增强CT扫描可鉴别诊断少见肾细胞癌亚型  

Enhanced CT scan can identify rare renal cell carcinoma subtypes

作　　者：李珂 李彦锋 江军 张军 黄灶明 童大力 LI Ke;LI Yanfeng;JIANG Jun;ZHANG Jun;HUANG Zaoming;TONG Dali(Department of Urology,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院泌尿外科,重庆400042

出　　处：《分子影像学杂志》2020年第3期415-421,共7页Journal of Molecular Imaging

摘　　要：目的探讨多层螺旋增强CT扫描在鉴别诊断少见肾细胞癌病理亚型中的作用。方法回顾性分析我院经术后病理确诊的60例少见肾细胞癌(RCCs)临床资料,其中乳头状癌(PRCC)Ⅰ型15例,PRCCⅡ型16例,嫌色细胞癌(ChRCC)16例,其他罕见RCCs 13例。RCC患者均行增强CT扫描,比较分析4组亚型间的CT影像学特征,以及增强后各亚型肿瘤各期CT值与腹主动脉CT值的比值。结果 4组亚型在边缘是否光滑和肾门及腹膜后有无淋巴结肿大等指标上差异有统计学意义(P<0.05)。其他少见肾细胞癌边缘光滑率为53.8%,低于PRCCⅠ型(86.7%)、PRCCⅡ型(75.0%)和ChRCC(100.0%)(P<0.05);PRCCⅡ型和其他少见类型组肾门及腹膜后淋巴结肿大率分别为37.5%、53.8%,高于PRCCⅠ型(13.3%)和ChRCC(12.5%)(P<0.05)。实质期肿瘤CT值在4组间的差异有统计学意义(P<0.05);PRCCⅡ型三期增强的肿瘤CT值均小于PRCCⅠ型;ChRCC肿瘤CT值除在排泄期较低外,其余三期均高于其他3组。肿瘤与腹主动脉血管CT值比值在4组间两两比较,实质期PRCCⅡ型与ChRCC、其他少见类型组比较,差异有统计学意义(P<0.05)。结论增强CT可对不同RCCs亚型进行初步鉴别,对RCCs的术前诊断有一定的参考价值。Objective To investigate the value of multislice computed tomography enhanced scan in the differential diagnosis of rare subtypes of renal cell carcinoma. Methods We retrospectively collected the data of rare renal cell carcinoma(RCCs),diagnosed by pathology in our hospital, including 15 cases of papillary carcinoma(PRCC) type I, 16 cases of PRCC type II, 16 cases of chromocytic cell carcinoma(ChRCC), and 13 cases of other rare RCCs. All the patients with RCC underwent examination of enhanced CT, using GE LightSpeed VCT. The CT imaging characteristics of each subtype and the ratio of CT value of each phase to that of abdominal aorta were compared and analyzed. Results There were significant differences among four groups on whether the margin was smooth and whether there was lymph node enlargement in the hilum and retroperitoneum. The margin smooth rate of other rare renal cell carcinoma was only 53.8%, which was significantly lower than that of PRCC type I(86.7%), PRCC type II(75.0%) and CHRCC(100.0%)(P<0.05). The occurrence rates of hilar and retroperitoneal lymph node enlargement in PRCC type II and other rare types were 37.5% and 53.8%, respectively, which were significantly higher than those in PRCC type I(13.3%) and CHRCC type(12.5%)(P<0.05).The difference of CT value of solid tumors among the four groups was significant(P<0.05). The tumor CT value of enhanced three phases in PRCC type II was lower than that in PRCC type I. The CT value in ChRCC tumors was obviously lower in excretion phase, but significantly higher in the rest three phases than those of the other three groups. The ratio of PRCC type II in parenchymal phase was significantly different from those in ChRCC and other rare types(P<0.05). Conclusion Enhanced CT can be used for the initial identification of different RCCs subtypes. It is helpful in the preoperative diagnosis of RCCs.

关 键 词：肾细胞癌 亚型 多层螺旋增强CT扫描 

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