肾脏巨大血管平滑肌脂肪瘤彩色多普勒超声及超声造影表现

Color Doppler ultrasound and contrast-enhanced ultrasound findings of renal giant angiomyolipoma

目的:探讨肾脏巨大血管平滑肌脂肪瘤(angiomyolipoma,AML)彩色多普勒超声及超声造影表现,提高超声对肾脏巨大AML的诊断准确度,为临床诊断和治疗提供可靠依据。方法:分析23例经病理学检查证实为肾脏巨大AML患者的图像特征,包括与肾脏位置关系、形态、大小、边界、内部回声及超声造影增强模式等特征。结果:23例肾脏巨大AML患者,右肾10例,左肾13例(其中2例有2个肿块),共计25个肿块;25个肿块均向肾外生长突出于肾脏轮廓之外,肾皮质和/或集合系统受挤压;20个肿块呈高回声,其中15个呈较为均匀的高回声,5个内部回声不均匀,呈多发斑片状高回声夹杂不规则低回声;3个呈不均匀混杂回声(2个肿块内部出血坏死,1个肿块破裂至肾周血肿);2个呈低回声。8例行超声造影检查,其中3例为“快进慢出”增强模式,5例为“慢进慢出”增强模式。结论:彩色多普勒超声对肾脏巨大AML具有较高的诊断价值,超声造影可以显示肿块血供情况及造影剂灌注模式,尤其对破裂出血肿块具有很高的诊断价值。

Objective:To investigate the color Doppler ultrasound and contrast-enhanced ultrasound findings of renal giant angiomyolipoma(AML)for improving the diagnostic accuracy of renal giant AML,and providing reliable basis for clinical diagnosis and treatment.Methods:A total of 23 cases of renal giant AML confirmed by pathology were analyzed,including relation to renal location,shape,size,boundary,internal echo and contrast agent perfusion mode.Results:There were 25 masses in 23 patients with giant AML of the kidney,including 10 cases in the right kidney and 13 cases in the left kidney(including 2 masses in 2 cases).Twenty masses were hyperechoic,15 of them were homogeneous hyperechoic,5 were heterogeneous,multiple patchy hyperechoic with irregular hypoechoic;3 were heterogeneous mixed echo(2 masses had hemorrhage and necrosis,1 mass ruptured to perirenal hematoma);2 were hypoechoic.8 cases were examined by contrast-enhanced ultrasound,including 3 cases of fast in slow out enhancement mode,5 cases of slow in slow out enhancement mode.Conclusion:Color Doppler ultrasound has a high diagnostic value for renal giant AML.Contrast-enhanced ultrasound can show the blood supply of the tumor and the mode of contrast agent enhancement,especially for ruptured and bleeding masses.