血管周上皮样细胞肿瘤的CT诊断及鉴别诊断  

CT diagnosis and differential diagnosis of perivascular epithelioid cell tumor

作　　者：于永梅[1] 韩翔宇[2] 邢启韵 于海洋 YU Yongmei;HAN Xiangyu;XING Qiyun;YU Haiyang(Department of Computed Tomography,Jining No.1 People’s Hospital,Jining 272000 China;Emergency Department of Jining No.1 People’s Hospital,Jining 272000 China;Clinical Medical College,Jining Medical University,Jining 272013 China)

机构地区：[1]济宁市第一人民医院放射科,山东济宁272000 [2]济宁市第一人民医院急诊内科,山东济宁272000 [3]济宁医学院临床医学院,山东济宁272013

出　　处：《中国辐射卫生》2025年第1期91-95,共5页Chinese Journal of Radiological Health

基　　金：济宁市重点研发项目(2022YXNS145)。

摘　　要：目的 探讨血管周上皮样细胞肿瘤(PEComa)的CT诊断及鉴别诊断,提高对PEComa诊断的准确性,减少误诊。方法 回顾性分析2020年1月-2024年4月于济宁市第一人民医院经病理证实的8例PEComa的CT表现,分析病变的部位、形态、大小、边界、平扫密度、强化特征。结果 8例肿瘤均为单发,5例位于肾脏,1例位于肝脏,1例位于腹膜外,1例位于腹膜后。肿瘤3例为类圆形,1例为椭圆形,4例形态不规整。7例为良性,边界清,1例为恶性,边界不清。平扫2例呈稍低密度,3例呈稍高密度,3例呈低密度。1例密度均匀,7例密度不均,内见坏死、囊变。增强扫描强化多样化,4例为“快进快出”式强化,动脉期明显强化,门静脉强化减低。3例为“快进慢出”式强化,动脉期强化明显,门脉期持续性强化,延迟期呈稍低密度。1例动脉期轻度强化,门脉期强化明显。3例肿瘤周围见多发迂曲增粗血管,3例肿瘤内见迂曲血管影。结论 PEComaCT表现具有特点,增强主要为“快进快出”或“快进慢出”式强化,肿瘤内部或周围出现增粗迂曲血管时,结合临床应考虑PEComa。Objective To explore the CT diagnosis and differential diagnosis of perivascular epithelioid cell neoplasms(PEComa),improve the accuracy of PEComa diagnosis,and reduce misdiagnosis.Methods CT findings of 8 cases of PEComa confirmed by pathology in Jining First People’s Hospital from January 2020 to April 2024 were retrospectively analyzed for the location,shape,size,boundary,plain scan density,and enhancement characteristics of the lesions.Results All 8 tumors were solitary,with 5 located in the kidney,1 in the liver,1 in the extraperitoneal space,and 1 in the retroperitoneal space.The tumors were round in 3 cases,oval in 1 case,and irregular in 4 cases.Seven cases were benign with clear boundaries and 1 case was malignant with unclear boundaries.On plain CT,2 cases showed slightly low density,3 cases showed slightly high density,and 3 cases showed low density.One tumor had uniform density,and 7 tumors had nonuniform density with internal necrosis and cystic changes.Contrast-enhanced CT revealed diverse enhancement patterns.Four cases showed a“fast in and fast out”enhancement pattern,with significant arterial-phase enhancement and reduced portal venous-phase enhancement.Three cases showed a“fast-in and slow-out”enhancement pattern,with significant en-hancement in the arterial phase,persistent enhancement in the portal venous phase,and slightly reduced density in the delayed phase.One case showed mild enhancement in the arterial phase and significant enhancement in the portal venous phase.In 3 cases,multiple tortuous and thickened blood vessels were observed around the tumors,while 3 cases showed tor-tuous vascular shadows within the tumors.Conclusion PEComa demonstrates characteristic CT features,predominantly with“fast in and fast out”or“fast in and slow out”enhancement patterns.When thickened and tortuous blood vessels are ob-served within or around the tumor,PEComa should be considered in combination with clinical findings.

关 键 词：血管周上皮样细胞肿瘤 体层摄影术 螺旋计算机 肾 肝 腹膜后 腹膜外 

分 类 号：R814[医药卫生—影像医学与核医学]