肾周脂肪肉瘤与肾脏巨大血管平滑肌脂肪瘤的CT和MRI鉴别诊断价值

目的评价CT和MRI对肾周脂肪肉瘤与肾脏巨大血管平滑肌脂肪瘤(AML)的鉴别诊断价值。资料与方法搜集经手术病理证实的肾周脂肪肉瘤18例和肾脏巨大AML(直径>8cm)14例患者资料。32例均行CT检查,10例同时行MRI检查,分析脂肪肉瘤和AML的影像学特点。结果AML有14例显示肾实质缺损、11例发现瘤内扩张血管、5例肿瘤出血及3例伴有更小AML;而脂肪肉瘤无肾实质缺损、出血及不伴有更小AML征象,仅1例发现瘤内血管。肾实质缺损、瘤内扩张血管及肿瘤出血对鉴别两者差异有统计学意义。结论肾实质缺损、瘤内血管和出血是肾周脂肪肉瘤与肾脏巨大AML鉴别的重要影像学征象。     

肾透明细胞癌和乏脂肪血管平滑肌脂肪瘤CT鉴别诊断分析

目的 探讨CT在肾透明细胞癌与乏脂肪血管平滑肌脂肪瘤的诊断与鉴别中应用价值。方法 分析40例肾透明细胞癌和25例肾乏脂肪血管平滑肌脂肪瘤患者的临床资料及CT扫描结果,探讨肾透明细胞癌与肾乏脂肪血管平滑肌脂肪瘤的CT诊断与鉴别诊断。结果 对比肾透明细胞癌患者与乏脂肪血管平滑肌脂肪瘤患者在平扫和各期增强扫描的CT值可以发现,在皮质期和肾盂期肾透明细胞癌患者的CT值明显高于乏脂肪血管平滑肌脂肪瘤患者,且差异具有统计学意义。对比两组肿瘤的CT常规征象可以发现肿瘤强化是否均匀及肿瘤强化方式在鉴别肾透明细胞癌和乏脂肪血管平滑肌脂时差异具有统计学意义,乏脂肪血管平滑肌脂表现为强化均匀的概率高于肾透明细胞癌,肾透明细胞癌多表现为快进快出的强化方式,而乏脂肪血管平滑肌脂多表现出延迟强化的特点。结论 平扫期高密度及皮髓期、皮质期、肾盂期强化数值〈120HU是乏脂肪血管平滑肌脂肪瘤最具诊断价值的CT特征。     

肾血管平滑肌脂肪瘤的CT诊断与治疗(附35例分析)

目的:评价肾血管平滑肌脂肪瘤(angiolipoleiomyoma,ALL)的CT诊断价值及治疗方法。方法:分析35例肾血管平滑肌脂肪瘤的CT表现,并与29例手术病理结果对照。结果:肾血管平滑肌脂肪瘤患者多见于女性,外向性肾血管平滑肌脂肪瘤病灶较大,直径大于3cm,肿瘤出血及自发性破裂是本病最常见的严重并发症,23例多脂肪及少脂肪肾血管平滑肌脂肪瘤CT可作出诊断,脂肪成分很少或无脂肪的肾血管平滑肌脂肪瘤应结合B超、MRI诊断。结论:CT对肾血管平滑肌脂肪瘤及瘤内出血、自发性肾破裂多能作出明确诊断,对确定治疗方案有一定的指导作用。     

肾血管平滑肌脂肪瘤自发性出血的CT分析

目的:评价螺旋CT检查对肾血管平滑肌脂肪瘤自发性出血的意义,提高对该病的诊断与鉴别诊断的认识.方法:回顾性分析12例肾血管平滑肌脂肪瘤自发性出血患者的CT和病理特征.结果:12例肾血管平滑肌脂肪瘤自发性出血主要CT表现为肾实质内密度不均的肿块内含更低密度影(脂肪),其CT值为-20～-90 Hu.其中肾肿块内出血5例,肾肿块内出血并包膜下出血3例,肾肿块内出血并肾周积血2例,肾肿块内出血并腹腔积血2例.动态增强扫描肾血管及软组织成分明显强化,脂肪成分及出血均不强化.本组12例术前诊断与手术病理诊断结果符合率100%.结论:螺旋CT及多期动态增强扫描对判断肾血管平滑肌脂肪瘤自发性出血具有重要临床价值,有助于术前定位定性诊断.     

