肾血管平滑肌脂肪瘤影像学诊断及鉴别

Diagnosis and differentiation of renal angiomylipomas

目的 探讨肾脏血管平滑肌脂肪瘤影像学 (AML)征象特点与鉴别。方法 选择征象典型 ,部分经手术病理证实AML 6 6例。全组病例均行B超及CT平扫及增强检查 ,35例KUB和IVP检查 ,14例MRI扫描 ,10例血管造影。结果 6 6例AML中 ,右肾 4 3例 ,左肾 2 3例。单肾多发 10例 ,双肾多发 12例 ,双肾巨大弥漫性AML 1例。少脂肪AML18例 (2 7% ) ,多脂肪者 4 8例 (73% ) ,AML出血 3例。IVP显示肾盏、肾盂形态、位置异常 8例 ,多脂肪AML显示病变区呈低密度 2例。CT征象典型 6 0例 ,经薄扫及螺旋薄层重建后明确诊断 4例 ,误诊肾癌 2例。 2例自发性出血。MRI检查 14例 ,1例可疑肾癌 ,血管造影 10例 ,AML实质区显示扭曲、扩张血管。结论 在诊断AML中CT可作为首选方法。US及MRI对鉴别诊断有着重要的作用。

Objective To investigate the features and characteristics of the renal angiomyolipoma (AML) in medical images, to improve the accurate rate of diagnosis for renal AML. Methods Sixty-six cases with AML were all examined by CT (plain scan and enhanced scan) and US, 35 cases were performed with intravenous pyelography (IVP), 14 cases by MRI, and 10 cases were examinated with renal arteriography. Results Of 66 cases with AML, 43 cases in the right kidney, and 23 cases in the left kidney. Multiple lesions of single kidney were found in 10 cases, multiple lesions of the bilateral kidneys in 12 cases, multiple giant AML of the bilateral kidneys in one case. The AML which contained the less fat in 18 cases (27%), and contained more fat in 48 cases (73%). Haemorrhage of AML in 3 cases. Intravenous pyelography (IVP) showed lower density in the bigger AML because of containing rich fat in tumor in two cases. Sixty-four cases with AML were accurately diagnosed by CT, 13 cases by MRI. Selective renal angiography can find distortion and abnormity dilatation of vessels. 2 cases were misdiagnosed as renal carcinoma because of without detectable fat. Conclusion CT is the best imaging method for diagnosing AML, and it is helpful to combined US and MRI when necessary.