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目的探讨乏脂肪血管平滑肌脂肪瘤(LPRAML)CT、MRI和病理征象。方法搜集经手术病理证实的28例LPRAML患者的CT和MRI资料,观察分析肿瘤的成分(脂肪、出血、坏死、钙化)、肿瘤与周围正常组织的关系(包膜、角度)及肿瘤的强化方式,计算CT和MRI对该病各种征象的检出准确性。结果 28例中有23例(82.1%)在病理检查中检出含有脂肪成分,钙化、出血、坏死及假包膜均少见;18例(78.3%)HMB45呈阳性,16例(69.6%)Melan-A呈阳性。CT对脂肪成分的检出准确性低于MRI,且差异具有统计学意义(P<0.05);对钙化成分的检出率高于MRI,且差异具有统计学意义(P<0.05);CT和MRI对肿瘤假包膜、出血、坏死征象的检出率差异不明显(P均>0.05)。CT对“劈裂征”或“杯口征”征象的检出情况优于MRI,且差异具有统计学意义(P<0.05);CT和MRI增强扫描后呈均匀持续强化的病变分别占89.3%和82.1%,具有一定的一致性(Kappa=0.711)。结论脂肪成分、“劈裂征”或“杯口征”和均匀持续的强化特点均是CT和MRI对该病诊断的特殊征象,该病的确诊需要依靠病理和相关免疫组织化学检查。
Objective To investigate the CT, MRI and pathological features of LPRAML. Methods CT and MRI data of 28 patients with LPRAML confirmed by surgery and pathology were collected. The composition of the tumor (fat, hemorrhage, necrosis, calcification), the relationship between the tumor and surrounding normal tissues (capsule, angle) and the enhancement of the tumor , Calculate the accuracy of CT and MRI detection of various signs of the disease. Results Twenty-three of the 28 patients (82.1%) had fatty components detected in the pathological examination. Calcification, hemorrhage, necrosis and pseudocapsules were rare. 18 (78.3%) HMB45 positive and 16 -A positive. The detection accuracy of CT was lower than that of MRI (P <0.05). The detection rate of calcification was higher than that of MRI (P <0.05). CT and There was no significant difference in the detection rate of tumor pseudocapsule, hemorrhage and necrosis (all P> 0.05). CT was superior to MRI in the detection of signs of “splitting sign” or “cup sign”, and the difference was statistically significant (P <0.05). CT and MRI enhanced scanning showed a uniformly and continuously enhanced lesions Accounting for 89.3% and 82.1% respectively, with a certain consistency (Kappa = 0.711). Conclusion The fat composition, the “splitting sign” or the “cup sign” and the uniform and continuous enhancement features are the special signs of CT and MRI diagnosis of the disease, the diagnosis of the disease need to rely on pathology and related immunohistochemistry an examination.