肾血管平滑肌脂肪瘤的CT诊断

目的：探讨肾血管平滑肌脂肪瘤的CT表现,以提高诊断水平.方法：回顾性分析19例肾血管平滑肌脂肪瘤患者的临床资料并探讨其CT诊断及鉴别诊断.结果：本组19例中,CT检查发现含脂肪成分者16例,其中常规层厚扫描发现脂肪成分12例,薄层扫描发现（常规扫描不能确定的）脂肪成分4例;CT检查无明显脂肪成分者3例.结论：CT对肾血管平滑肌脂肪瘤诊断的关键是在肿瘤中测得脂肪密度影,对于含脂肪成分较多的肾血管平滑肌脂肪瘤可明确定性诊断,对于少脂或无脂的肾血管平滑肌脂肪瘤,薄层CT扫描可提高诊断准确率.     

乏脂肪肾错构瘤的螺旋CT表现

目的探讨乏脂肪肾错构瘤的螺旋CT表现。方法本组6例,男5例,女1例,均为单肾单个病灶,其中右肾2例,左肾4例。先行双肾常规CT平扫,然后行螺旋CT动态增强扫描。6例均行手术切除,并做病理检查。结果6例均表现为实性肿块,大小由2.2cm×2.5cm～8.0cm×10.0cm,CT片上瘤内均未见脂肪性低密度。平扫4例呈等密度,1例呈稍低密度,1例密度稍高。增强扫描3例肾皮质期肿瘤明显强化,2例肾皮质期肿瘤轻度强化,1例瘤内见少量强化血管。病理证实4例为肾血管平滑肌脂肪瘤,2例为肾血管平滑肌瘤。结论当瘤内血管成分居多时,螺旋CT动态增强扫描肿瘤常表现为一过性明显强化,应与多血供肾癌鉴别;当瘤内平滑肌成分居多时,肿瘤轻度强化,需注意与少血供肾癌及其他肾脏良性肿瘤鉴别。     

肾血管平滑肌脂肪瘤的CT诊断

目的：总结肾血管平滑肌脂肪瘤的CT表现特点和薄层扫描的价值。方法：对我院1998年-2004年经手术病理证实的10例肾锴构溜的CT表现进行回顾性分析。结果：含脂肪组织明显的肿瘤9例，少脂或无脂的肿瘤1例。结论：含脂肪较多的肾血管平滑肌脂肪瘤CT表现典型，诊断容易；少脂或无脂的肾血管平滑肌脂肪瘤容易漏诊，薄层扫描可提高诊断率。     

肾血管平滑肌脂肪瘤的CT诊断及误诊分析

目的 探讨肾脏血管平滑肌脂肪瘤(RAML)的CT征象. 资料与方法 对照病理表现回顾性分析27例RAML的CT表现. 结果 27例RAML中23例CT征象典型,3例误诊为肾癌,1例误诊为脂肪瘤.1例合并肾透明细胞癌. 结论 CT诊断典型RAML容易,而对于不典型RAML容易误诊为恶性肿瘤,有些CT征象可帮助鉴别诊断.     

巨大肾血管平滑肌脂肪瘤自发性破裂大出血CT误诊4例分析

目的：探讨肾血管平滑肌脂肪瘤破裂出血手术前误诊的原因及CT手术前诊断该病的可能性。方法：复习手术与病理证实的4例术前CT误诊的巨大的肾血管平滑肌脂肪瘤伴破裂出血的病例。结果：巨大的肾血管平滑肌脂肪瘤可发生肿瘤内、肾筋膜囊内,盆腔膜后甚至腹腔内出血;仔细寻找肿块内代表脂肪成分的CT征是支持肾血管平滑肌脂肪瘤诊断的关键。误诊原因可能 与出血掩盖肿块内实际存在的脂肪征有关,也可能与将被挤到肿块的边缘的肿瘤内的脂肪结构误诊为肾筋膜囊内或肾窦内的脂肪有关,结论：巨大的肾血管平滑肌脂肪瘤可发生自发性破裂出血,手术前CT发现肿块内脂肪征是诊断的关键。     

非典型肾血管平滑肌脂肪瘤的影像诊断

目的分析肾脏无或少脂肪血管平滑肌脂肪瘤的影象学表现,探讨CT和MRI在其鉴别诊断中的价值。方法回顾分析13例经手术病理证实的非典型肾血管平滑肌脂肪瘤的影象学表现,所有病例均做CT检查,其中6例做MRI检查。结果肾血管平滑肌脂肪瘤13例共15个病灶,其中仅4例含少量脂肪成分,余所有病例均未见明显脂肪成分。CT平扫除4例呈等密度外,余均呈略高密度,动态增强扫描在肾皮质期呈明显均匀强化。MRI显示所有肿瘤在T2WI脂肪抑制时均呈低信号。结论非典型肾血管平滑肌脂肪瘤易与和肾癌相混淆,CT表现具有一定的特征性和鉴别诊断价值,如鉴别诊断仍有困难,应做MRI检查以提供进一步的诊断依据。     

