乏脂肪肾血管平滑肌脂肪瘤与肾透明细胞癌的CT鉴别诊断  

CT differential diagnosis of fat-poor angiomyolipoma and clear cell renal carcinoma

作　　者：张亚琴 朱俊颖[2] 侯永和 方友强[4] 

机构地区：[1]中山大学附属第五医院放射科,珠海519000 [2]中山大学附属第三医院放射科,广州510630 [3]广州视源健康管理中心,510530 [4]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2017年第5期46-50,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：珠海市医疗卫生科技计划项目(20171009E030011);广州市科技计划项目产学研协同创新重大专项(201704020052)

摘　　要：目的探讨CT平扫及动态增强扫描在肾血管平滑肌脂肪瘤与肾透明细胞癌鉴别诊断中的临床应用价值。方法回顾性搜集CT误诊为肾癌的肾血管平滑肌脂肪瘤(AML)16例及肾透明细胞癌(ccRCC)30例患者的CT平扫及动态增强扫描资料,由2名影像医师分别独立评价肿瘤形态特征如有无钙化、假包膜、劈裂征、喙征;测量乏脂肪肾血管平滑肌脂肪瘤(fpAML)和(ccRCC)CT平扫及增强扫描各期的CT值、计算强化指数,进行独立样本t检验。结果平扫fpAML肿瘤CT值为(44±9)Hu,ccRCC平扫CT值为(31±4)Hu,差异有统计学意义(P<0.05),增强扫描各期CT值两者间差异无统计学意义(P>0.05)。fpAML与ccRCC皮质期、实质期、排泄期强化指数比较,差异有统计学意义(P<0.05)。实质期fpAML75%强化较为均匀一致,而ccRCC组93.3%表现为强化不均匀。结论 fpAML平扫CT值明显高于ccRCC,增强扫描fpAML在皮质期、实质期和排泄期强化程度均低于ccRCC,实质期fpAML强化较为均匀一致,ccRCC强化不均匀。这三点是fpAML与ccRCC重要的CT鉴别诊断要点。Objective To evaluate the clinical value of CT plain scan and dynamic contrast enhanced scan in the differential diagnosis of renal angiomyolipoma and renal clear cell carcinoma. Methods CT scan and dynamic enhancement scan data were collected from 30 patients with renal clear cell carcinoma（ccRCC） and 16 cases of renal angiomyolipoma which were misdiagnosed as RCC. Two radiologists retrospectively evaluated the morphological features（i.e. split sign, beak sign, with or without pseudocapsule and calcification） and enhancement features（i.e.CT value of ROI in each phase, the enhancement index of each phase. For the parameters that had statisticall differences between the two groups, we calculated the P values by using the independent sample t test. Results The CT value of fpAML tumor was（44±9） Hu, and the CT value of renal clear cell carcinoma was（31±4） Hu（P0.05）.The enhancement index of fpAML was less than ccRCC in cortical phase, nephrographic phase and excretory phase（P0.05）. In nephrographic phase,75% of fpAML showed a homogeneous enhancement, while 93.3% of ccRCC showed heterogeneous enhancement. Conclusion In this study, we confirmed common imaging features of fpAML are different with ccRCC：higher attenuation on unenhanced CT sequences;less enhancement on enhanced phases,more uniform enhancement in nephrographic phase.

关 键 词：血管平滑肌脂肪瘤 肾透明细胞癌 计算机体层摄影术 

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