不同类型浸润性肾盂癌:MDCT动态增强表现及误诊分析  

Different Types of Invasive Renal Pelvic Carcinoma:MDCT Dynamic Enhancement Performance and Misdiagnosis Analysis

作　　者：姚婧[1] 周建军[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海市影像医学研究所,复旦大学上海医学院影像学系,上海200032

出　　处：《临床放射学杂志》2017年第4期526-530,共5页Journal of Clinical Radiology

摘　　要：目的分析浸润性肾盂癌的CT增强表现,旨在提高诊断正确率。方法回顾性分析经病理证实的20例浸润性肾盂癌的CT影像表现特点,术前均行多排螺旋CT及CTU扫描。根据影像学图像上肾盂内肿块形态及肾实质浸润程度将本组病例分为Ⅰ型:肿块浸润型,肾盂内明显肿块,病变隆起高度≥横径,肾窦脂肪受侵,伴或不伴肾实质浸润;Ⅱ型:浅表浸润型,肾盂内扁平型肿块,病变隆起高度<横径,肾窦脂肪消失,肾实质受侵,扁平的肾盂肿块、增厚肾盂壁及肾实质融合;Ⅲ型:深部浸润型,向肾盂外浸润生长,肾盂内无明显肿块,增厚的肾盂壁、肿块及肾实质融合,常伴肿大淋巴结、邻近血管及输尿管受侵。结果 20例中,16例术前诊断为肾盂癌,2例误诊为肾癌,1例误诊为急性肾盂肾炎,尚有1例误诊为集合管癌,经病理诊断全部为浸润性肾盂癌。Ⅰ型4例,Ⅱ型4例,Ⅲ型12例。结论浸润性肾盂癌不仅仅是肾盂内肿块伴肾窦脂肪和肾实质浸润,部分肿瘤、肾盂、肾实质融合,部分肿瘤肾盂外浸润明显而肾盂壁增厚相对不显著。认识浸润性肾盂癌不同表现有助于提高诊断准确性。Objective Analyzing the enhanced CT features of invasive carcinoma of the renal pelvis with the aim of improving diagnostic accuracy. Methods 20 cases of CT manifestations of invasive carcinoma of renal pelvis which was confinned by surgical excision and pathology examination were analyzed retrospectively, having received MDCT or CTU scanning preoperatively. According to the radiographic images of the tumor in the renal pelvis and the degree of infiltration of the renal parenchyma, these cases were divided into type Ⅰ： infiltrating tumor type, apparent mass of the renal pelvis can be seen, lesions bulge height （H） ≥transverse diameter （L）, renal sinus fat was invaded, with or without infiltration of the renal parenchyma; Type Ⅱ ： superficial infiltration type, the flat mass in renal pelvis, lesions bulge height （ H ） 〈 transverse diameter （L）, disappeared renal sinus fat, with infiltrated renal parenchyma , additionally, a fiat pelvic mass, thickened wall of the renal pelvis and renal parenchyma mixed together;Type m ：deep infiltration, spread outside of the renal pelvis, no obvious mass in the renal pelvis, thickened wall of the renal pelvis,mass and renal parenchyma were fused, usually with enlarged lymph nodes, invasion of blood vessels and adjacent ureter. Results In these 20 cases, 16 were di- agnosed with renal pelvis carcinoma, 1 case was wrongly diagnosed as renal carcinoma, l was misdiagnosed as acute pyelo-nephritis and 1 was collecting tubule carcinoma. All of them were finally diagnosed as invasive carcinoma of renal pelvis by surgical excision and pathology examination. Type Ⅰ was 4 cases, Ⅱ was 4 and Ⅲ was 12. Conclusion The diagnosis of invasive carcinoma of the renal pelvis is not only according to the renal pelvic mass or the infiltrated renal sinus fat and re- nal parenchyma, sometimes the mass, renal pelvis and renal parencbyma in combination, and sometimes the infiltration out-side the renal pelvis is very obvious, however, the thickened wall of renal pelvis

关 键 词：肾肿瘤 肾盂癌 

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