Ⅰ型和Ⅱ型乳头状肾细胞癌的影像学表现及其差异  

Imaging performance and differences of type Ⅰ and type Ⅱ papillary renal cell carcinoma

作　　者：戴辰晨[1,2,3] 丁玉芹[1,2,3] 曹颖丽[1,2,3] 周建军[1,2,3] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]上海市影像医学研究所,上海200032 [3]复旦大学上海医学院影像医学系,上海200032

出　　处：《复旦学报（医学版）》2017年第3期294-299,共6页Fudan University Journal of Medical Sciences

基　　金：上海市自然科学基金(14ZR1438400)~~

摘　　要：目的探讨Ⅰ型和Ⅱ型乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)的影像学表现及其差异。方法回顾性分析经手术病理证实的47例PRCC患者资料,其中Ⅰ型21个病灶,Ⅱ型27个病灶(1例患者左肾含2个病灶)。所有患者术前均行肾脏CT或MRI平扫及动态增强检查。对PRCC的形态学特征、肿瘤外侵征象、增强CT表现进行定性和定量分析。采用独立样本t检验对病灶最大径、三期CT值及皮髓交界期△CT、实质期△CT进行比较,采用Pearsonχ~2检验或Fisher确切概率法对分类变量进行比较。结果一般形态学上,Ⅱ型PRCC平均最大径大于Ⅰ型(t=-2.604,P=0.013),密度/信号更不均匀(χ~2=14.928,P=0.000),更易出现囊变或坏死(χ~2=5.598,P=0.018),且程度更明显(χ~2=4.769,P=0.029);在CT图像上,两型之间出血和钙化征象的差异均无统计学意义。分别有66.7%Ⅱ型PRCC和23.8%Ⅰ型PRCC出现乳头结节,两型之间的差异有显著统计学意义(χ~2=8.694,P=0.003)。在肿瘤外侵表现方面,除边界征象外,Ⅱ型较Ⅰ型PRCC更易发生肾周脂肪侵犯、肾窦侵犯及转移(P<0.05)。在增强CT表现方面,两型在皮髓交界期CT值、皮髓交界期△CT的差异均有统计学意义(t=-2.674,P=0.012;t=-3.109,P=0.005),而在平扫期CT值、实质期CT值、实质期△CT上的差异均无统计学意义。结论Ⅰ型和Ⅱ型PRCC在形态学特征、肿瘤外侵征象及强化程度上有一定差异,部分Ⅱ型肿瘤具有侵袭性生物学行为,预后更差。Objective To identify the imaging performance and differences between type I and type II papillary renal cell carcinoma （PRCC）. Methods Data of 21 lesions of type I ,27 lesions of type （1 patient had 2 lesions） in 47 patients was retrospectively analyxed. All patients with pathologically proven PRCC were examined by contrast CT or MRI preoperatively. The morphological features, outside invasion signs and performance on contrast-enhanced CT were compared by qualitative and quantitative studies. The maximum diameter of tumors and CT values, △CT values in corticomedullary and nephrographic phase were analyzed by two-sample t-test, classified variable were compared by the Pearson χ2 test or the Fisher exact test. Results On morphological behaviors , type II PRCC weresignificantly larger than type I PRCC （t= - 2,604,P = 0. 013） ,more heterogeneous （χ2= 14. 928,P= 0. 000）, greater probability to show cysnc degeneration or necrosis （χ2 = 5. 598, P = 0. 018） with more severity （χ2 = 4. 769, P = 0. 029）. There was no significant difference in hemorrhage and calcification between the two types observed by contrast-enhanced CT. Respectively,66. 7 % of type II PRCC and 23.8% of type I PRCC had papillary nodule, with obviously significant difference （χ2= 8.694,P= 0. 003）. In outside invasion signs, except for margins, type II had more easily invaded peripheral fat, renal sinus and distant metastasis compared with type I （P〈0. 05）. On contrast- enhanced CT, there were significant differences in CT values and △CT values in corticomedullary phase between the two types （t = - 2.674, P = 0.012;t = - 3. 109, P = 0.005）. And there were no significant difference in unenhanced and nephrographic phase. Conclusions There were certain difference in morphological features,outside invasion signs and enhancement degree between type I and type II PRCC,and part of type II PRCC had aggressive biological behaviors with worse prognosis.

关 键 词：肾肿瘤 乳头状肾细胞癌 鉴别诊断 断层摄影术 X线计算机 

分 类 号：R737.11[医药卫生—肿瘤] R445.3[医药卫生—临床医学]