CT和MRI对合并出血肾占位性病变的诊断与鉴别诊断  

CT and MRI in diagnosis and differential diagnosis of renal occupying lesions with hemorrhage

作　　者：段文峰[1] 祝志云[2] 彭德昌[1] 李海军[1] 余宏辉 DUAN Wenfeng;ZHU Zhiyun;PENG Dechang;LI Haijun;YU Honghui(Department of Radiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Cardiology,the People's Hospital of Jiangxi,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院影像科,江西南昌330006 [2]江西省人民医院心内科,江西南昌330006

出　　处：《实用放射学杂志》2021年第12期2017-2021,共5页Journal of Practical Radiology

摘　　要：目的探讨CT和MRI对合并出血的肾脏占位性病变的诊断及鉴别诊断价值,提高诊断的准确率。方法回顾性分析经病理或随访证实的75例合并出血的肾脏占位性病变患者的临床及影像资料,其中,血管平滑肌脂肪瘤31例,囊肿26例,肾癌18例。所有患者行CT或MRI平扫和增强扫描,分析比较病灶的影像学征象,包括病灶的发生位置及类型、大小、形态、瘤肾界面、病灶内成分、强化程度及肿瘤内血管等。结果3类病变在病灶类型、大小、形态、瘤肾界面的边界及形态方面存在统计学差异。血管平滑肌脂肪瘤较后两者出血更易破向肾包膜外且平均直径更大。血管平滑肌脂肪瘤与囊肿合并出血形态规则、边界清楚、瘤肾界面以喇叭口或杯口状为主。肾癌合并出血则表现为形态不规则或分叶形,边界不清,瘤肾界面以不规则或分叶状为主。囊肿合并出血以其内无实性成分及无强化的特点与其余2类比较差异有统计学意义。结论CT平扫和增强检查可以准确地检出合并出血的肾脏占位性病变,明确病灶的影像学特点,提高原发灶的诊断准确率。MRI对病灶界面、成分等影像学表现作出重要补充。两者联合应用对鉴别不同性质合并出血的肾脏占位性病变有重要的临床应用价值。Objective To explore the value of CT and MRI in the diagnosis and differential diagnosis of renal occupying lesions complicated with hemorrhage,and to improve the diagnostic accuracy.Methods The clinical and imaging data of 75 cases with renal occupying lesions complicated with hemorrhage confirmed by pathology or follow-up were analyzed retrospectively.There were 31 cases of angiomyolipoma,26 cases of cyst,and 18 cases of renal carcinoma.All of the patients underwent CT or MRI plain scan and enhanced scan.The imaging features,including location,type,size,shape,tumor-kidney interface,composition of the lesions,enhanced degree and blood vessels in the tumors were analyzed and compared.Results There were statistical differences in the type,size,shape,and the tumor-kidney interface among the three types of the lesions.Hemorrhage of the angiomyolipoma lesions was easier rupture to extracapsular with larger average diameter.Hemorrhage of the angiomyolipomas and cysts showed more regular shape,clear margin,and the tumor-kidney interfaces were mainly trumpet or cup shape.However,the renal carcinomas with hemorrhage showed irregular or lobulated,poorly defined margin,and irregular or lobulated tumor-kidney interface.There were significant differences between the cysts complicated with hemorrhage and the other two type lesions because of non-solid component and non-enhancement.Conclusion Unenhanced and contrast-enhanced CT can accurately detect the renal occupying lesions with hemorrhage,clarify the imaging features of the lesions and improve the diagnostic accuracy of the primary lesions.MRI can provide an important supplement to the imaging findings such as the interface and composition of the lesions.The combined application of the two has important clinical value in distinguishing different types of renal occupying lesions with hemorrhage.

关 键 词：血管平滑肌脂肪瘤 囊肿 肾癌 计算机体层成像 磁共振成像 

分 类 号：R732.2[医药卫生—肿瘤] R737.11[医药卫生—临床医学]