误诊为肾癌的良性肾占位的影像学回顾(附24例分析)

Imaging Feature of Misdiagnosed Benign Renal Mass

目的 提高肾良性恶性占位病变的影像鉴别能力。方法 对比分析24例误诊的良性肾占位(BRM)与50例肾癌(RCC)的影像特征。结果 高密度肾囊肿常表现为B超均匀低回声,CT均质等或高密度灶,彩色多普勒超声有助诊断;不典型肾血管肌脂瘤常表现为B超均匀等回声,CT平扫均质高密度且均匀强化;黄色肉芽肿性肾盂肾炎(XGP)的特征是CT示群集的类圆形的低密度区以及环形增强带形成“熊掌征”;急性局限性细菌性肾炎(AFBN)的CT延时增强扫描以及动态观察显示楔形病灶以及条纹征,并随治疗逐渐消退。结论 多数误诊的的良性肾占位与肾癌的影像表现不同。

Purpose To improve methods of differential diagnosing benign renal mass(BRM)from renal cell carcinoma(RCC). Methods A comparative study of 24 cases of BRM versus 50 cases of RCC was performed. Results High dense renal cyst is usually homogeneous hypoechogenicity on sonograms and homogeneous high/iso attenuation on CT images and color doppler is helpful in diagnosing.Atypical angiomyolipoma usually shows homogeneous high attenuation on unenhanced CT images,homogeneous enhancement on enhanced CT and homogeneous isoechogenicity on sonograms.The CT features of Xanthogranulomatous pyelonephritis(XGP)include multiple,rounded,low density areas with enhancing rings arranged in a hydronephrotic pattern known as bear paw sign.Acute focal bacterial nephritis(AFBN)shows wedge lesion and stripe sign on delayed enhanced CT images. Conclusion Almost all misdiagnosing of benign renal mass may be avioded. [