黄色肉芽肿性肾盂肾炎与囊实性肾盂鳞状细胞癌的CT鉴别诊断  

CT Differential Diagnosis of Xanthogranulomatous Pyelonephritis and Solid-Cystic Squamous Cell Carcinoma of Renal Pelvis

作　　者：黄晶晶[1] 袁阳光[1] 韩丽莹 喻晴[1] 梁文[1] HUANG Jingjing;YUAN Yangguang;HAN Liying(Department of Radiology,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,P. R. China)

机构地区：[1]南方医科大学珠江医院放射科

出　　处：《临床放射学杂志》2018年第11期1883-1887,共5页Journal of Clinical Radiology

摘　　要：目的探讨黄色肉芽肿性肾盂肾炎(XGP)与肾盂鳞状细胞癌(SCC)CT征象的差异。方法回顾性分析经手术病理证实的8例XGP和10例SCC患者的CT表现,对XGP和SCC的部分CT征象进行统计学分析。结果18例均表现为全肾或者局部囊实性肿块。8例XGP最厚分隔为2.4~16.1mm,△Dmax为0.9~6.6mm,△Dmin为0.1~1.3mm,分隔大多均匀强化均匀、光滑,动态增强ΔCT实质期-皮质期为18~42HU,XGP淋巴结短径为7~16mm、均匀强化,肾盂壁厚度均匀,无肾静脉充盈缺损,多数病灶囊腔与肾盂不相通且伴肾盂结石。10例SCC最厚分隔为7.4~25.0mm,△Dmax为1.5~13.2mm,△Dmin为0.4~8.2mm,分隔多不光滑、强化不均匀,动态增强ΔCT实质期-皮质期为-7~48HU,淋巴结短径为9~29mm且半数病例不均匀强化,6例肾盂壁厚度不均匀,9例病灶囊腔与肾盂相通,仅1例出现肾盂结石,6例出现肾静脉充盈缺损。XGP和SCC在病灶的Dmax、△Dmax、△Dmin、ΔCT实质期-皮质期、淋巴结短径存在统计学差异(P<0.05)。另外,XGP和SCC在分隔强化是否均匀、分隔边缘、结石分布、囊腔是否与肾盂相沟通、肾静脉充盈缺损、肾盂壁厚度是否均匀及淋巴结的强化亦存在统计学差异(P<0.05)。结论XGP与SCC存在一些相似的CT表现,但仍可通过分析二者不同的CT特征,提高早期诊断及鉴别诊断的准确率。Objective To investigate the differences between the CT features of xanthogranulomatous pyelonephritis( XGP) and squamous cell carcinoma of renal pelvis ( SCC) . Methods The CT findings of 8 XGP cases and 10 SCC ca-ses confirmed by pathology were analyzed retrospectively. Fisher's exact-test and independent-samples T-test were applied toanalyze some of the CT features of XGP and SCC lessions. Results Solid-cystic masses could be found in the whole kid-neys or part of kidneys in 18 cases. Dmax( defined as the thickness of thickest partitions) in the 8 XGP cases ranged from2. 4 mm to 16. 1 mm,and △D max ( define as the differences between the thickest part and the thinnest part of the thicknesspartition) ranged from 0. 9 mm to 6. 6 mm. △D min ( define as the differences between the thickest part and the thinnest partof the thinnest partition) ranged from 0. 1 mm to 1. 3 mm. The partitions were smooth and mostly homogeneously enhancedand dynamic enhancement showed △CT parenchymal phase-cortical phase ( define as the CT value in parenchymal phase subtracting theCT value in cortical phase) ranging from 18 HU to 42 HU. Lymph nodes were homogeneously enhanced with small diameterof 7 -16 mm. The wall of renal pelvis in all XGP patients displayed uniformity. There were no renal vein filling defect in anycase of XGP. Renal pelvises in most XGP cases appeared stones and were not interlinked with the cavites of the lession. In10 SCC cases,Dmax arranged from 7. 4 mm to 25. 0 mm,△D max from 1. 5 mm to 13. 2 mm,and △D min from 0. 4 mm to 8.2mm. The partitions were rough and inhomogeneously enhanced and dynamic enhancement showed △CT parenchymal phase-cortical phaseranging from -7 HU to 48 HU. Lymph nodes in 4 SCC cases were inhomogeneously enhanced with small diameter of 9 -29mm. The wall of renal pelvis in 6 SCC cases were nonuniform. Renal vein filling defect were showed in 6 SCC cases. Renalpelvises in 9 cases were interlinked with the cavites of the lession . Only 1 case possessed renal pelvic stones. Dmax,△D

关 键 词：黄色肉芽肿性肾盂肾炎 肾盂鳞状细胞癌 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R730.44[医药卫生—肿瘤] R737.11[医药卫生—临床医学] R692.7