肾细胞癌的不典型CT、MRI表现

Atypical CT and MRI findings of renal cell carcinoma

目的 分析肾细胞癌 (RCC)的不典型CT、MRI表现 ,探讨如何提高CT、MRI对RCC的诊断正确率。 方法 回顾分析 10 0例经手术、病理证实的RCC。男 71例 ,女 2 9例。年龄 2 9～ 75岁 ,平均5 5岁。其中透明细胞癌 82例、混合细胞癌 8例、颗粒细胞癌 5例、乳头状癌 4例、肉瘤样肾细胞癌 1例。共 10 1个瘤灶 ,最大径为 0 .8～ 9.0cm ,平均 4 .3cm。总结RCC的典型CT、MRI表现 ,统计不典型CT、MRI表现的RCC病例 ,并与手术、病理结果对照。 结果 17例RCC在CT、MRI上呈不典型表现 ,分为四类 :少血供RCC :12例 ,其中透明细胞癌 3例、混合细胞癌 1例、颗粒细胞癌 5例、乳头状癌 3例 ;囊性RCC :3例 ,均为透明细胞癌 ;RCC合并大片出血 :1例 ,为乳头状癌 ;直径 <1cm的RCC :1例 ,为透明细胞癌。 结论 正确认识少血供及囊性RCC的CT、MRI表现 ,采用适当的扫描方法及仔细阅片有助于提高对RCC的诊断正确率。

Objective To analyze the atypical CT and MRI findings of renal cell carcinoma (RCC) and to discuss how to improve the diagnostic accuracy of RCC using CT and MRI. Methods The data of 100 cases of RCC (71 males and 29 females;age range from 29 to 75 years with a mean of 55 years) were reviewed.The surgical and pathological findings showed clear cell carcinoma in 82 cases,mixed cell carcinoma in 8,granular cell carcinoma in 5,papillary RCC in 4 and sarcomatoid RCC in 1.A total of 101 masses were found.The masses were 0.8 to 9.0 cm (mean,4.3 cm) in greatest dimension. According to the CT and MRI findings of most cases in this group and the relevant information in literature,the typical CT and MRI findings of RCC were summarized. The atypical CT and MRI findings of RCC were analyzed,and correlated with surgical and pathological findings. Results There were 17 cases presenting with atypical CT and MRI findings.The atypical CT and MRI findings of RCC were divided into 4 types:① hypovascular RCC (12 cases,including 3 of clear cell carcinoma, 1 of mixed cell carcinoma, 5 of granular cell carcinoma and 3 of papillary RCC);②cystic RCC (3 cases of clear cell carcinoma);③RCC with volumes of hemorrhage (1 case of papillary RCC);④tumor's diameter less than 1㎝ (1 case of clear cell carcinoma). Conclusions Correct evaluation of the CT/MRI findings of hypovascular and cystic RCC,application of adequate scanning methods and careful interpretation of the imaging films are helpful for improving diagnostic accuracy of RCC.