肾血管平滑肌脂肪瘤破裂出血彩色多普勒超声及超声造影表现

Features of renal angiomyolipoma rupture by color Doppler and contrast-enhanced ultrasonography

目的总结肾血管平滑肌脂肪瘤破裂出血的彩色多普勒超声及超声造影表现。方法回顾性分析我院2005年1月至2010年1月7例经手术病理证实的肾血管平滑肌脂肪瘤破裂出血患者的彩色多普勒超声及超声造影声像图表现。结果 7例患者均行彩色多普勒超声检查,声像图表现为肾区肿物呈不规则形、边界不清、不均匀混合回声,以高回声为主,后方回声均见明显衰减。瘤体内可见丰富的迂曲走行的动静脉血流信号。肾包膜下血肿表现为边界清晰的低回声区或界限不清的混合性回声区。其中2例行超声造影检查,表现为:各期均呈高增强,增强形态为周边呈结节状高增强,逐渐向中心填充,增强欠均匀。肾包膜下血肿造影各期均表现为新月形无增强区,造影后血肿与瘤体分界清晰。结论肾血管平滑肌脂肪瘤破裂出血无论在彩色多普勒超声表现,还是在超声造影表现上,其瘤体仍保留着原发病变即肾血管平滑肌脂肪瘤的特征。肾包膜下血肿在超声造影表现为各期无增强,与瘤体分界截然,有利于明确其范围。常规超声结合超声造影有利于肾血管平滑肌脂肪瘤破裂出血的诊断。

Objective To summarize the imaging features of renal angiomyolipoma rupture by color Doppler ultrasonography（CDUS） and contrast-enhanced ultrasonography（CEUS）.Methods Seven patients with histopathologically proven renal angiomyolipoma rupture were included in the present study.The CDUS and CEUS imaging features of renal angiomyolipoma rupture were retrospectively analyzed.Results All the seven patients were examined by CDUS.The rupture of renal angiomyolipomas appeared as irregular,ill-defined,heterogeneous echogenicity masses,most part of which showed as hyperechoic areas with obvious posterior acoustic attenuation.A number of tortuous flow signals with arterial-venous Doppler spectrum were detected in the masses.Subcapsular hematoma was shown as hypoechoic or heterogeneous echogenicity area.Two cases had CEUS,in which the tumors showed as heterogeneous periphery-to-center hyper-enhancement throughout three phases.Subcapsular hematoma always appeared as well-defined,crescent-shaped and non-enhancement area.Conclusion The imaging features of the renal angiomyolipoma rupture were consistent with those of the primary tumor（renal angiomyolipoma） by CDUS and CEUS.The hematoma was shown as well-defined,crescent-shaped,non-enhancement area by CEUS,which contributed to accurately delineate the extent of hematoma.Combination CDUS with CEUS is useful to diagnose renal angiomyolipoma rupture.