螺旋CT双期增强扫描在肾细胞癌亚型诊断中的价值  

Diagnostic Value of MDCT Dual-phased Scanning in Differentiating the Subtypes of Renal Cell Carcinoma

作　　者：徐春玲[1] 周胜利[1] 吴华连[1] 张永刚[1] 王宗盛[1] 李树芸[1] 

机构地区：[1]连云港市第一人民医院影像科,江苏222002

出　　处：《放射学实践》2008年第1期54-58,共5页Radiologic Practice

摘　　要：目的:评价多层螺旋CT动态双期增强扫描在肾细胞癌亚型鉴别诊断中的作用。方法:回顾性分析106例经手术和病理证实的肾细胞癌患者行多层螺旋CT平扫加皮髓期、实质期双期扫描的影像资料,重点分析CT动态强化方式及类型在各种亚型之间的异同。结果:皮髓期时88.6%(62/70)透明细胞癌、80%(4/5)多房囊性细胞癌及83.3%(5/6)混合型癌呈明显强化;84.6%(11/13)乳头状癌、100%(9/9)嫌色细胞癌、66.7%(2/3)集合管癌轻度强化;91.5%(64/70)透明细胞癌、69.2%(9/13)乳头状癌、80%(4/5)多房囊性细胞癌、83.3%(5/6)混合性癌及100%(3/3)集合管癌呈不均匀或周边强化;而88.9%(8/9)嫌色细胞癌呈均匀强化。皮髓期与实质期两期动态分析示88.6%(62/70)透明细胞癌呈典型"快进快出"表现;84.6%(11/13)乳头状癌呈"延迟强化"的特点。结论:肾细胞癌皮髓期的强化程度在各亚型的鉴别诊断中具有重要的价值,而CT双期扫描中肿瘤的动态强化方式及类型是鉴别各亚型的重要补充依据。Objective： To evaluate of the diagnostic value of the two phased scan technique using a multi-detector rowed CT（MDCT） scanner in the differentiation of the subtypes of renal cell carcinoma （RCC）. Methods：We retrospectively studied the CT materials of 106 cases of RCC （surgically and pathologically proven） in which plain and two-phased contrast enhanced scans with a MDCT scanner had been undergone. The analysis was undertaken emphatically on the investigation of the correlation and relationship of the dynamic CT enhancement patterns to the various subtypes of RCC. Results： In the cortico-medullary phase,88. 6% （62/70） of the clear cell RCC, 80% （4/5） of the multilocular and cystic RCC and 83.3% （5/6） of the mixed cell RCC showed stronger enhancements; 84.6% （11/13） of the papillary RCC,100% （9/9） of the chromophobic RCC and 66.7% （2/3） of the collecting duct RCC revealed mildly enhanced;91.5% （64/70） of the clear cell RCC,69.2% （9/13） of the papillary RCC,80% （4/5） of the multilocular and cystic RCC,83.3% （5/6） of the mixed cell RCC and 100% （3/3） of the collecting duct RCC demonstrated heterogeneous or peripheral enhancements; whereas, 88.9 % （8/9） of the chromophobic RCC showed homogeneous enhancements. On dynamic two-phased （cortico-meduulary and nephrogram phases） MDCT scans,88.6% （62/70） of the clear cell RCC showed a typical enhancing phenomenon of ＂ fast rushing in and washing out＂ sign; while 84.6 % （ 11/13） of the papillary RCC revealed a ＂delayed enhancement＂ sign. Conclusion：For a further differentiation of the subtypes of renal cell carcinoma,the extent of contrast enhancement at CMP （cortico-medullary phase） of dynamic CT scans played a valuable parameter, while the contrast enhancement patterns and their features on the two phased （CMP and NP） scans were capable of serving as supplemental roles.

关 键 词：肾肿瘤 体层摄影术 X线计算机 X线影像增强 

分 类 号：R737.11[医药卫生—肿瘤]