肾盂移行上皮癌:螺旋CT诊断

Diagnosis of Transitional Cell Carcinoma of Renal Pelvis in Spiral CT

目的 :探讨肾盂移行上皮癌螺旋CT扫描的影像特征和诊断价值。方法 :经手术病理证实的肾盂移行上皮癌 30例 ,术前均经螺旋CT皮质期和实质期扫描 ,少数加做肾盂期扫描。将CT扫描结果并和手术病理作回顾性对照分析。结果 :在 30例肾盂移行上皮癌中 ,病理结果为 :17例乳头状移行上皮癌 ,13例非乳头状移行上皮癌。在螺旋CT扫描图像上 ,17例乳头状移行上皮癌均有肿块形成 ,13例非乳头状移行上皮癌中的 6例见到肿块 ,其余 7例无明显肿块 ,其中 4例示肾盂壁增厚 ,3例示肾盂和肾窦脂肪浸润消失。皮质期增强扫描仅 2例乳头状移行上皮癌显示明显强化 ,1例局限浸润型移行上皮癌呈中度均匀强化 ,余 2 1例均呈轻 -中度延迟 (实质期 )强化。本组病例中 ,18例因各种原因有程度不等的肾功能下降。所有 30例肾盂癌均无肾轮廓的变化。结论 :螺旋CT双期扫描可提高肾盂移行上皮癌的诊断正确率 ,但更应重视肾实质期的CT扫描。

Objective: To investigate the features of transitional cell carcinoma of renal pelvis in spiral CT scans and evaluate it's clinical value. Methods: All 30 cases with transitional cell carcinoma confirmed by surgical pathology underwent two or three phase spiral CT scanning before operation ,the CT data were reviewed retrospectively in comparison with surgical and pathological results. Results: In 30cases of transitional cell carcinoma,17 cases were diagnosed pathologically as papillary type,13 cases as non-papillary.CT scans showed obvious mass in renal pelvis in all papillary type and 6 of 13 non-papillary type.7 cases of the non-papillary type had no obvious mass seen in the pelvis but with pelvis wall thickening in 4 cases and fatty infiltration or disappearance in pelvis sinus in 3 cases.In 23 cases with mass seen in CT scans,only 2 cases presented inhomogeneous?obvious enhancement in cortical phase , 21 cases demonstrated mild to moderate enhancement in delayed(parenchymal) phase.18 cases had decrease of renal function in different degree. Conclusion: The result suggests that two or three phase SCT scanning is valuable and renal parenchyma phase should be emphased.