腎血管平滑肌脂肪瘤的CT診斷及其介入治療
發(fā)布時間：2019-02-21 13:02
【摘要】：目的：探討腎血管平滑肌脂肪瘤(Renal angiomyolipoma, RAML) CT影像學表現(xiàn)及超選擇性經腎動脈栓塞術(Transrenal artery embolization, TRAE)在其治療中的應用。 材料與方法：收集2010年6月-2013年12月行CT平掃及增強檢查的患者102例。其中經病理證實腎血管平滑肌脂肪瘤的患者50例,男11例,女39例,年齡22-73歲,平均47.24歲。以病理結果為金標準,根據有無誤診分為兩組,觀察CT診斷RAML的敏感性。另外52例患者經CT平掃及增強檢查診斷為腎血管平滑肌脂肪瘤,其中男13例,女39例；年齡20-69歲,平均45.8歲；急診破裂出血15例,腰部疼痛31例,體檢發(fā)現(xiàn)巨大腫塊6例,均行數(shù)字減影血管造影及超選擇性經腎動脈栓塞術。 結果：50例經病理證實腎血管平滑肌脂肪瘤患者,其中48例CT正確診斷為腎AML,2例CT誤診為腎臟腫瘤,CT對腎AML的診斷敏感性96%。發(fā)生于左腎23例,右。腎25例,雙。腎2例。診斷正確的一組48例患者,CT平掃,腫塊見典型的脂肪低密度影和軟組織密度影混雜,軟組織部分平掃CT值15-60Hu,增強掃描動脈期明顯強化,CT值50-110Hu,靜脈期強化減退,延遲期強化不明顯；脂肪部分,平掃CT值-120--10Hu,動脈期、靜脈期及延遲期均未見強化,腫塊平掃時平均CT值-5.6Hu,增強動脈期平均CT值23.7Hu。誤診的一組2例,誤診為腎臟腫瘤,CT平掃見腫塊等或稍低密度,未見明顯低密度影,平掃CT值15～65Hu,平均CT值29.3Hu,增強掃描動脈期腫瘤明顯強化,CT值60～130Hu,平均CT值72.3Hu,靜脈期腫瘤強化減退,延遲期腫瘤強化不明顯。兩組患者平掃及增強后動脈期平均的CT值相比,均有極顯著性差異(P0.01)。52例超選擇性經腎動脈栓塞術患者,發(fā)生于左腎24例,其中孤立腎3例,右腎19例,其中孤立腎3例,雙腎9例；所有患者腎動脈造影均顯示腫瘤部位不同程度的腫瘤染色,部分突出于腎影外,腫瘤部位血管紊亂,呈螺旋狀,腫瘤多為單支腎內分支動脈供血,瘤體血管上可見有點狀或串珠狀動脈瘤存在。破裂出血的15例患者,動脈期還可見分支動脈造影劑外溢。栓塞術后,所有患者造影可見腫瘤染色消失,靶血管閉塞,I臨床癥狀減輕,破裂出血的患者血壓回升,血尿消失,術后未出現(xiàn)明顯并發(fā)癥,隨診回訪3-6月,腫瘤大小都有不同程度的縮小。 結論：cT可準確的診斷RAML。通過超選擇性經腎動脈栓塞治療能有效的控制腫瘤生長,防治出血并能最大限度保護正常腎組織。
[Abstract]:Objective: to investigate the (Renal angiomyolipoma, RAML) CT imaging findings of renal angiomyolipoma and the application of superselective transrenal artery embolization (Transrenal artery embolization, TRAE) in the treatment of renal angiomyolipoma. Materials and methods: 102 cases of CT plain scan and enhanced examination from June 2010 to December 2013 were collected. There were 50 cases of renal angiomyolipoma confirmed by pathology, including 11 males and 39 females, aged 22-73 years with an average age of 47.24 years. The sensitivity of CT in the diagnosis of RAML was observed by using pathological results as gold standard and divided into two groups according to misdiagnosis. The other 52 patients were diagnosed as renal angiomyolipoma by CT plain scan and contrast-enhanced examination, including 13 males and 39 females, aged 20-69 years with an average of 45.8 years old. 15 cases of emergency rupture hemorrhage, 31 cases of lumbar pain, 6 cases of massive mass were detected by physical examination. All cases were performed digital subtraction angiography and superselective transrenal artery embolization. Results: of the 50 cases of renal angiomyolipoma confirmed by pathology, 48 cases were correctly diagnosed as renal AML,2 by CT and CT was misdiagnosed as renal tumor. The sensitivity of CT to the diagnosis of renal AML was 96%. It occurred in 23 cases of left kidney, right side. Kidney 25 cases, double. Kidney 2 cases. In a group of 48 patients diagnosed correctly, CT plain scan showed typical low density fat and soft tissue density mixed, CT value of soft tissue was 15-60 Hu. enhanced arterial phase obviously enhanced, CT value 50-110 Hu. and venous phase enhancement decreased. The enhancement of delayed period was not obvious; In the fat part, the CT value of plain scan was-120 渭 10 Hu.No enhancement was found in arterial phase, venous phase and delayed phase. The average CT value in plain scan of mass was-5.6 Huand the average CT value in enhanced arterial phase was 23.7Hu.In the fat part, the mean CT value in contrast-enhanced arterial phase was 23.7 Hu. 2 cases were misdiagnosed as renal tumor, CT showed mass or low density, no obvious low density, plain scan CT value was 15 ~ 65 Hu. average CT value was 29.3Hu. enhanced arterial phase tumor was obviously enhanced, CT value was 60 ~ 130Hu. The mean CT value was 72.3 Hu. the enhancement of tumor in venous phase was decreased, but that in delayed phase was not obvious. There was a significant difference in the mean CT values between the two groups in both plain scan and enhanced posterior arterial phase (P0.01). 52 cases of superselective transrenal artery embolization occurred in 24 cases of left kidney, including 3 cases of solitary kidney and 19 cases of right kidney. There were 3 cases of isolated kidney and 9 cases of double kidney. Renal arteriography in all patients showed different degree of tumor staining, partly protruding outside the shadow of the kidney, the tumor site vascular disorder, spiral shape, the tumor is mostly a single intra-renal branch of blood supply, Punctate or beaded aneurysms were found in the blood vessels of the tumor. In 15 patients with ruptured hemorrhage, branch arterial contrast agent spills were also found in arterial phase. After embolization, the tumor staining disappeared, the target vessel occluded, the clinical symptoms of I alleviated, the blood pressure increased and hematuria disappeared in the patients with ruptured hemorrhage, and no obvious complications occurred after the embolization. The patients were followed up for 3 months and 6 months, and the patients were followed up for 3 months and 6 months. The size of the tumor shrinks to varying degrees. Conclusion: cT can accurately diagnose RAML.. Superselective renal artery embolization can effectively control tumor growth, prevent bleeding and protect normal renal tissue.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11
