16层螺旋CT肾脏皮质早期扫描及CTA在肾癌诊断和术前评估中的价值  

Value of 16-slice Spiral CT Early Corticomedullary Phase Scanning in Diagnosis and Preoperation Evaluation of Renal Cell Carcinoma

作　　者：李清海[1] 严福华[1] 颜志平[1] 徐鹏举[1] 侯君[2] 

机构地区：[1]复旦大学附属中山医院放射科,200032 [2]复旦大学附属中山医院病理科,200032

出　　处：《中国医学计算机成像杂志》2006年第4期256-260,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨16层螺旋CT肾脏皮质早期扫描及血管成像在肾癌定性诊断及术前评估中的价值。材料和方法:采用Siemens16层螺旋CT机,对超声提示有肾占位性病变的46例病人进行扫描,利用获得的皮质早期容积数据,显示肾占位性病变对邻近肾内动脉分支的影响、肿瘤血管及类似肿瘤染色等方面的情况,同时显示肾动脉有无变异和其他病变。结果:28例肾癌中23例(82.1%)在皮质早期病灶即呈明显强化,实质期强化程度迅速下降;25例(89.3%)可见邻近动脉分支的受侵改变;21例(75.0%)可见确切的一支或多支粗大的供血动脉,以及瘤体内可见明显的肿瘤血管影或血池影;23例(82.1%)出现类似血管造影的肿瘤染色表现;2例(7.1%)患肾出现静脉早显;3例(10.7%)病人中患肾出现副肾动脉,其中1例为两支;1例(3.6%)病人患侧肾动脉重度狭窄,健侧肾动脉中度狭窄。8例血管平滑肌脂肪瘤中,仅2例(25%)见供血动脉影,其中1例供血动脉增粗,均未见相邻动脉分支破坏、明显肿瘤血管、血池及肿瘤染色改变。10例囊肿,仅表现为相邻肾动脉分支受压移位、拉直变细。结论:应用优化方案扫描进行皮质早期扫描及CTA重建,不仅为肾癌的定性诊断提供了重要的信息,对肾癌的术前评估也具有重要的补充价值。Purpose： To discuss the value of 16- slice spiral CT contrast enhanced early corticomedullary phase scanning and CT angiography（CTA） in diagnosis and preoperative evaluation of renal cell carcinoma. Materials and Methods： Forty- six patients with suspected renal occupied lesions by ultrasonography underwent multi - phase scanning with Siemens 16 - slice CT system. The early corticomedullary phase was obtained to show influences of lesions on adjacent intralrenal arterial branchs, tumor vasculaity, tumor stained and so on. Meanwhile malformation and other pathological changes of renal arteries were observed if any. Results： Obvious enhancement of lesions was observed in twenty - three patients （82.196 ）of twenty - eight patients with renal cell carcinoma in early corticomedullary phase, and then the lesions rapidlly became hypodense compared to parenchyma in parenchymal phase. Adjacent arterial branchs displayed invaded changes in 25 patients（89.3% ） . Feeding arteries, tumor vascularity and blood pool were observed in 21 patients（75% ） .Analogousely tumor stained appeared in 23 patients（82.1% ） . Renal veins of diseased kidneys enhanced earlier in two patients（7.1% ） . Accessary renal arteries existed in three diseased kidneys（10.7%）. Among eight patients with AML, feeding arteries were observed only in two pations （25 % ）and enwidend in one patient. No invaded arteries, obviouse tumor vascularity, blood pool and tumor stained were observed. Only adjacent arterial branchs compressed and shifted was demonstrated in ten patients with cysts. Conclusion： Using improved scanning protocol to perform contrast enhanced early corticomedullary phase scanning combined with CTA reconstruction not only provides important characteristic information in renal cell carcinoma diagnosis, but also vossesses significant value in preoperative evalution.

关 键 词：肾细胞癌 CT 血管成像 

分 类 号：R737.11[医药卫生—肿瘤]