CT预测典型肾血管平滑肌脂肪瘤自发破裂的价值

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[摘要] 目的 探讨CT预测肾血管平滑肌脂肪瘤（RAML）自发破裂的价值。 方法 选择2004年5月～2014年5月乐清市人民医院和温州市人民医院CT诊断为RAML 42例患者（肿瘤48个）为研究对象，定期CT随访。对48个肿瘤的位置、肿瘤直径、脂肪密度、肿瘤血管、肿瘤直径与肾实质厚度的比值、肿瘤直径与肾皮质“裂隙”宽度的比值的CT表现进行评估，单因素分析采用χ2检验，多因素分析采用Logistic回归分析。通过绘制ROC曲线，对危险因素的敏感度和特异度进行评价，确定其CT诊断效能。 结果 48个肿瘤中17个发生自发破裂出血，31个未发生破裂。发生肿瘤破裂中，外生型15个，脂肪密度≥-60 Hu的10个，肿瘤直径≥38.7 mm的13个，瘤内异常血管13个，肿瘤直径/肾实质厚度≥1的13个，肿瘤直径/肾皮质“裂隙”宽度≥1的13个。未发生肿瘤破裂中，外生型18个，脂肪密度≥-60 Hu的11个，肿瘤直径≥38.7 mm的13个，瘤内异常血管的5个，肿瘤直径/肾实质厚度≥1的12个，肿瘤直径/肾皮质“裂隙”宽度≥1的8个。单因素分析果显示肿瘤位置、肿瘤直径、肿瘤血管、肿瘤直径与肾实质厚度比、肿瘤直径与肾皮质“裂隙”宽度比与肿瘤破裂有关（P < 0.05）。多因素Logistic回归分析，结果显示，肿瘤位置（OR = 7.75，95%CI：1.14～52.72，P < 0.05）、肿瘤直径（OR = 6.59，95%CI：1.04～41.93，P < 0.05）、肿瘤血管（OR = 17.68，95%CI：2.83～110.53，P < 0.05）是发生破裂的危险因素，在预测肿瘤发生自发破裂中起着决定性的因素。以上3个因素ROC曲线分析的结果表明，肿瘤内异常血管的出现在诊断肿瘤自发破裂中具有较高的敏感度和准确率。 结论 肾错构瘤自发破裂出血非单一因素作用，与肿瘤所处的位置、肿瘤直径、瘤内血管、肿瘤直径与肾实质厚度比及肿瘤直径与肾皮质“裂隙”宽度比密切相关。肿瘤位置、肿瘤异常血管和肿瘤直径能较好反映肿瘤发生破裂的关键因素，CT检查可以大致预测肿瘤发生自发破裂的危险性。

[关键词] 肾血管平滑肌脂肪瘤；CT；自发破裂；预测

[中图分类号] R737.11 [文献标识码] A [文章编号] 1673-7210（2015）10（a）-0092-06

Value of CT on predicting renal angiomyolipoma with spontaneous rupture

ZHANG Aiwei1 ZHOU Haisheng1 XIE Qi1 ZHENG Hanpeng1 WANG Xurong1 WANG Jun1 QIU Qiande2

1.Department of Radiology， Yueqing Hospital Affiliated to Wenzhou Medical Universtiy Yueqing People"s Hospital， Zhejiang Province， Yueqing 325600， China； 2.Department of Radiology， the Third School of Clinical Medicine of Wenzhou Medical University Wenzhou People"s Hospital， Zhejiang Province， Wenzhou 325000， China

[Abstract] Objective To explore the value of CT on predicting renal angiomyolipoma （RAML） with spontaneous rupture. Methods From May 2004 to May 2014， in Yueqing People"s Hospital and Wenzhou People"s Hospital， the imaging data of 42 patients with RAML （48 tumors） were selected as the subjects， checked by the CT at regular intervals. The location of tumor， tumor diameter， fat density， tumor vessel， the ratio of tumor diameter and thickness of renal parenchyma， the ratio of tumor diameter and renal gap width of 48 tumors were evaluated， single factor was analyzed by χ2 test， multiple factors were analyzed by Logistic regression analysis， the risk factors of the sensitivity and specificity of CT diagnosis was evaluated by drawing ROC curve， then its effectiveness was determined. Results In the 48 tumors， 17 cases had spontaneous rupture and hemorrhage， which 15 cases were external type， fat density ≥ -60 Hu were 10 cases， tumor diameter ≥ 40 mm were 13 cases， abnormal tumor vessel were 13 cases， tumor diameter/thickness of renal parenchyma ≥ 1 were 13 cases， tumor diameter / renal gap width≥ 1 were 13 cases； 31 cases had no spontaneous rupture， which 18 cases were external type， fat density ≥ -60 Hu were 1 case， tumor diameter ≥ 40 mm were 13 cases， 5 cases had abnormal tumor vessel， tumor diameter/thickness of renal parenchyma ≥ 1 were 12 cases， tumor diameter/renal gap with≥ 1 were 8 cases. The results of single factor analysis showed that the location of tumor， tumor diameter， tumor vessel， the ratio of tumor diameter and thickness of renal parenchyma， the ratio of tumor diameter and renal gap width， these 5 factors were related to spontaneous rupture of renal angiomyolipoma （P < 0.05）， the results of Logistic regression analysis showed that the location of tumor （OR = 7.75， 95%CI： 1.14-52.72， P < 0.05）， tumor diameter （OR = 6.59， 95%CI： 1.04-41.93， P < 0.05） and tumor vessel （OR = 17.68， 95%CI： 2.83-110.53， P < 0.05）， these three factors were belonged to the risk factors of spontaneous rupture， and played a decisive factor in the prediction of the spontaneous rupture of renal angiomyolipoma. ROC efficiency curve analysis of abnormal tumor vessel， tumor location and tumor diameter showed that the emergence of abnormal blood vessels within the tumor had higher sensitivity and accuracy in the diagnosis of tumor spontaneous rupture. Conclusion The spontaneous rupture with hemorrhage of renal angiomyolipoma is not result of single factor， there is a closely correlation among the location of the tumor， the tumor diameter， the tumor vessel， the ratio of tumor diameter and thickness of renal parenchyma， the ratio of tumor diameter and renal gap width. Abnormal tumor vessel， tumor location and tumor diameter can better reflect relevance of tumor spontaneous rupture， also can roughly predict the risk of spontaneous rupture.

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