MRI findings of angiomyolipoma of the renal sinus in 5 cases

The magnetic resonance imaging (MRI) appearance of 5 cases of angiomyolipoma (AML) centered in the renal sinus is presented. All cases exhibited similar imaging findings, including well-circumscribed margins, minimal perceived enhancement without soft tissue components, insinuation around the renal collecting system, and localized hydrocalicosis with associated localized renal parenchymal atrophy but without generalized hydronephrosis. Findings in some cases included extension out of the renal sinus and presence of aneurysmal vessels. Although identification of a renal parenchymal defect has been reported to be useful for the differentiation of a large exophytic AML from a perirenal liposarcoma, none of the cases in our series demonstrated this finding on MRI. To our knowledge, there have been only 2 previous reported cases showing the cross-sectional imaging appearance of an AML of the renal sinus without a renal parenchymal defect. In view of the shared and characteristic imaging features of the 5 cases in our series, we believe that the diagnosis of this condition can be strongly suggested by MRI despite the absence of a visible parenchymal defect. While histology remains the only way to definitively establish the diagnosis, the typical imaging appearance of this entity should enable conservative management with follow-up imaging in an asymptomatic patient. In some cases, embolization and needle biopsy could be used to avoid a surgical approach.     

CT differentiation of large exophytic renal angiomyolipomas and perirenal liposarcomas

OBJECTIVE: The purpose of our study was to describe the imaging findings and CT characteristics that lead to accurate distinction of large exophytic renal angiomyolipomas from retroperitoneal perirenal liposarcomas, which at times can be confused on imaging studies and even at pathologic examination. MATERIALS AND METHODS: We retrospectively analyzed CT images of 15 large exophytic renal angiomyolipomas and 12 well-differentiated perirenal liposarcomas. Pathologic correlation was available for six of 15 angiomyolipomas and all of the liposarcomas. All examinations were evaluated for lesion size, renal parenchymal defect, enlarged vessels, kidney displacement, lesion encapsulation or margination, associated hemorrhage, and additional angiomyolipomas. The records of patients with tuberous sclerosis or the forme fruste of that condition were excluded from the study. RESULTS: The average size of the angiomyolipomas was 14 x 10 cm. They showed a renal parenchymal defect (n = 15), enlarged vessels (n = 12), renal displacement (n = 14), good margination without a distinct capsule (n = 14), hemorrhage (n = 1), and additional (one or two) angiomyolipomas (n = 4). The average size of the liposarcomas was 18 x 11.6 cm. They showed enlarged vessels (n = 3), renal displacement (n = 11), and encapsulation (n = 4); none showed a renal parenchymal defect, hemorrhage, or associated angiomyolipomas. CONCLUSION: Although large exophytic angiomyolipomas and well-differentiated retroperitoneal liposarcomas may have similar appearances on imaging, careful evaluation for a defect in the renal parenchyma combined with the presence of enlarged vessels in angiomyolipomas should enable accurate differentiation in almost all cases. Achieving an accurate diagnosis can have a significant impact on patient treatment.     

合并出血的肾血管平滑肌脂肪瘤的多层螺旋CT诊断

目的：提高对合并出血的肾血管平滑肌脂肪瘤的诊断准确率。方法：回顾性分析13例经手术病理证实为肾血管平滑肌脂肪瘤合并出血的患者CT资料,观察其影像学表现。结果：发生于左肾者8例,右肾者4例,1例为双侧者。病灶最大者达25 cm,最小者约3 cm。所有病灶内均可见出血,部分合并肾包膜下或肾周出血。增强后病灶内脂肪成分及出血无强化,实性成分可见轻至中度强化。所有病灶内均可见血管影。4例病灶突破肾包膜,2例同时合并肾周感染。结论：多层螺旋CT尤其是增强检查,对合并出血的肾血管平滑肌脂肪瘤的诊断极有价值。     

少见和不典型肾血管平滑肌脂肪瘤CT诊断

目的：提高ＣＴ对少见和不典型肾血管平滑肌脂肪瘤的认识。方法：作者回顾性分析了１５例少见和不典型肾血管平滑肌脂肪瘤ＣＴ检查资料，重点讨论了ＣＴ检查肾血管平滑肌脂肪瘤的方法和ＣＴ在不典型肾血管平滑肌脂肪瘤诊断中的价值。结果：本组资料中，ＣＴ检查１５个病人，发现２２个病灶，７例为双侧，５例合并肾内和肾包膜下出血，ＣＴ诊断少见和不典型肾血管平滑肌脂肪瘤有较高准确性（８０％）。结论：笔者认为采用合适的检查技术，多数不典型肾血管平滑肌脂肪瘤可获得正确诊断     

