肾上皮样血管平滑肌脂肪瘤的MSCT表现及误诊原因分析  

Analysis of MSCT manifestations and misdiagnosis of renal epithelioid angiomyolipoma

作　　者：姜国锦 王亮 方松华[2] JIANG Guojin;WANG Liang;FANG Songhua(Department of Radiology, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing 312000, P.R.China;Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou 310000, P.R.China)

机构地区：[1]绍兴文理学院附属医院放射科,浙江绍兴312000 [2]浙江省人民医院放射科,浙江杭州310000

出　　处：《医学影像学杂志》2021年第8期1363-1366,共4页Journal of Medical Imaging

基　　金：浙江省绍兴市级医卫类科技计划项目(编号:2018C30032,2020A13061)。

摘　　要：目的探讨肾上皮样血管平滑肌脂肪瘤MSCT征象、诊断价值及分析其误诊原因,以提高对该病的术前诊断正确率。方法选取经手术病理证实但CT检查误诊的12例肾上皮样血管平滑肌脂肪瘤的临床资料、病理及MSCT表现,结合相关文献进行综合分析。结果本组病例均表现为单发、外突肾轮廓,圆形、类圆形或不规则形肿块,含脂肪3例,呈“楔形征”6例,CT平扫表现为稍高密度9例,等密度2例,稍低密度1例,未见钙化灶;增强后呈“快进快出”3例,“快进慢出”4例,“持续强化”5例,增强后肿瘤内出现粗大血管6例、假包膜2例。误诊为血管平滑肌脂肪瘤3例,肾癌8例,肉瘤1例。结论肾上皮样血管平滑肌脂肪瘤的MSCT表现有一定特征,当CT平扫表现为不均匀稍高密度,呈“楔形征”,增强后呈“快进快出”、“快进慢出”或“持续强化”,出现粗大瘤内血管时,应考虑上皮样血管平滑肌脂肪瘤可能。Objective To investigate the MSCT signs and diagnostic value of renal epithelioid angiomyolipoma and to analyze the reasons for its misdiagnosis,so as to improve the correct rate of preoperative diagnosis of the disease.Methods The clinical data,pathology and MSCT manifestations of 12 cases of renal epithelioid angiomyolipoma that were confirmed by surgery and pathology but misdiagnosed by CT examination were retrospectively analyzed,combined with relevant literature for comprehensive analysis.Results All cases in this group showed a single,protruding kidney contour,round,round or irregular masses,3 cases with fat,6 cases with“wedge-shaped sign”,and 9 cases showed slightly higher density on CT scan with 2 cases of iso-density,1 case of slightly lower density,no calcifications;there were 3 cases of“fast in and out”after enhancement,4 cases of“fast in and slow out”,5 cases of“continuous enhancement”,and there appeared in the tumor after enhancement.There were 6 cases of thick blood vessels and 2 cases of pseudocapsules.3 cases were misdiagnosed as angiomyolipoma,8 cases were kidney cancer,and 1 case was sarcoma.Conclusion The MSCT manifestations of renal epithelioid angiomyolipoma have certain characteristics.When the CT scan shows uneven and slightly high density,it shows a“wedge-shaped sign”.After enhancement,it shows“fast in and fast out”,“fast in and slow out”or“Continuous enhancement”,when large blood vessels in the tumor appear,the possibility of epithelioid angiomyolipoma should be considered.

关 键 词：肾 上皮样血管平滑肌脂肪瘤 体层摄影术 X线计算机 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]