多层CT对肾细胞癌术前分期的应用价值  

The role of multi-slice spiral CT in preoperative staging of renal cell carcinoma

作　　者：孙志强[1] 黄文才[1] 阳昱恒[1] 宋佳[1] 赵林[1] 曾晓华[1] 陈信坚[1] 

机构地区：[1]广州军区武汉总医院放射影像科,湖北武汉430070

出　　处：《实用放射学杂志》2012年第11期1725-1727,1737,共4页Journal of Practical Radiology

摘　　要：目的评价多层CT（MsCT）对肾细胞癌（RCC）进行术前肿瘤TNM分期的准确性。方法回顾性分析38例RCC患者的术前CT图像并按TNM分期标准进行肿瘤分期，应用Kappa（k）检验比较MSCT与手术一病理分期结果的一致性。结果MSCT对RCC的肿瘤（T）分期与手术病理结果具有很好的一致性（k=0．867），而在RCC的淋巴结（N）分期中的一致性一般（k=0．404）。肿塘（T）分期中，MSCT准确评价了32例RCC（占84．2％），另外5例肿瘤（占13．2％）被高估，1例（占2．6％）被低估。MSCT准确评价了所有（7例）下腔静脉瘤栓。淋巴结（N）分期中，MSCT准确评价了28例RCC（占73．7％）淋巴结受累状况，但有8例患者。（占21．1％）淋巴结受累被高估，2例患者（占5．3％）被低估。对于肝脏和毗邻腹腔脏器转移瘤的检查，MSCT和术中超声检查具有非常好的一致性（k=1）。结论多层CT结合三维重建后处理技术能显示肿瘤范围、静脉内瘤栓、区域性淋巴结及远处器官转移，从而有助于RCC术前分期。Objective To evaluate the accuracy of multi-slice spiral computed tomography （MSCT） for preoperative staging of renal cell carcinoma （RCC）. Methods Preoperative MSCT of 38 patients with RCC were retrospectively reviewed for tumor staging according to TNM staging system. Agreement between MSCT and the histopathological staging results was evaluated using the kap- pa （k） statistic. Results Consistency between MSCT and histopathologic staging was excellent for T staging （k=0. 867） and fair for N staging （k=0. 404）. 32 of 38 tumors （84.2%） were correctly evaluated by MDCT, but five （13.2%） were overstaged and one （2.6%） understaged. Thrombus in inferior veno cava （IVC） was correctly evaluated by MSCT in all 7 patients. Nodal involvement was correctly staged in 28 of 38 patients （73.7 %）, but was overstaged in 8 （21.1%） and understaged in 2 （5.3 %）. With regard to the detection of metastatic tumor of liver and other adjacent organs, consistency between the results of MSCT and intraoperative ultrasonography was excellent. Conclusion With the ability to well demonstrate tumor extension, IVC thrombus, nodal involvement and metastasis, MSCT combined with 3D post-possession techniques is a valuable method for preoperative staging of RCC.

关 键 词：肾细胞癌 肿瘤分期 计算机体层成像 

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