Computed tomography of ureteral disruption

Computed tomography in four cases of urine extravasation due to ureteropelvic disruption secondary to blunt trauma were compared with CT in 15 cases of renal parenchymal injury. In three cases of isolated ureteropelvic disruption the renal parenchyma was intact; contrast medium excretion was normal; no perirenal hematoma was present. Contrast medium extravasation was confined predominantly to the medial perirenal space. The ipsilateral ureter was not opacified in three of the four cases of ureteropelvic disruption. These CT findings of ureteral injury are distinct from those of renal parenchymal injury. When these findings are present on CT done for trauma, confident diagnosis of ureteral disruption can be made. In one case, combined renal parenchymal injury and ureteropelvic disruption occurred.     

肾脏上皮样血管平滑肌脂肪瘤的螺旋CT表现及病理对照研究

目的：初步探讨肾脏上皮样血管平滑肌脂肪瘤的CT表现。方法：搜集4例经手术病理及免疫组化证实的肾上皮样血管平滑肌脂肪瘤,均行双肾螺旋CT平扫及动态增强扫描,回顾性分析其CT表现,并与手术病理对照。结果：2例CT平扫,含有明确脂肪密度,并呈侵袭性表现;增强扫描实性成分明显强化。2例病灶较小,平扫呈略高密度实性肿块,边界清楚,病灶内无明显脂肪密度;增强扫描密度相对均匀,实质期强化程度最高,排泄期密度下降较少。免疫组化均证实为上皮样肾血管平滑肌脂肪瘤。结论：肾脏上皮样血管平滑肌脂肪瘤即可富含脂肪,又可为乏脂肪病变,与经典血管平滑肌脂肪瘤在影像学上区分困难,当AML出现侵袭性表现,应考虑到肾脏上皮样血管平滑肌脂肪瘤。     

肾淋巴瘤的CT诊断

目的 探讨CT对肾淋巴瘤的诊断价值。材料与方法 回顾性分析6例经病理证实的肾淋巴瘤的CT表现。结果 肾淋巴瘤的CT表现可分为多发肿物型、弥漫增大型和肾周肿物型。结论 肾淋巴瘤常是全身性淋巴瘤的一部分,其CT表现常与其他实质性脏器一致。     

Computed tomography of renal lymphoma

The CT studies of 29 patients with renal or perirenal lymphoma were retrospectively reviewed. Four patterns of disease were identified. Seventeen of 29 patients (59%) had bilateral renal masses. Only seven of these patients had associated enlarged retroperitoneal lymph nodes. Eight patients (28%) had single renal or perirenal lesions adjacent to or contiguous with bulky retroperitoneal lymphadenopathy. Three patients had infiltration of the perirenal space without significant renal parenchymal involvement, and one patient had a solitary renal mass. No patients in this series had diffuse involvement of the kidney without a focal mass. Renal involvement with lymphoma should be considered in any patient who develops multiple homogeneous solid renal or perirenal masses, even in the absence of other retroperitoneal disease.     

Renal trauma in occult ureteropelvic junction obstruction: CT findings

The aim of this study was to present CT findings of occult ureteropelvic junction obstruction in patients with renal trauma and to describe the clinical signs and singular CT features that are characteristically observed with trauma and are relevant to management of these patients. We retrospectively reviewed 82 helical CT studies in patients with renal trauma referred to our institution. We found 13 cases of occult preexisting renal pathology, six of which were occult ureteropelvic junction obstructions. The clinical presentation, radiologic findings of trauma according to the Federle classification, and CT findings of obstructed ureteropelvic junction are presented. We found three category-I lesions (one in a horseshoe kidney), two of them treated with nephrostomy because of increased ureteropelvic junction obstruction due to pelvic clots; two category-II lesions (parenchymal and renal pelvis lacerations) that had presented only with microhematuria; and one category-IV lesion (pelvic laceration alone). Pelvic extension was demonstrated in all the cases with perirenal collections. The CT studies in all the cases with suspected ureteropelvic junction obstruction showed decreased parenchymal thickness and enhancement, and dilatation of the renal pelvis and calyx, with a normal ureter. Computed tomography can provide information to confidently diagnose underlying ureteropelvic junction obstruction in renal trauma, categorize the traumatic injury (at times clinically silent) and facilitate proper management according to the singularities observed, such us rupture of the renal pelvis alone (Federle category IV) and increasing ureteropelvic obstruction due to clots which can be decompressed by nephrostomy. Received: 3 October 1997; Revision received: 6 April 1998; Accepted: 1 July 1998