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少量脂肪腎臟血管肌脂瘤在電腦斷層攝影之特性:與腎細胞癌之區別

Computed Tomographic Characteristics of Minimal Fat Renal Angiomyolipoma: Differentiation from Renal Cell Carcinoma

摘要


少量脂肪腎臟血管肌脂瘤在組織病理上僅含少量脂肪組織,導致在電腦斷層攝影中很難被偵測出脂肪組織影像,因此容易被誤認為是腎細胞癌,而造成不必要之手術切除。本文主要在比較少量脂肪腎臟血管肌脂瘤與腎細胞癌在顯影前後電腦斷層攝影中之影像差異。此研究收集本院自2002年1月至2007年6月經手術切除及組織病理診斷為少量脂肪腎臟血管肌脂瘤之病患共3例;在同樣條件下亦收集大小相近之腎細胞癌共10例。回溯分析比較此兩種不同腫瘤在顯影前後電腦斷層攝影之影像特徵。另亦記錄包含年齡、性別、臨床症狀、腫瘤大小、數目與位置及病理切片報告等。電腦斷層攝影之判讀由一位事先不知診斷結果之放射診斷科醫師記載腫瘤在未顯影前呈現影像密度之高低、勻稱度與形狀,及其在顯影後呈現均質性或異質性之加強顯影。結果顯示所有3例少量脂肪腎臟血管肌脂瘤在顯影前電腦斷層攝影均呈現出勻稱性且較腎臟組織密度高之影像,且在顯影後電腦斷層攝影都呈現出均質性加強顯影之特性。相反地,在10例腎細胞癌這組中,無任何一例同時呈現出此兩種特性,且在統計上有顯著的差異。因此藉由這兩者在電腦斷層攝影顯影前後差異之特性,即少量脂肪腎臟血管肌脂瘤在顯影前後電腦斷層攝影會分別呈現出勻稱性且較腎臟組織密度高之影像,和均質性加強顯影影像,應可提供一重要線索,幫助我們在應用電腦斷層攝影時,能鑑別診斷少量脂肪腎臟血管肌脂瘤與腎細胞癌。

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並列摘要


Patients with minimal fat renal angiomyolipoma have only minimal fat on histopathology which usually undetectable on CT scan. They were often presumed to be with renal cell carcinoma and could lead to unnecessary nephrectomy. The purpose of our study was to review the patients with minimal fat renal angiomyolipoma and compare their tumor CT scan data with those of size-matched renal cell carcinomas. A total of 3 patients with histologically proven minimal fat renal angiomyolipoma from January 2002 to June 2007 were reviewed at our medical center. Serving as a reference group, we also collected a total of 10 histological confirmed cases with size-matched renal cell carcinoma. The medical records, CT study and pathological results as well as the patient's age, sex, tumor size, number and location were reviewed. The unenhanced and contrast-enhanced CT findings of the two different tumors were then analyzed and compared. A radiologist who was unaware of the diagnosis recorded the tumor attenuation on unenhanced and contrast-enhanced CT images, enhancement characteristics (homogeneous or heterogeneous) and gross configuration of the tumor. After careful comparison, all 3 minimal fat renal angiomyolipomas were found homogeneous high attenuation relative to the renal parenchyma on unenhanced CT images and had demonstrated homogeneous enhancement on contrast-enhanced CT images. Conversely, none of the 10 renal cell carcinomas showed the same radiological features on the unenhanced and contrast-enhanced CT images simultaneously. In conclusion, this study suggests that minimal fat renal angiomyolipoma showed features of homogeneous hyperdense and homogeneous enhancement on unenhanced and contrast-enhanced CT scans respectively. These CT characteristics may be the important clue to differentiate minimal fat renal angiomyolipoma from renal cell carcinoma.

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