肾上皮样血管平滑肌脂肪瘤(长径≤3cm)的影像诊断  

Imaging diagnosis of renal epithelioid angiomyolipoma(EAML)with major axis equal or less than3.0cm

作　　者：罗敏[1] 蔡文超[1] 张玮[1] 包强[1] LUO Min;CAI Wen-chao;ZHANG Wei(Department of Radiology,Fujian Provincial Hospital,Clinical Medical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院附属福建省立医院放射科,福州350000

出　　处：《放射学实践》2018年第12期1295-1301,共7页Radiologic Practice

基　　金：2017年福建省卫生厅中青年骨干人才培养项目(2017-ZQN-13)

摘　　要：目的:探讨长径≤3cm的肾上皮样血管平滑肌脂肪瘤(EAML)的影像学特征,提高对早期EAML的影像诊断准确性。方法:回顾性分析经手术病理证实的23例(共27个病灶)肾脏EAML(长径≤3cm)的影像学特征及临床病理资料,其中1例合并结节性硬化。术前23例均行超声及CT检查,6例行MRI平扫及多期增强扫描。结果:(1)部位:27个病灶中,位于肾皮质近包膜下19个(其中16个病灶的主体位于肾轮廓外),肾实质邻近包膜及肾窦4个,位于肾髓质2个,肾窦旁2个。(2)大小及形态:长径<1.0cm的病灶2个(A组),1.0～2.0cm的15个(B组),2.0～3.0cm的10个(C组);4个病灶形态不规则,23个呈类圆形或类椭圆形。(3)超声表现:18个病灶呈高低混杂回声,超声造影均呈流出型强化。(4)CT表现:平扫显示20个病灶呈稍高密度,6个病灶内含有脂肪密度呈等低混杂密度,1个病灶呈等密度;增强后24个病灶呈流出型、1个呈平台型、2个呈流入型强化;可见皮质掀起征16个,黑星征9个,条索征19个;(5)MRI表现:3个病灶的边缘部分在反相位图像上的信号较同相位减低;5个病灶在T2WI上呈等低信号、增强扫描呈流出型强化,1个病灶在T2WI上呈等高信号、增强后呈平台型强化;(6)诊断符合率:B超、CT及MRI在A组的诊断符合率分别为0%(0/2)、50%(1/2)及0%(0/1);B组分别为40%(6/15)、73.33%(11/15)及100%(3/3);C组分别为60%(6/10)、80%(8/10)及100%(2/2)。结论:肾EAML(长径≤3cm)的影像学表现具有一定特征性,结合多种影像检查有助于提高术前诊断准确性。Objective:The purpose of this study was to explore the imaging features of renal epithelioid angiomyolipoma(EAML)with major axis equal or less than 3cm,so as to improve the accuracy of early diagnosis.Methods:Imaging manifestations and clinical pathologic information of 23 cases(27 lesions)of renal epithelioid angiomyolipoma(major axis equal or less than 3cm)proved by surgery and pathology were retrospectively analyzed,including one case complicated with tuberous sclerosis.All 23 cases received both ultrasound and CT examinations,6 cases received additional MRI plain and multi-phase enhanced scan before surgery.Results:①Location:19 lesions were located at subcapsular renal cortex,among which the main body of 16 lesions were protruding out of the kidney contour;4 lesions were located at renal parenchyma close to renal sinus,2 lesions were located at renal medulla and 2 lesions were located near renal sinus.②Size and shape:2 lesions with major axis less than 1cm(group A),15 lesions with major axis between 1 to 2cm(group B),and 10 lesions with major axis between 2 to 3cm(group C).Four lesions were of irregular shape and 23 lesions were round or oval.③Ultrasonic manifestations:18 lesions were mixed low to high echo with"wash out"enhancement pattern during ultrasonic contrast scan;④CT manifestations:6 lesions showed fat density on CT plain scan while 21 lesions showed slightly high density without fat;24 lesions showed"wash out"and one lesion showed"platform"and 2 lesions showed"wash-in"enhancement patterns on contrast-enhanced CT."Renal cortex lifted"sign was seen in 16 lesions,"black star"sign was seen in 9 lesion,"cord"sign was seen in 19 lesions;⑤MRI manifestation:the signal intensity of lesion margin of 3 cases on in-phase images was reduced compared with that on out-phase images,5 lesions showed equal to low signal intensity on T 2WI,5 lesions showed"wash-out"and one lesion showed"platform"enhancement patterns on contrast-enhanced MRI.⑥Diagnostic accuracy of AML before surgery:the accuracy of US,CT a

关 键 词：肾肿瘤 上皮样血管平滑肌脂肪瘤 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] R737.11[医药卫生—诊断学]