目的 提高对典型RAML自发破裂 出血相关因素的认识和诊断效能；为临床 合理选择RAML治疗方案提供影像依据。方 法 收集经手术病理或临床随诊证实48例 典型肾血管平滑肌脂肪瘤，对比分析自发 破裂出血组和未破裂出血组的病灶生长方 式、大小、血管异常等征象。结果 RAML 的CT表现具有典型特征，肿瘤内部具有脂 肪组织、软组织密度，迂曲、增粗的血管 影。破裂出血组RAML表现为含有脂肪、出 血等混杂密度团块影，增强呈“洋葱皮 样”或“漩涡状”。自发破裂组多表现为 外生型(18/24)、最大径≧50mm(19/24)、 肿瘤内血管异常(21/24)；且与未破裂出 血组对比，差异有统计意义(P<0.05)。结 论 典型肾血管平滑肌瘤破裂出血具有一 定提示征象，对于未破裂出血病灶进行积 极预防治疗具有重要价值。

Objective To improve the typical Real angiomyolipoma (RAML) spontaneous rupture of bleeding related factors of cognitive and diagnostic efficacy; to provide imaging basis for the rational selection of RAML treatment. Methods Forty-eight patients with RAML were confirmed by operation or clinical follow-up. The signs of growth, size and vascular abnormalities of spontaneous rupture of bleeding group and unruptured bleeding group were compared. Results The CT manifestations of RAML have typical characteristics，such as adipose tissue, soft tissue density, tortuous and thickening blood vessels. Breaking hemorrhage group RAML showed fat, bleeding and other mixed density lumps, displaying "onion skin" or "swirling" after contrast-enhanced. Most tumor of spontaneous rupture group showed exogenous (18/24), maximal ≧ 50mm (19/24), vascular abnormalities (21/24). There was significant difference between the two groups (P<0.01). Conclusion Typical RAML rupture of bleeding has some indication, which is an important value for the prevention and treatment of unruptured bleeding of RAML.