能谱CT技术及MRI在少脂肪肾错构瘤与早期肾癌的鉴别诊断分析  

Energy spectrum CT and MRI in differential diagnosis of low adipose kidney hamartoma and early kidney cancer

作　　者：黄科峰[1] 伍晓刚[1] 宋君[1] 周保成[1] 黄华[1] 方晓熠[1] 周鹏[1] 甘红波[1] 

机构地区：[1]解放军第四七七医院放射科,湖北襄阳441000

出　　处：《临床军医杂志》2015年第5期516-518,520,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨少脂肪肾错构瘤（RAML）与肾透明细胞癌（ccRCC）能谱CT技术及MRI检查的影像特征。方法对经手术病理证实的少脂肪RAML（17例）和ccRCC（28例）共45例患者的影像学资料进行回顾性比较分析。结果少脂肪RAML患者17例,CT平扫12例呈稍高密度,3例呈等密度,2例呈混杂低密度,5例T2WI均呈均匀低信号,T1呈等信号;17例均强化较均匀,14例呈持续强化,3例呈＂快进快出＂强化方式。ccRCC患者28例,CT平扫14例低密度,8例呈等密度,6例呈混杂低密度;6例T2WI均呈混杂稍高信号,3例有假包膜;25例呈不均匀强化,呈＂快进快出＂强化方式,3例呈持续强化。能谱CT技术分析：17例少脂肪RAML中,10例平扫脂（水）密度图病灶呈稍高密度,水（脂）密度图呈稍低密度,平扫70 Kev ROI图的能谱曲线呈直线型,与脂肪标准曲线有一定不同,直方图显示大部分CT值位于30~40 HU,但仍有一小部分CT值在0 HU以下,三期增强能谱曲线呈衰减型,皮质期及实质期其曲线形态一致。28例ccRCC患者均未见RAML类似征象。结论能谱CT技术分析对少脂肪RAML诊断具有一定的特征性,结合MRI检查,可明显提高对少脂肪RAML及ccRCC的鉴别诊断价值。Objective To explore the imaging characteristics of low adipose kidney hamartoma [renal angiomyolipoma（ RAML） ]and clear-cell renal cell carcinoma（ ccRCC）,so as to improve preoperative diagnosis accuracy and provide valuable information to clinical treatment. Methods Totally 45 cases of imaging data including RAML（ n = 17） and ccRCC（ n = 28） confirmed by surgery were retrospectively analyzed. Results In the 17 cases of low adipose RAML CT plain scan,12 showed slightly high density,3 showed equidensity,2 showed mixed low density and 5 showed uniformly low signal of T2 WI and equisignal of T1. All the 17 cases appeared uniform intensity,14 of which appeared continuously increasing intensity,and 3 of which appeared＂fast in and fast out＂intensity. In the 28 cases of ccRC plain scan,14 appeared low density,8 appeared equidensity,and 6 appeared mixing low density; 6 appeared mixed slight continuously increasing intensity of T2 WI,3 appeared pseudocapsule; 25 appeared uneven intensity and＂fast in and fast out＂,3 appeared continuously increasing intensity. As for energy spectrum CT for the 17 cases of low adipose RAML,10 cases＇ plain scan adipose（ water） density graphs appeared slightly high density in lesion,and slightly low density in adipose（ water）; plain scan70 Kev ROT graph＇s energy spectrum appeared to be linear type which was different from adipose standard curve. Column diagram majority CT values appeared between 30-40 HU,but a few of values were less than 0 HU; phase-3 enhanced energy spectrum graph appeared a reducing trend; cortical period and substance period had the same pattern of graph tracings. Conclusion Energy spectrum CT plain scan and dynamic intensity shows feature on low adipose RAML diagnosis. In combination with MRI,it may obviously improve diagnosis of low adipose kidney hamartoma and early phase kidney cancer.

关 键 词：少脂肪 肾错构瘤 早期肾癌 X线计算机断层扫描 能谱技术分析 磁共振成像 

分 类 号：R737.11[医药卫生—肿瘤]