螺旋CT诊断囊性肾癌的价值

Value of spiral CT in diagnosis of cystic renal cell carcinoma

目的探讨囊性肾细胞癌（简称囊性肾癌）的螺旋CT（SCT）表现和诊断价值。方法对17例经手术病理证实为囊性肾癌患者的SCT图像进行回顾性分析。患者临床表现无特殊，6例偶有腰痛，2例有腹痛，2例发现过肉眼血尿。17例中，9例为体检时B超发现肾脏囊性占位病变，进一步做SCT检查而发现；8例为随访肾囊肿时发现。使用Siemens Somatom plus单层螺旋CT或Siemens Sensation 16层螺旋CT，先行常规平扫，再行增强扫描。增强扫描使用非离子对比剂80—100ml，经前臂静脉用压力注射器给药，注射流率为2—3ml／s。分别于注射对比剂后30—40s时开始动脉（皮质）期扫描，60-70S时开始静脉（髓质、实质）期扫描，120—180s时再行排泄（肾盂）期扫描。原始扫描数据传送至Siemens Volume Wizard工作站，进行各种图像重建及后处理。结果病灶位于右肾5例，位于左肾12例。病变通常为圆形、类圆形囊性密度肿块，边缘光整；直径2．1—10cm，平均5．7cm。其中病变直径〉5cm者15例，占88．2％。病灶属单房者10例，多房者7例。多房者囊内可见1—5条分隔，SCT显示囊壁和间隔多数厚薄均匀（1—2mm），增强扫描可见轻度强化，其中2例可见附壁小结节。平扫时，囊液CT值近于水或略高，其中1例为均匀血液密度（48HU）；增强扫描时，囊液均不强化。本组病例少见侵袭性生长，3例可见局部浸润；未见有淋巴结转移者。仅1例于术后5年死于肺转移癌。结论囊性肾癌生物学行为较好，影像学表现相对有特征性，SCT可作为术前诊断的手段。

Objective To investigate the image features and the diagnostic value of spiral CT for cystic renal cell carcinoma. Methods The clinical data and CT manifestations of 17 operated and pathologically proven cystic renal cell carcinoma were retrospectively analyzed. There were 12 males and 5 females with an average age of 47.3 years （ 33-82 years ）. Plain and contrast CT scan （Siemens somatom） single layer sensation 16 layer spiral CT had been performed before operation. The image of artery phase（30- 40 s） ,venous （60-70 s） and excretory （ 120-180 s） were respectively obtained after contrast administration. Various image reconstructions were done using Siemens Wizard workstation based on the raw images. Results It was found that 5 cystic renal cell cancers located in the right kidney and 12 in the left kidney. The long dimension of the tumor arranged from 21-100 mm with an average of 57 mm. The tumor looked like a round or round-like shape with density similar to fluid on plain CT scan. Some cystic renal carcinomas had a thick wall. Some had single or multiple cystic spaces filled with fluid of different densities. Some had infiltrated out of kidney surface or into renal sinus. Some showed enhanced nodules on the wall. Conclusion Cystic renal cell carcinoma has its own specific morphologic features in spiral CT scan. Spiral CT may be very helpful in the diagnosis of cystic renal cell carcinoma before operation.