肾细胞癌的CT影像特点及病理分型

CT Features and Pathological Typing of Renal Cell Carcinoma

目的结合病理分型分析肾细胞癌的CT影像特点以提高诊断的准确率.方法收集昆明医科大学第二附属医院手术病理证实的36肾细胞癌,术前均做CT检查(平扫、动态增强扫描),回顾性分析CT影像特点并与病理结果对照.结果 25例透明细胞癌,1例颗粒细胞癌,2例多房囊性肾细胞癌,4例乳头状癌,3例嫌色细胞癌,1例集合管癌.新的病理分型将颗粒细胞癌和多房囊性肾细胞癌均归入透明细胞癌,此类型血供丰富,增强扫描后明显强化;而乳头状癌和嫌色细胞癌相血供相对较少,强化程度低于透明细胞癌.结论各型肾细胞癌的CT影像表现的特异性不强,最终分型仍依靠病理,仔细分析肾癌的CT影像特点与病理之间的关系有助于诊断和鉴别诊断.

Objective To analyze the features of CT image combined with the pathological types of renal cell carcinoma to improve the diagnostic accuracy.Methods 36 patients with pathologically confirmed renal cell carcinoma were enrolled in this study.The preoperative CT scan(unenhanced and dynamic contrast enhanced CT)was performed in all patients.The CT imaging characteristics and pathological findings were retrospectively analyzed.Results There were 25 cases of clear cell carcinoma,1 case of granular cell carcinoma,2 cases of multilocular cell carcinoma,4 cases of papillary renal carcinoma,3 cases of chromophobe cell carcinoma and 1 case of collecting duct carcinoma.Granular cell carcinoma and multilocular cell carcinoma were both classified as clear cell carcinoma in new pathological typing.With rich blood vessel,this subtype showed dramatic enhancement on CT image and simple cystic degeneration was the characteristic.While granular cell carcinoma and chromophobe cell carcinoma was relatively with poor blood vessel and the degree of enhancement was lower than clear cell carcinoma.Conclusions The CT features in every subtype of renal cell carcinoma show no obvious specificity and the pathology is still the base of confirmed diagnosis.Careful analysis of the relationship between the CT imaging features and pathology of renal cell carcinoma contributes to the diagnosis and differential diagnosis.