乏脂肪肾血管平滑肌脂肪瘤的CT表现及病理特征

CT manifestations and pathological features of renal angiomyolipoma with minimal fat

目的:探讨乏脂肪肾血管平滑肌脂肪瘤(RAML)的CT表现,以提高其诊断水平。方法:回顾性分析23例经手术病理证实的RAML CT表现,并与临床病理进行对照分析。结果:20例RAML呈边界清楚的类圆形肿块,3例呈不规则形,边界欠清,病灶均向肾外突出。18例表现为实性肿块,1例为囊实性,1例伴有钙化,3例伴有出血,CT片上瘤内均未见脂肪性低密度。CT平扫14例呈略高密度,4例等密度,1例低密度,4例密度欠均匀。增强扫描19例表现为均匀强化,4例不均匀强化,17例表现为延迟性强化,6例表现为一过性明显强化。结论:乏脂肪RAML多表现为边界清楚的实性肿块,病灶呈外生性生长,CT观察其形态、密度及强化方式等影像学表现并结合临床,有助于提高该病定性诊断的准确性。

Objective To explore the CT features of renal angiomyolipoma （RAML） with minimal fat so as to improve the diagnostic accuracy. Methods The CT manifestations of 23 RAML patients confirmed by operation were analyzed retrospectively, and then the results were compared with those by pathological examination. Results Circular masses with clear boundaries were found in 20 cases, and abnormal masses with unclear boundaries were found in the remained three ones, with all the foci extruding to the outside of the kidney. Solid masses were found in 18 cases, cystic solid mass was found in 1 case, calcification was found in 1 case and hemorrhage was found in 1 case, with no fatty low density. CT plate scanning proved that 14 cases had slightly hyperdense masses, 4 cases had iso-dense masses, 1 case had hypodense mass and 4 cases had uneven masses. Enhanced scanning showed that 19 cases had homogeneous enhancement, 4 ones had heterogeneous enhancement, 17 cases had delayed enhancement and 6 cases had transient and marked enhancement. Conclusion RAML with minimal fat often has the manifestations of solid mass with clear boundary as well as the exophytic focus, and CT manifestations combined with pathological examination can improve the accuracy of its diagnosis.