【摘要】 目的　探讨肾上腺骨髓脂肪瘤影像表现的组织学基础 ,评价影像方法对该肿瘤的诊断价值。方法　回顾分析 2 1例经手术、病理证实的肾上腺骨髓脂肪瘤的影像表现和病理学表现。结果　该肿瘤组织学上表现为脂肪与骨髓组织混杂存在 ,无明确的分界边缘 ,骨髓血供丰富 ,瘤灶与正常肾上腺组织紧邻 ,CT、MRI表现为含脂肪夹杂不规则斑块、条状骨髓组织 ,无明显肿瘤包膜 ,少见有不规则局限性“包膜” ,则为被挤压的瘤外肾上腺组织构成。增强扫描可见骨髓组织强化 ,造成骨髓斑块扩大 ,边缘模糊 ,脂肪组织内“雾状”强化现象。超声显示肾上腺含脂肪的高回波团块 ;静脉尿路造影仅见肿瘤同侧肾脏移位 ,肾轴改变。结论　CT平扫是肾上腺骨髓脂肪瘤最准确的定性方法 ;MRI的冠状及矢状面扫描使定位更加准确 ;超声是该肿瘤检出的重要手段 ,而静脉尿路造影及腹部平片不能作为定性的标准。更多还原

【Abstract】 Objective To investigate the histologic basis of imaging manifestations on adrenal myelolipoma and evaluate the value of various imaging modalities in diagnosing the tumor.Methods The imaging manifestations and pathological features of 21 cases of adrenal myelolipoma proved by postsurgical pathology were retrospectively analysed.Results Histologically,the myelolipoma presented hematopoietic elements amidst fatty tissue and showed indefinite border.The myeloid tissue was well vascularized and were adherent closely to normal adrenal gland.Both CT and MRI detected a single mass with irregular plaque or streak of bone marrow tissues between fatty components.The capsule of the tumor was not apparent,but rarely it presented an irregular local “capsule”which was composed of adrenal tissue with compression surrounding the tumor.Enhanced-scan found foggy enhancement in fatty tissue and enhancement of bone marrow tissue which made myeloid plaque enlarged and the edge misted.Ultrasonography demonstrated highly echogenic fat-containing ball of adrenal,while intravenous urography only showed translocation and renal axis alteration of homolateral kidney.Conclusion CT scan appears to be the most accurate qualitative modality to demonstrate adrenal myelolipoma while coronal and sagittal section scanning on MRI can make its localization more exact.Ultrasonography is also an important way in detecting the mass whereas intravenous urography and abdominal plain film should not be used to be the qualitative criterion.更多还原