肾癌常见病理亚型的多层螺旋CT表现及诊断  

Differentiation of pathologic subtypes of renal cell carcinoma on helical CT scanning

作　　者：马晓军[1] 白人驹[1] 孙浩然[1] 刘颖[1] 汪俊萍[1] 闫喆[1] 

机构地区：[1]天津医科大学总医院放射科,天津300052

出　　处：《天津医科大学学报》2011年第1期88-92,共5页Journal of Tianjin Medical University

摘　　要：目的:探讨肾细胞癌常见病理亚型多层螺旋CT多期增强扫描表现特征,提高其诊断及鉴别诊断水平。方法:回顾性分析192例经手术和病理证实的肾细胞癌多层螺旋CT平扫及增强检查皮髓质期、实质期和排泄期扫描的影像资料,观察并比较各种亚型CT动态强化方式及表现特征。结果:平扫CT,160例透明细胞癌中密度不均141例,24例乳头状癌中密度不均17例,而8例嫌色细胞癌中6例密度均匀。多期增强检查,透明细胞癌(153/160)增强皮髓质期呈明显不均匀强化,实质期强化程度快速下降,排泄期持续下降,表现为"快进快出"型;而乳头状癌(23/24)和嫌色细胞癌(6/8)皮髓质期均呈轻、中度强化,实质期和排泄期呈持续强化,表现为"渐进性强化"型。经统计学分析,三种亚型肾癌间的平扫及排泄期CT值无统计学差异;而皮髓质期及实质期透明细胞癌与乳头状癌和嫌色细胞癌间的CT值有统计学差异,但乳头状癌与嫌色细胞癌间CT值在皮髓质期无统计学差异。结论:多层螺旋CT多期增强扫描对透明细胞癌与其它亚型肾癌的鉴别有一定的价值,但乳头状癌与嫌色细胞癌的鉴别常常较为困难。Objective： To investigate the CT findings of the subtypes of renal cell carcinoma（RCC） for improving the accuracy of diagnosis.Methods： 193 cases of RCC proved by surgery and pathology were performed by CT.All patients received CT unenhanced phase（UP）,corticomedullary phase（CMP）,parenchymal phase（NP） and excretory phase（EP）.Their CT manifestations were compared with the pathology of the subtypes of RCC.Results： On UP,141 of 160 cases of clear cell carcinoma（CCC） showed inhomogeneous density,17 of 24 cases of papillary renal cell carcinoma（PRCC） showed inhomogeneous density on UP,6 of 8 cases of chromophobe cell carcinoma（CRCC） showed homogenous density.153 cases of RCC were inhomogeneous enhanced on CMP,during NP and EP,the contrast-materials were washed out quickly,however,23 cases of PRCC and 6 cases of CRCC were slightly or moderately enhanced on CMP,during NP and EP,they showed persistent enhancement.According to statistical analysis,the CT values showed no difference among the three subtypes of RCC on UP and EP,but on CMP and NP,the CT values showed statistical significance between CCC and PRCC,CCC and CRCC,while no difference between PRCC and CRCC on CMP.Conclusion： The CT feature in the three subtype of RCC show certain imaging characteristics,the dynamic CT scanning provides the important information and it could be used for the differential diagnosis,however,it remain difficult to differentiate PRCC from CRCC.

关 键 词：肾细胞癌 组织病理亚型 多层螺旋CT 强化 

分 类 号：R734.2[医药卫生—肿瘤]