CAJ | 학술논문

目的：探讨非腔内生长型原发性下腔静脉平滑肌肉瘤（PIVCLMS）的 CT 表现及其诊断价值，并复习相关文献。方法选取2004—2013年台州市中心医院经手术病理证实为非腔内生长型 PIVCLMS 患者4例，均行 CT 平扫、双期增强扫描和多方位重建。结果男1例，女3例；年龄47~62岁，平均56岁；肿块直径61~113 mm，平均83.8 mm；肿块呈圆形或类圆形，边界尚清，病灶内均伴多发斑片状液化坏死区，未见钙化及出血密度；增强双期扫描肿块 CT 值平均升高27.4、18.5 HU。4例病灶皆起源于下腔静脉右前方，2例起源于中段（Ⅱ段），1例起源于下段（Ⅰ段），1例同时累及中段及下段，肿块紧贴下腔静脉，下腔静脉增粗但均无移位，增强扫描管腔消失被不均匀强化软组织填充，1例同时累及左肾静脉，2例伴侧支循环形成。CT 所见与手术及病理结果基本相符。结论 CT 扫描能客观判断肿块与下腔静脉的关系及肿块本身的影像特点，为术前正确诊断和制定合适的临床治疗方案提供可靠的依据。
목적：탐토비강내생장형원발성하강정맥평활기육류（PIVCLMS）적 CT 표현급기진단개치，병복습상관문헌。방법선취2004—2013년태주시중심의원경수술병리증실위비강내생장형 PIVCLMS 환자4례，균행 CT 평소、쌍기증강소묘화다방위중건。결과남1례，녀3례；년령47~62세，평균56세；종괴직경61~113 mm，평균83.8 mm；종괴정원형혹류원형，변계상청，병조내균반다발반편상액화배사구，미견개화급출혈밀도；증강쌍기소묘종괴 CT 치평균승고27.4、18.5 HU。4례병조개기원우하강정맥우전방，2례기원우중단（Ⅱ단），1례기원우하단（Ⅰ단），1례동시루급중단급하단，종괴긴첩하강정맥，하강정맥증조단균무이위，증강소묘관강소실피불균균강화연조직전충，1례동시루급좌신정맥，2례반측지순배형성。CT 소견여수술급병리결과기본상부。결론 CT 소묘능객관판단종괴여하강정맥적관계급종괴본신적영상특점，위술전정학진단화제정합괄적림상치료방안제공가고적의거。
Objective To study the imaging features of primary leiomyosarcoma of the inferior vena cava(PIVCLMS) that was not intraluminal and review the literatures to improve the diagnostic accuracy. Methods The clinical data and CT findings of four cases with pathologically - proved PIVCLMS that was not intraluminal from 2004 to 2013 in Taizhou Central Hospital were retrospectively summarized and analyzed. Both non - contrast,contrast scans and multiplanar reconstruction (MPR)with spiral CT were performed in the four cases. Results Three cases were females and one case was male,with an average age of 56 years. The diameter of tumors ranged from 61 mm to 113 mm with a mean diameter of 83. 8 mm. The masses appeared to be round or oval with clear border. Cystic necrotic areas were found in all cases,and visible bleeding and calcification were not found. The CT value average increased 27. 4 HU and 18. 5 HU on the arterial phase and the portal venous phase respectively. Four lesions originated from the right anterior of inferior vena cava,two lesions from segment Ⅱ,one lesion from segment Ⅰ,one lesion involved both segment Ⅰ and Ⅱ. The masses were quite close to the inferior vena cava and could be hardly separated. The inferior vena cava were dilated and non - displaced in all cases,and the lumen were filled by heterogenous enhancing soft tissues,involving the left renal vein in one case and forming collateral venous circulation in two cases. The CT performance was consistent with operation and pathology. Conclusion The CT findings can estimate the imaging characteristic and the relationship between the mass and the inferior vena cava objectively,and provide reliable basis for preoperative correct diagnosis and clinical treatment.