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目的分析肾上皮样血管平滑肌脂肪瘤(EAML)的影像学表现,进一步提高诊断准确性。方法回顾性分析经手术病理证实的19例EAML患者的影像学资料,11例行CT平扫及增强检查,7例仅行CT增强检查,1例行CT增强检查和MRI平扫及增强检查。结果肾EAML 19例共21个病灶,2例双侧发病,瘤体最大径1.8～25.2 cm,平均6.5 cm;多数病灶突出于肾轮廓外(19/21)且与肾实质分界清晰(17/21)。11例CT平扫检出12个病灶,8个病灶密度不均匀,其中7个病灶内含脂肪成分,1个病灶内示囊变坏死区;4个病灶密度均匀且高于肾实质;2例出现肾包膜下血肿。21个病灶行CT增强扫描,动脉期14个病灶不均匀明显强化,内示粗大血管影,静脉期血管影仍可见;13个病灶强化方式为快进快出,8个病灶为持续性强化。1例行MRI,T1WI及T2WI呈混杂信号,病灶局部在反相位像上信号强度较同相位像明显下降。结论影像学表现结合临床资料对正确诊断肾EAML有重要价值,但最后确诊仍需依赖病理。
Objective To analyze the imaging features of renal epithelial angiomyolipoma (EAML) to further improve the diagnostic accuracy. Methods The imaging data of 19 patients with EAML confirmed by surgery and pathology were retrospectively analyzed. Eleven patients underwent CT scan and contrast enhancement, 7 patients underwent CT enhancement only, 1 patient underwent CT contrast enhancement and MRI plain scan and contrast enhancement. Results There were 21 lesions in 19 cases of EAML and 2 cases of bilateral lesions. The maximum diameter of tumor was 1.8 ~ 25.2 cm (6.5 cm in average). Most lesions protruded beyond the outline of the kidney (19/21) twenty one). Twelve lesions were detected by CT scan in 11 cases. The density of 8 lesions was not uniform. Among them, 7 lesions contained fat components and 1 lesions showed cystic necrosis; 4 lesions were uniform and higher than those in renal parenchyma; 2 occurred Subrenal hematoma. Twenty-one CT scans were performed in all the 21 lesions. The 14 lesions in the arterial phase were significantly non-uniformly enhanced, which showed thick blood vessels and venous vascular lesions were still visible. Thirteen lesions were rapidly advanced and rapidly cleared and 8 lesions were persistent. 1 cases of MRI, T1WI and T2WI was a mixed signal, local lesion on the anti-phase image signal intensity compared with the phase image decreased significantly. Conclusions The imaging findings combined with clinical data have important value in the correct diagnosis of renal EAML, but the final diagnosis still depends on the pathology.