘤的主要影像学特征为发生于肾脏边缘密度或信号均匀的软组织肿块,CT或MRI增强扫描呈均匀延迟强化特点;虽然确诊需要依靠组织病理学检查,但熟悉其影像表现特点,可以帮助临床医生尽早选择更合适的治疗措施,减少不必要的肾切除.Objective To summarize the imaging features of renal leiomyoma and to improve the diagnosis and treatment of the disease. Methods The imaging features of 6 cases with renal leiomyoma were analyzed retrospectively from January 2005 to December 2016. There were 5 males and 1 female, aged 26-77 years old. All of 6 cases had been diagnosed by surgery and pathology. Plain and enhanced scan of CT were performed in all 6 cases. Two cases received MRI plain scan, and 1 of them received MRI enhanced scan at the same time. Results In total, 7 leiomyoma lesions were discovered, 5 located in the right kidney and 2 in the left kidney. There were 5 lesions situated at the border of the kidney, 1 in the renal parenchyma, and 1 in the renal pelvis. Five lesions showed high density and 2 showed equal densities in pictures of CT scan. There was 1 lesion with uneven thickness, cystoid variation and necrosis, while 6 other cases were uniform. All 7 lesions showed progressive delayed reinforcement in enhanced scan of CT, 6 of them were evenly enhanced and 1 of them was not. MRI scan was performed in 2 cases, and 3 lesions were detected. Two lesions showed equal signal with MRI, which were low T1 WI and slight high T2 WI for 1 and equal T1 WI and obvious low T2 WI for another. One lesion showed unequal signal with mixed T1 WI and T2 WI, and the low signal tumor envelope was seen around the lesion in T2 WI. Two cases showed flecked calcifications in the tumor. MRI enhanced scan revealed a homogeneous delayed enhancement in 1 lesion. Conclusions The main imaging features of renal leiomyoma are soft tissue masses that occur at the renal margin,with uniform density or signal and delayed reinforcement in enhanced scan of CT or MRI. Although diagnosis depends on histopathological examination, learning about these futures will contribute to select more appropriate treatment options as early as possible and reduce unnecessary nephrectomy.

关 键 词：肾肿瘤 平滑肌瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.44[医药卫生—诊断学] R737.11[医药卫生—临床医学]