本文編號：2427526
[Abstract]:Objective: to investigate the (Renal angiomyolipoma, RAML) CT imaging findings of renal angiomyolipoma and the application of superselective transrenal artery embolization (Transrenal artery embolization, TRAE) in the treatment of renal angiomyolipoma. Materials and methods: 102 cases of CT plain scan and enhanced examination from June 2010 to December 2013 were collected. There were 50 cases of renal angiomyolipoma confirmed by pathology, including 11 males and 39 females, aged 22-73 years with an average age of 47.24 years. The sensitivity of CT in the diagnosis of RAML was observed by using pathological results as gold standard and divided into two groups according to misdiagnosis. The other 52 patients were diagnosed as renal angiomyolipoma by CT plain scan and contrast-enhanced examination, including 13 males and 39 females, aged 20-69 years with an average of 45.8 years old. 15 cases of emergency rupture hemorrhage, 31 cases of lumbar pain, 6 cases of massive mass were detected by physical examination. All cases were performed digital subtraction angiography and superselective transrenal artery embolization. Results: of the 50 cases of renal angiomyolipoma confirmed by pathology, 48 cases were correctly diagnosed as renal AML,2 by CT and CT was misdiagnosed as renal tumor. The sensitivity of CT to the diagnosis of renal AML was 96%. It occurred in 23 cases of left kidney, right side. Kidney 25 cases, double. Kidney 2 cases. In a group of 48 patients diagnosed correctly, CT plain scan showed typical low density fat and soft tissue density mixed, CT value of soft tissue was 15-60 Hu. enhanced arterial phase obviously enhanced, CT value 50-110 Hu. and venous phase enhancement decreased. The enhancement of delayed period was not obvious; In the fat part, the CT value of plain scan was-120 渭 10 Hu.No enhancement was found in arterial phase, venous phase and delayed phase. The average CT value in plain scan of mass was-5.6 Huand the average CT value in enhanced arterial phase was 23.7Hu.In the fat part, the mean CT value in contrast-enhanced arterial phase was 23.7 Hu. 2 cases were misdiagnosed as renal tumor, CT showed mass or low density, no obvious low density, plain scan CT value was 15 ~ 65 Hu. average CT value was 29.3Hu. enhanced arterial phase tumor was obviously enhanced, CT value was 60 ~ 130Hu. The mean CT value was 72.3 Hu. the enhancement of tumor in venous phase was decreased, but that in delayed phase was not obvious. There was a significant difference in the mean CT values between the two groups in both plain scan and enhanced posterior arterial phase (P0.01). 52 cases of superselective transrenal artery embolization occurred in 24 cases of left kidney, including 3 cases of solitary kidney and 19 cases of right kidney. There were 3 cases of isolated kidney and 9 cases of double kidney. Renal arteriography in all patients showed different degree of tumor staining, partly protruding outside the shadow of the kidney, the tumor site vascular disorder, spiral shape, the tumor is mostly a single intra-renal branch of blood supply, Punctate or beaded aneurysms were found in the blood vessels of the tumor. In 15 patients with ruptured hemorrhage, branch arterial contrast agent spills were also found in arterial phase. After embolization, the tumor staining disappeared, the target vessel occluded, the clinical symptoms of I alleviated, the blood pressure increased and hematuria disappeared in the patients with ruptured hemorrhage, and no obvious complications occurred after the embolization. The patients were followed up for 3 months and 6 months, and the patients were followed up for 3 months and 6 months. The size of the tumor shrinks to varying degrees. Conclusion: cT can accurately diagnose RAML.. Superselective renal artery embolization can effectively control tumor growth, prevent bleeding and protect normal renal tissue.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11
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