CAJ | 학술논문

目的：探讨下腔静脉平滑肌肉瘤的影像学表现，提出诊断和鉴别诊断要点。方法从2009年～2013年，我院诊治下腔静脉平滑肌肉瘤患者5例，其中2例在术前行 MR 检查，3例行 CT 检查，5例均行下腔静脉造影检查。回顾性分析其影像表现，并对比相关文献分析。结果 5例中有2例表现为腔内病变伴下腔静脉阻塞，分别累及下腔静脉中段及下段。 3例表现为腹膜后肿块，腔内外均受累且侵犯周围组织，其中2例病变范围较大，跨越下腔静脉两段分布，1例分布在下段。腹膜后病变主要表现为巨大，边界不清的软组织肿块影，呈低密度（CT ）或稍长 T1混杂稍长 T2信号（MR），增强后不均匀强化。腔内肿瘤表现为低密度软组织肿块伴下腔静脉管腔扩张，增强后呈边缘强化。全部病例均形成广泛侧支循环，而无腹膜后淋巴结转移。与腹膜后病变相比，腔内肿瘤的预后较好。结论影像学表现有利于对此少见病的术前准确诊断。
목적：탐토하강정맥평활기육류적영상학표현，제출진단화감별진단요점。방법종2009년～2013년，아원진치하강정맥평활기육류환자5례，기중2례재술전행 MR 검사，3례행 CT 검사，5례균행하강정맥조영검사。회고성분석기영상표현，병대비상관문헌분석。결과 5례중유2례표현위강내병변반하강정맥조새，분별루급하강정맥중단급하단 。 3례표현위복막후종괴，강내외균수루차침범주위조직，기중2례병변범위교대，과월하강정맥량단분포，1례분포재하단。복막후병변주요표현위거대，변계불청적연조직종괴영，정저밀도（CT ）혹초장 T1혼잡초장 T2신호（MR），증강후불균균강화。강내종류표현위저밀도연조직종괴반하강정맥관강확장，증강후정변연강화。전부병례균형성엄범측지순배，이무복막후림파결전이。여복막후병변상비，강내종류적예후교호。결론영상학표현유리우대차소견병적술전준학진단。
Objective Leiomyosarcoma of the inferior vena cava (IVC ) is a rare soft‐tissue sarcoma .It is difficult to make a preoperative imaging diagnosis because of limited experience .The purpose of this study was to describe the imaging features of leiomyosarcomas of the IVC and to introduce the key points of diagnosis and differential diagnosis .Methods Five patients with leiomyosarcomas of the IVC were referred to our hospital during a period of 4 years .Two patients un‐derwent MR scan ,3 patients received CT examination and all patients did cavography .Imaging results were analyzed and compared with those of other published institutional experiences .Results The radiological findings ranged from the in‐traluminal lesions with obstruction of the IVC in 2 cases to the extraluminal masses infiltrating into the surrounding tissues in 3 cases .In two of three patients with extraluminal growth of the tumors ,two segments of the IVC were involved ,in another one ,the lower portion was affected ;two intraluminal lesions were located in the middle and lower IVC segment respectively .In cases with extraluminal growth ,leiomyosacomas were demonstrated ill‐defined and large‐sized soft tissue masses with hypo‐density on CT / equal T1 mixed long T2 signal intensity on MRI and inhomogeneous contrast uptake .In cases with intraluminal growth ,low density tumors in the dilatated IVC were peripherally enhanced .All masses were ac‐companied with extensive collateral circulatoin and no retroperitoneal lymph node enlargement .Compared with the extralu‐minal type ,intraluminal tumors indicated a good long‐ term survival after surgery .Conclusion Imaging findings may help to accurately diagnose this rare entity .