【摘要】 目的 探讨肾脏乏脂肪性血管平滑肌脂肪瘤多层螺旋CT(MSCT)表现,提高对该病的影像表现认识。方法 回顾性分析20例经手术病理证实的乏脂肪性肾平滑肌脂肪瘤MSCT及临床资料,重点分析病灶的大小、部位、形态、密度及血供情况等。结果20例患者共有23个病灶,其中22个病灶均表现为实质性肿块,1个病灶为巨大囊性并出血。病灶最大的为11.5 cm×9 cm,最小的为0.8 cm×0.8 cm。左肾13个病灶,右肾10个病灶。其中10个病灶呈类圆形,11个病灶呈圆形,2个病灶呈菌伞状,5个病灶见劈裂征;平扫12个病灶呈均匀略高密度,11个病灶呈等密度。8个病灶内见少量脂肪成分,余病灶薄层(1 mm)未见脂肪成分。20个病灶在CT动态增强肾皮质期呈明显不均匀强化,1个病灶呈环形强化,2个病灶呈均匀强化。增强扫描呈明显强化的病灶20个,轻中度强化病灶2个。增强皮质期多呈明显不均匀强化,实质期及延迟早期呈均匀强化,强化较肾实质弱,其内脂肪密度无强化。结论 乏脂肪性肾血管平滑肌脂肪瘤在CT平扫薄层显示细微脂肪成分具有特征性诊断价值;对于乏脂肪性血管平滑肌脂肪瘤延迟早期呈均匀强化,以及自肾脏实质发出粗大的血管穿行于病灶的征象有助于鉴别诊断。更多还原

【Abstract】 Objective To evaluate the variable appearances of renal angiomyolipomas(AML) with minimal fat on multislice CT(MSCT),and to improve the CT diagnostic knowledge.Methods 20 cases with pathologically proved renal AML with minimal fat were analysed retrospectively,including their MSCT findings and clinical manifestations.Focused on tumor size,location,shape,density,enhancement degree and patterns.Results Totally,23 lesions were found in the 20 patients.Among them,22 were solid tumor masses and 1 was cytic-solid mass with bleeding.The tumors ranged from 0.8 cm×0.8 cm to 11.5 cm ×9 cm in diameter.13 masses located in left kidney,and the others 10 lesions located in right kidney.Ten massses were ellipsoidal,11 masses were round,and 2 masses were "fungus" shape.5/23 masses showed restricted growth pattern.On pre-contrast CT,12 masses showed homogeneously hyperdense,11 masses showed isodense.Only 8 masses were found a few fat composition in thin-slice CT scan(1mm).On dynamic-enhanced CT,heterogeneous enhancement in the cortical phase was seen in 20 masses,annular enhancement in one mass and homogenous enhancement in 2 masses,respectively.Twenty masses showed strong enhancement,and 2 masses showed slight-moderate enhancement.In the parenchymal and early delayed phase,the masses showed a weaker homogeneous enhancement than the renal parenchyma.Fat composition within the tumor has no enhancement.Conclusion The few fat composition could demonstrated by thin-slice CT scan as the characteristic appearances in the renal AML with minimal fat.The features of MSCT:early delayed homogeneous enhancement and gross blood vessels through the masses of renal AML with minimal fat were very helpful to improve the diagnosis and distinguish.更多还原