超声诊断巨大肾血管平滑肌脂肪瘤

Ultrasonographic diagnosis of giant renal angiomyolipoma

目的探讨巨大肾血管平滑肌脂肪瘤(最大径大于5cm)的声像图特点。方法回顾性分析手术病理证实的17个巨大肾血管平滑肌脂肪瘤的超声表现,包括病变大小、边界、位置、内部回声及血流特点。结果采用超声检查,11个准确定位(其中9个正确诊断为RAML),5个定位不清,1个误诊为肾上腺占位;声像图表现为边界清晰的高回声、低回声、中等回声或高低回声相间的混合性回声。较大的高回声、大多数混合性回声及所有低回声病灶内可探及程度不等的血流信号,其声像图表现类型与病灶内脂肪、平滑肌和血管的组成和分布密切相关。结论巨大肾血管平滑肌脂肪瘤具有特征性的声像图表现,超声结合其他影像学检查,对多数病灶可于术前明确诊断。

Objective To observe the characteristics of giant（larger than 5 cm） renal angiomyolipoma（RAML）.Methods Seventeen RAMLs confirmed pathologically were examined with ultrasound,and the size,margin,location,gray-scale and color Doppler flow imaging characteristics were observed.Results Eleven RAMLs were located correctly（9 were diagnosed as RAML correctly）,5 were located inaccurately while 1 was identified incorrectly as adrenal gland occupying lesion with ultrasound.The sonographic features of RAML were homogeneous hyperechoic,isoechoic,hyporechoic or heterogeneous internal echoes（hyperechoic with hypoechoic areas） with sharp margins,color Doppler flow signal was detected in larger hyperechoic,most heterogeneous and all the hyporechoic angiomyolipoma.The ultrasonographic appearances were correlated with the composition and distribution of fat,vascular,smooth muscle tissue.Conclusion Giant RAML has characteristic ultrasound manifestations and combined with other imaging methods,most of RAMLs can be diagnosed preoperatively.