肾脏乏脂肪血管平滑肌脂肪瘤的临床病理及CT表现

Clinical,pathological and CT features of lipid-poor renal angiomyolipoma

目的:探讨肾脏乏脂肪血管平滑肌脂肪瘤(AML)的临床、病理及CT表现特征。方法:回顾性分析36例经手术病理证实的乏脂肪AML的临床、病理及CT资料,将其分为上皮样血管平滑肌脂肪瘤(EAML)组和其他乏脂肪AML组,观察病灶的数目、大小、形状、密度及其均匀性、劈裂征、血管影、假包膜、病灶的强化程度及强化方式等,采用SPSS 19.0软件进行统计学分析。结果:EAML组18例19灶,平均年龄40岁,其他乏脂肪AML组18例22灶,平均年龄49岁。两组病灶最大径分别为(58.63±56.59)mm和(16.97±8.59)mm,P<0.05;密度不均匀者分别为10例和4例,P<0.05;形态不规则者分别为12例和10例,劈裂征阳性者分别为8例和13例,血管影分别为6例和2例,假包膜分别为6例和2例;病灶强化方式快进快出者分别为4例和10例,持续性强化者分别为14例和12例,渐进性强化者分别1例和0例,两组间病灶形状、劈裂征、血管影、假包膜均无统计学差异。EAML组病灶平扫、皮髓质期和肾实质期CT值分别为(44.3±10.7)HU、(101.6±26.6)HU和(86.9±17.9)HU,其他乏脂肪AML组各期CT值分别为(37.1±7.3)HU、(108.7±23.8)HU和(87.6±13.6)HU。EAML组比其他乏脂肪AML组平扫CT值高,P<0.05,增强后CT值无统计学差异。结论:乏脂肪AML CT表现有一定特征性,EAML较其他乏脂肪AML发病年龄小,病灶体积大,平扫密度相对高且不均匀,明确诊断依赖于病理。

Objective：To investigate the clinical,pathological and CT features of lipid-poor renal angiomyolipoma （AML）.Methods：The clinical,pathological and CT data of 36 patients with pathologically proven lipid-poor renal AML were retrospectively analyzed and divided into two groups：epithelioid anigomyolipoma （EAML）and non-EAML.The number,size,shape,density and uniformity,crack sign,vessel sign,pseudocapsule,enhancement degree and pattern of the lesions were observed and documented.Statistical analysis was performed by use of IBM SPSS 19.0.Results：There were 18 patients of 19 lesions in the EAML group with an average age of 40 years and 18 patients of 22 lesions in the non-EAML group with an average age of 49 years.The maximum diameter of the lesions was （58.63±56.59）mm in EAML and （16.97±8.59） mm in non-EAML （P〈0.05）respectively;lesions with CT inhomogeneity was 10 and 4 （P〈0.05）.Irregular shape was 12 and 10.Crack sign was 8 and 13.Vessel sign was 6 and 2 Pseudocapsule sign was 6 and 2.Wash-in and washout enhancement was 4 and 10.Prolonged enhancement was 14 and 12.Gradual enhancement cases was 1 and 0.Lesion shape,crack sign,vessel sign and pseudocapsule between the two groups were not statistically different.The CT values of the lesion in plain scan,corticomedullary and parenchymal phase were （44.3±10.7）HU,（101.6±26.6）HU and （86.9±17.9）HU in EAML,and （37.1±7.3）HU,（108.7±23.8）HU and （87.6±13.6）HU in non-EAML.CT values of the lesions in plain scan were higher in EAML （P〈0.05）.However,there was no statistical significance in contrast enhancement.Conclusion：There are certain CT characteristics in lipid-poor AML.EAML is larger in size,higher in attenuation on the plain scan and more inhomogeneous compared with non-EAML with younger onset age.The final diagnosis depends on pathology.