肾脏嫌色细胞癌的磁共振表现  

Magnetic resonance imaging findings of Chromophobe renal cell carcinoma

作　　者：王鑫坤[1] 王海屹[1] 王佳[1] 王英伟[1] 王叶[1] 唐业欢[1] 叶慧义[1] 

机构地区：[1]解放军总医院放射科,北京100853

出　　处：《中华医学杂志》2013年第13期1016-1019,共4页National Medical Journal of China

摘　　要：目的观察肾脏嫌色细胞癌（CRCC）的磁共振（MR）表现及不同大小CRCC间的影像特征是否存在差异。方法回顾分析2009年1月至2011年12月在解放军总医院外科手术、病理证实的肾脏嫌色细胞癌患者34例（男16例、女18例，年龄24～61岁，平均49岁），共35个病灶。利用GEAdvantage4．4工作站对病变动态增强扫描（3DLAVA序列）信号强度变化和ADC值进行测定，以及对T1、T2加权、化学位移成像图像分析。根据病变最大径分为≤4cm和〉4cm共2组，用Fisher精确概率统计方法分析2组影像特征的差异，用单因素方差分析2组信号强度变化和ADC的差异。结果35个病灶中含脂肪脂质的0个，T2WI低信号的27个（77．1％），有囊变的4个（11．4％），有出血的4个（11．4％），有坏死（坏死范围〈20％）的5个（14．2％），有假包膜的30个（85．7％），有瘢痕的10个，病灶为类圆形（长宽高相差在0．5cm以内）的29个（82．9％），有侵犯和转移的0个。35个病灶平均信号强度变化为皮质期119．8％，髓质期176．4％，延迟期154．5％，病灶ADC值为（1．08±0．28）×10^-3mm2／s。最大径≤4cm者21例，最大径〉4cm者14例，2组病变之间囊变（分别为0和4例），出血（分别为0和4例），坏死（分别为0和5例），瘢痕（分别为2和8）差异有统计学意义（P〈0．05），而其他征象两组间的差异无统计学意义，两组病变之间的ADC值和信号强度变化差异无统计学意义。结论肾脏嫌色细胞癌的MR特征性主要为T2WI低信号，假包膜明显，肿瘤整体信号较均匀，囊变、坏死和出血少见，肿瘤越大越容易出现瘢痕，轻到中度均匀强化。肿瘤因大小不同MR征象可存在差异。Objective To document the MRI features of Chromophobe cell carcinoma and to explore whether MR features vary with the tumor size. Methods MRI features of 34 patients （ 16 male, 18 female, age range from 24 - 61, average age is 49 years old）, totally 35 focuses with histologically proved chromophobe cell carcinoma were studied retrospectively, All the patients underwent MR plain and dynamic contrast-enhanced scan before their surgery. Variation of signal intensity（3D LAVA） and ADC values of the lesions, and the analysis of images of T1WI, T2WI and chemical shift were all evaluated on the GE Advantage 4. 4 work station. All lesions were categorized into 2 groups （tumor diameter ≤4 cm, or 〉4 cm）. The difference of imaging characteristics between these two groups was analyzed using Fisher exact test. Signal intensity variation and ADC values were analyzed by using one-way ANOVA method. Results None of the 35 cases contained fat or lipid. On T2WI 27 cases showed slightly low signal intensity （77.1%）. In all cases, 4 appeared local cystic change （ 11, 4% ） ; 4 spotty hemorrhage （ 11.4% ） ; 5 necrosis （covering less than 20% of whole tumor） （ 14. 2% ） ; 30 clear pseudo capsule （85.7%） ; 29 round-like lesions （the difference among the length, width and height was within 0. 5 em） （82. 8% ） ; and no eases showed signs of invasiveness or metastasis. The average changes of signal intensity of all the 35 eases were 119. 8% on cortex period, 176. 4% on medulla period and 154. 5% on delayed phase. The mean ADC value of tumor was 1.08 ±0. 28 ×10 ^-3mm2/s. 35 leasions were divided into two groups ,21 in group 1 （diameter≤4 cm） and 14 in group 2（ diameter 〉 4 cm）. Cystic degeneration was seen in 0/21 in group 1 versus 4/14 in group 2 respectively, and hemorrhage 0/21 versus 4/14, necrosis 0/21 versus 5/14 , central scar 2/21 versus 8/14. The difference of these findings between two groups demonstrated statistical significance（P 〈 0. 05 ）. Variation of signal inten

关 键 词：磁共振成像 磁共振成像 弥散 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]