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頁籤選單縮合
題名 | Imaging Diagnosis of Renal Angiomyolipoma on Computed Tomography=腎臟血管肌肉脂肪瘤在電腦斷層攝影之影像診斷 |
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作 者 | 陳良光; 陳昱宏; 林裕民; 張家千; 羅偉業; 李進成; | 書刊名 | 中華放射線醫學雜誌 |
卷期 | 32:4 2007.12[民96.12] |
頁次 | 頁167-176 |
分類號 | 415.818 |
關鍵詞 | 電腦斷層; 腎臟血管肌肉脂肪瘤; |
語文 | 英文(English) |
中文摘要 | 腎臟血管肌肉脂肪瘤是一種由不同比例的脂肪、平滑肌與異常的血管所構成的良性腫瘤。臨床的處置策略主要依據病人之症狀及腫瘤大小,腫瘤愈大造成出血甚至破裂的危險性愈高。因此正確的診斷出腎臟血管肌肉脂肪瘤是非常重要的,可避免不必要的腎臟切除,以保存腎臟功能。本文主要在探討電腦斷層攝影在診斷腎臟血管肌肉脂肪瘤之準確性,並分析比較經術後病理切片證實為此腫瘤之病患與其術前電腦斷層攝影檢查結果之關連性。此外亦歸納分析少量脂肪之腎臟血管肌肉脂肪瘤在電腦斷層攝影之特性,評估正確診斷此腫瘤之可能性。針對疑似腎細胞癌之病例,亦提出正確診斷之方法以供參考。 此研究收集本院自1997 年至2006 年共22 例,其中女性19 例,男性3 例,經病理診斷為腎臟血管肌肉脂肪瘤之病患,回溯其病歷記載,包含年齡、性別、臨床症狀、腫瘤大小、數目與位置、術前電腦斷層攝影診斷報告及影像特徵、手術方法、病理切片報告,及是否合併有結節性硬化症。 研究結果顯示其中19 例(86.4%)有典型腎臟血管肌肉脂肪瘤之電腦斷層診斷影像,其餘2 例則因腫瘤之脂肪含量偏低,另有1 例出現鈣化,導致無法在電腦斷層攝影中偵測出脂肪組織影像,因此被診斷為腎細胞癌。而2 例少量脂肪腎臟血管肌肉脂肪瘤在顯影前會顯示出勻稱性高密度之影像,在顯影後呈現勻稱性加強顯影影像之特性。 本研究結果顯示應用電腦斷層攝影,能正確診斷出腎臟血管肌肉脂肪瘤之敏感性為 86.4% ,主要在於大多數腫瘤均可偵測出脂肪組織影像。然而對少數含少量脂肪之腎臟血管肌肉脂肪瘤而言,在顯影前會顯示出勻稱性高密度之影像,且在顯影後呈現勻稱性加強顯影影像之特性。此影像上之特性應可提供一重要線索,幫助我們在應用電腦斷層攝影時,較能正確診斷出少量脂肪腎臟血管肌肉脂肪瘤。對小於4cm 且無法偵測出脂肪或出現鈣化之腎臟血管肌肉脂肪瘤易被診斷為腎細胞癌,為了幫病患做出正確診斷,可藉由術中之冷凍切片做病理上之確認。 |
英文摘要 | Renal angiomyolipoma is a benign tumor composed of variable amounts of fat, smooth muscle and abnormal blood vessels. Clinical management strategies are dependent on clinical presentation and tumor size, as larger tumors carry greater risks for hemorrhage and even rupture. Therefore accurate preoperative diagnosis of renal angiomyolipoma is critical to prevent an unnecessary nephrectomy and therefore preserve renal functions. The purpose of this paper was to evaluate the accuracy of computed tomography (CT) in the diagnosis of renal angiomyolipoma, by correlating the confirmed pathologic diagnosis of angiomyolipomas with preoperative CT results. Furthermore, we review our experience with low fat renal angiomyolipomas on CT images to evaluate the feasibility of an accurate diagnosis and provide a method of correct diagnosis in cases suspicious of renal cell carcinomas. This study collected a total of 22 cases from 1997 to 2006, which consisted of 19 females and 3 males, with histological confirmation of renal angiomyolipoma. The medical records, CT study, surgical intervention and pathological results were retrospectively reviewed for patients’ age, sex, tumor size, number and location, as well as the presence of tuberous sclerosis complex. The study outcome showed that 19 (86.4%) of the 22 patients had typical imaging findings of angiomyolipoma on CT, since the remaining 3 patients’ tumors were preoperatively presumed to be renal cell carcinomas due to either undetectable fat content in 2 cases or in combination with calcification in 1 on CT. Two cases of low fat renal angiomyolipomas showed features of homogeneous high attenuation on unenhanced CT and homogeneous enhancement on contrast-enhanced CT. The outcome showed that the sensitivity of accurately diagnosing renal angiomyolipoma with CT was 86.4%; the main reason was that in the majority of tumors fat attenuation could be visualized. However, low fat renal angiomyolipomas showed features of homogeneous high attenuation on unenhanced CT and homogeneous enhancement on contrast-enhanced CT. These CT characteristics may have important implications and help us to diagnose low fat renal angiomyolipomas. When the tumors were smaller than 4cm and contained undetectable fat or were calcified, the diagnosis of angiomyolipoma was difficult and tumors were easily misinterpreted to be renal cell carcinomas. Thus, in order to achieve correct diagnoses, intraoperative frozen section and biopsy can provide histopathological confirmation in these tumors. |
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