肾脏上皮样血管平滑肌脂肪瘤的CT及MRI表现

发布时间：2018-03-03 19:19

本文选题：肾脏上皮样血管平滑肌脂肪瘤　切入点：诊断　出处：《癌症进展》2016年03期 　论文类型：期刊论文

【摘要】：目的探讨肾脏上皮样血管平滑肌脂肪瘤的影像学特点,以提高其诊断水平。方法搜集经手术病理证实的26例肾脏上皮样血管平滑肌脂肪瘤(EAML)患者的影像学资料并进行回顾性分析。26例患者均未合并结节性硬化症。16例行CT检查,18例行MRI检查。结果 26例患者病灶最大径为0.9~16.3 cm,平均7.3cm。病灶呈类圆形或类椭圆形20例(77.0%),分叶状4例(15.4%),沿肾周间隙铸型生长1例(3.8%),不规则形1例(3.8%);病灶完全位于肾轮廓之内2例(7.7%),部分突出于肾轮廓外24例(92.3%),其中以窄蒂状与肾实质相连2例(7.7%);2例(7.7%)肿瘤侵犯肾静脉形成静脉瘤栓;1例(3.8%)同时发现腹膜后淋巴结转移;1例(3.8%)同期发现肝脏和肺多发转移。12例CT平扫示9例(75.0%)呈高或稍高密度,2例(16.7%)呈等-低或低密度,1例(8.3%)呈等-高密度。18例MRI平扫T1W图像15例(83.3%)病灶以等信号为主,T2W或T2W/FS图像10例(55.6%)病灶以低信号为主,8例(44.4%)呈低-高、低-等或低-等-高混杂信号。双期增强CT和/或动态MRI增强扫描示25例(100%)均呈不均匀强化,其中10例(40%)呈网格样强化,23例(92.0%)病灶动脉期强化程度呈等或略低于正常肾皮质,实质期强化程度均低于正常肾实质。1例(3.8%)病灶内见弯曲条带状钙化;9例(34.6%)可观察到少量脂肪成分;8例(30.8%)病灶内见扩张或粗大迂曲走行的血管;8例(30.8%)瘤内伴有出血。结论肾脏EAML影像学表现具有如下特征:女性多见;多呈类圆形或膨胀性生长;肿瘤较大时可出现囊变及出血;病灶内成熟脂肪成分并不多见;钙化罕见;肿瘤实性成分CT平扫呈稍高或高密度;T2WI呈稍低信号或高低混杂信号;动态增强扫描多数呈"快进快出"的强化特点,不均匀筛网状强化较多见;部分病灶内可见迂曲扩张血管;可以伴有局部淋巴结及远处转移。
[Abstract]:Objective to investigate the imaging features of renal epithelioid angiomyolipoma. Methods the imaging data of 26 patients with renal epithelioid angiomyolipoma (EAMLL) confirmed by surgery and pathology were collected and analyzed retrospectively. 16 cases were not complicated with nodular sclerosis. Results the maximum diameter of lesions was 0.910 ~ 16.3 cm (mean 7.3 cm). The lesions were round or ellipsoid in 20 cases (77.0%), lobular in 4 cases (15. 4%), cast growth along the perirenal space in 1 case (3. 8 cm), irregular shape in 1 case (3. 8 cm); Two cases were located within the contours of the kidney, and some of them protruded out of the contours of the kidney in 24 cases (92.3%), of which 2 cases were connected with the renal parenchyma by narrow pedicle, 2 cases were involved in 7. 7%) the tumor invaded the renal vein to form the thrombus of vein tumor, 1 case was found with retroperitoneal lymph node metastasis, and 1 case was found with retroperitoneal lymph node metastasis. Multiple metastases of liver and lung were found in 12 cases. Plain CT scan showed 9 cases with high or slightly high density (2 cases with hight or slightly high density) with iso-low density or low density (8.3%). 18 cases with MRI plain T1W imaging 15 cases with T1W imaging showed the same signal intensity mainly with T2W or T2W. T2W / FS images of 10 cases (55.6%) the lesions were mainly hypointense in 8 cases (44.4%). Dual phase enhanced CT and / or dynamic MRI enhanced CT and / or dynamic MRI showed inhomogeneous enhancement in 25 cases, of which 10 cases showed mesh-like enhancement in 23 cases (92.0%). The enhancement degree of arterial phase of the lesion was equal or slightly lower than that of normal renal cortex. The enhancement degree of parenchymal phase was lower than that of normal renal parenchyma (.1 cases, 3.8). (9 cases had curved strip calcification in 9 cases (34.6%).) A small amount of fat was observed in 8 cases (30.8%). In the lesion, dilatation or extensive and tortuous flow of blood vessels were observed in 8 cases (30.8%). Conclusion the imaging features of renal EAML are as follows: female is more common; Most of them were round or dilated growth; when the tumor was larger, the cystic degeneration and hemorrhage could occur; the mature fat components in the lesion were rare; calcification was rare; the CT plain scan of the solid component of the tumor showed slightly low signal intensity or low mixed signal on the high or high density T _ 2WI. Most of the dynamic contrast enhanced scans were characterized by "fast in and out" enhancement, with inhomogeneous sieve mesh enhancement more common; some lesions were characterized by tortuous dilation of blood vessels; local lymph nodes and distant metastasis could be observed.
【作者单位】：北京协和医学院中国医学科学院肿瘤医院影像诊断科;
【基金】：国家自然科学基金(81201701)
【分类号】：R730.44;R445.2;R737.11

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