肾占位性病变的CT鉴别诊断

Computed tomographic differential diagnosis of renal massive lesions

目的 :分析肾占位性病变的CT表现 ,探讨CT对该类疾病的鉴别诊断价值。方法 :对手术 /病例证实的 2 8例肾占位性病变进行回顾性分析 ,所有病例均行平扫和增强扫描。结果 :肾恶性肿瘤 2 1例 (75 % ) ,其中肾癌 (RCC) 16例 ,CT表现为肾实质内形态不规则的低密度软组织肿块 ,增强后不强化或轻度强化 ;肾盂癌 2例 ,CT表现为肾盂内软组织肿块影 ,增强后不强化或轻度强化。肾母细胞瘤 (Wilms瘤 ) 3例 ,CT表现为较大不规则的分叶肿块 ,增强后不强化 ;肾良性肿瘤 3例 (11% ) ,均为肾血管平滑肌脂肪瘤 (ALL) ,2两例CT表现为多种不同成分的混杂密度肿块 ,1例表现为均匀等密度肿块 ,增强后软组织部分强化 ,而脂肪成分不强化。其它 4例 (14 % ) ,3例肾囊肿 ,CT表现为典型的边界清楚的囊性病灶 ,增强后未见强化 ;1例肾脓肿 ,CT表现为实质性与囊性混杂密度的肿块 ,增强后实质性部分有轻度强化 ,囊性部分不强化。结论 :CT平扫及增强扫描 ,以及诊断过程中密切结合病史 。

Objective:To analyse the CT findings of renal massive lesions and to investigate the value of CT imaging in differential diagnosis of these diseases.Methods:28 cases of renal massive lesions,had teen proven surgically and pathlogically, were retrospectively analysed. Pre- and post- contrast CT scans were performed in all the cases.Results:21 of 28 cases (75%) were malignant tumors with 16 cases of renal cell carcinoma (RCC) showing as irregular-shaped low density soft tissue mass with no or slight enhancement.2 of 21 cases were carcinoma of the renal pelvis showing as soft tissue mass in renal pelvis with no or slight enhancement.3 of 21 cases were nephroblastoma (Wilms' tumor) appearing as larger irregular lobulated mass with no enhancement. 3 of 28 cases (11%) of benign tumors were angioleiomyolipoma (ALL). Two cases show a mixed density mass while another case shows isodensity mass. The soft tissue part of the tumor showed enhancement while the area of fat didn't show any enhancement with the contrast medium. 4 of 28 (14%) with 3 cases of renal cysts showing as classic cystic lesions with clear-margin. No enhancement was found.1 of 4 cases was renal abscess appearing as a mixed density mass of soft tissue and cyst with slight enhancement of soft tussue part while no enhancement of cystic part.Conclusion:Pre-and post-contrast CT scans and history play an important roles in diagnosis of renal massive lesions.