多发肾细胞癌的CT、MR表现及误诊分析  

Findings and Misdiagnosis Analysis of CT and MR in Multiple Renal Cell Carcinoma

作　　者：张得旺[1] 唐光健[2] 刘振堂[3] 区俊兴[1] 李欣[4] 王建斌 卢东齐[6] 陈小聪[1] 王斌[1] 韩淑珍[1] 

机构地区：[1]广东医学院附属厚街医院医学影像科,广东东莞523945 [2]北京大学第一医院医学影像科 [3]西安交通大学医学院第二附属医院医学影像科 [4]河北医科大学附属唐山工人医院影像科 [5]北京市延庆县人民医院内科 [6]安徽省安庆市第二人民医院肾内科

出　　处：《实用放射学杂志》2011年第3期413-417,共5页Journal of Practical Radiology

摘　　要：目的 分析多发肾细胞癌的CT/MR影像特征,提高其诊断及鉴别诊断水平.方法 回顾分析经手术病理证实的9例多发肾细胞癌的CT和MRI征象.结果 9例共发现25个癌灶,乳头状细胞癌2个,透明细胞癌23个（包括以透明癌细胞为主混有少量乳头状癌细胞或颗粒癌细胞4个瘤灶）.6例多发肾癌同一患者多发癌灶间病理类型一致,3例病理类型不同.双肾发病6例,其中同时发病5例,异时发病1例 单肾多发3例.9例行CT检查显示25个病灶,其中6例行MR检查显示16个病灶.CT、MR平扫：CT呈等（5/25）、混杂（13/25）、低（7/25）密度,MR呈T1WI低（12/16）、等（2/16）、混杂（2/16）信号,T2WI高（4/16）、混杂（7/16）、低（5/16）信号.CT、MR增强：CT 17个癌灶（17/25）、MR 9个（9/16）皮髓期明显强化,其中CT 16个（16/25）、MR 9个（9/16）排泄期迅速减退,1个癌灶CT延迟性强化 CT（8/25）、MR（7/16）轻度强化或无强化.5例多发肾癌发生的癌灶呈一致性明显强化 3例强化程度不一致 1例呈一致性轻微强化或不强化.CT（16/25）、MR（11/16）可见假包膜.25个 癌灶中最小直径0.5 cm,最大8.3 cm×4.0 cm×4.5 cm,平均2.9 cm 囊性癌灶2个,癌灶实性为主合并不同比例坏死囊变7个,钙化1个.有4例中的8个病灶出现误诊.结论 多发肾细胞癌在临床中并非罕见,误诊率极高,主要原因是对其认识不足,应引起高度重视.Objective To analyse CT and MR imaging findings of multiple renal cell carcinoma（MRCC） so that to improve the knowledge of this tumor. Methods CT and MR imaging features of MRCC conformed surgically and pathologically in 9 cases were retrospectively analysed. Results 25 carcinomas were found in 9 cases,including 2 papillary cell carcinomas and 23 clear ceil carcinomas which including 4： lesions with clear cell mainly mixed with small amount of granular cells or papillary cells. The MRCCs in 6 patients were in same pathology type and 3 cases were different. The MRCCs occurred bilaterally in 6 cases,occurred simultaneously in 5 cases and heteroehronically in one case,and occurred unilaterally in 3 cases. All cases underwent CT and 5 cases underwent MR imaging examinations. 25 lesions in 9 cases and 16 lesions in 5 cases were detected by CT and MR imaging, respectively. On CT, the lesions showed isodensity in 5, hypodesity in 7, mixed deinsity in 13 ;on MR imaging, the lesions showed hypo-signal intensity（SI） in 12,iso-SI in 2,mixed SI in 2 on T^WI,and showed high SI in 4,mixed SI in 7 and low SI in 5 on T2WI. At contrast-enhanced CT or MR imaging scan, the lesions showed markedly enhanced in the cortical and medullary phase in 17 and 9 respectively, rapidly rush out in excretive phase in 16 and 9 lesions respectively,and 1 lesion showed delayed enhancement with CT,8 and 7 lesions showed slight or non-enhanced respectively with CT and MR scan. The MRCCs in 5 cases were significantly and homogeneously enhanced,inhomogeneously enhanced in 3 patients and slight or no enhanced in 1 case. Pseudocapsule could be seen in 8 and 7 lesions on CT and MR images respectively. Of the all foci,the minimum size was 0.5 cm and maximum was 8.3 cm×4.0 cm×4.5 cm with average of 2.9 cm in diameters. Cystic lesions in 2, mainly solid with cystic degeneration in different degree in 7 and calcification in 1 were detected. 8 lesions in 4 patients were misdiagnosed totally. Conclusion MRCCs are not rare clinically and with high r

关 键 词：肾脏 肾细胞癌 体层摄影术 X线计算机 磁共振成像 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]