膀胱非上皮性肿瘤的影像学表现

Imaging features of nonepithelial tumors of the bladder

目的探讨膀胱非上皮性肿瘤的影像学表现特点，提高术前诊断的准确率。方法回顾性分析20例经手术病理证实为膀胱非上皮性肿瘤患者的临床病理和影像学检查资料，其中平滑肌瘤9例，嗜铬细胞瘤6例，平滑肌肉瘤2例，横纹肌肉瘤、癌肉瘤及炎性肌纤维母细胞瘤各1例。结果平滑肌瘤呈圆形，边缘清晰、锐利，密度均匀；MRI的T1WI及T2WI序列均呈低信号；7例患者行CT增强扫描，有6例表现为轻度强化；4例患者行彩色多普勒超声检查，有3例显示为血流不丰富或有少许血流。嗜铬细胞瘤呈圆形或卵圆形，有时略有分叶，边缘清楚，密度均匀，1例伴有钙化；MRI的T1WI序列呈低信号、T2WI序列呈明显高信号；6例患者行CT增强扫描，有4例呈高度强化；5例患者行彩色多普勒超声检查，有3例显示为血流丰富。炎性肌纤维母细胞瘤的影像学表现同嗜铬细胞瘤。其他恶性肿瘤呈不规则实性肿块，边缘模糊，密度不均匀；CT增强扫描呈不均匀中等强化。结论膀胱平滑肌瘤及嗜铬细胞瘤的影像学表现有一定特点，再结合临床症状，术前能够作出正确诊断；其他恶性肿瘤的影像学表现无特征，仅能作出定性诊断。影像学检查是膀胱非上皮性肿瘤有价值的检查方法，术前可提供肿瘤部位及部分肿瘤性质的信息，有助于临床制定治疗计划。

Objective To summarize the imaging features of nonepithelial tumors of the bladder. Methods The Imaging findings in 20 surgically treated patients with pathologically proved nonepithelial tumors of the bladder were retrospectively analyzed. The tumors included leiomyona （n =9）, pheochromocytoma （ n = 6 ）, leiomyosarcoma （ n = 2 ）, rhabdomyosarcoma （ n = 1 ）, carcinosarcoma （ n = 1 ）, inflammatory mynfibroblastoma （n = 1 ） . Results The leiomyomas were round or ellipse in shape with a sharp border and homogeneous density, and showed a low signal intensity on T1WI and T2WI in 1/1 case; slight enhancement on CT after contrast enhancement in 6/7cases; and a poor blood supply on color Doppler ultrasonography in 3/4 cases. The pheochromocytoma had a round or oval shape and clear border, and slightly lobulated in 4/6 cases, homogeneous density/echo/signal in 5/6 cases, calcification in 1 case, low signal intensity on T1WI and high signal intensity on T2WI in 1/1 case, moderate or marked enhancement on CT and MRI in 4/5 cases, and strong blood supply on color Doppler uhrasonography in 3/4 cases. The inflammatory myofibroblastoma showed the same imaging features as the pheochromocytomas. Other malignant tumors showed an irregular configuration, with a poorly defined border, heterogeneous density/ echo/signal and moderate to strong enhancement on CT. Conclusion Most leiomyomas and pheochromocytomas of the bladder show some typical imaging features on CT, MRI and ultrasound, which are helpful in making correct diagnosis and treatment plan preoperatively. Other malignant nonepithelial bladder tumors do not show special imaging characteristics and can only be diagnozed qualitatively.