原发性输尿管癌的螺旋CT表现与病理对照分析

Primary ureteral carcinoma:comparison of CT findings with pathology

目的:探讨原发性输尿管癌的病变特点及螺旋CT在其诊断中的价值。材料与方法:分析16例输尿管癌的螺旋CT影像表现,并与病理组织学诊断、分期对照分析。结果:癌灶沿输尿管横径1.0￣2.1cm,纵径1.5￣15.2cm,于低分期组(pT0￣T2)和高分期组(pT3￣T4)中横径之间差别及纵径之间差别均无统计学意义(P>0.1)。癌灶平均CT值平扫时43HU,增强后74HU,增高幅度30HU,增强后显示更清晰;曲面重建(CPR)可显示泌尿道全程;pT3期6例,CT诊断正确1例,pT4期2例CT与病理诊断一致。结论:输尿管癌病灶沿输尿管蔓延纵径大于其横径,但横径及纵向累及范围并不能作为肿瘤分期的依据,T0￣T3期CT鉴别困难,T4期CT诊断准确;CT增强扫描具有确诊及鉴别诊断作用,CPR为临床医师直观地观察病灶提供方便。

Objective： To explore the characteristics of the primary ureteral carcinoma and discuss the value of spiral CT （SCT） in diagnosis of it. Methods： The SCT findings of primary ureteral carcinoma in 16 cases were analysed and compared with histopathological diagnosis. Results： The transverse diameters of the lesions were 1.0-2.1cm, and the longitudinal involvement lengths were from 1.5-15.2cm. There were no statistically significant differences （P〉0.1） in diameters and lengths among the low staging group （pT0-T2） and the high staging group （pT3-T4）. The average CT value of the lesion was 43HU on plain scanning, and 73HU on CE scanning. The increasement of CT value was 30HU. The lesions were clearer on CE scanning. Curved planar reconstruction（CPR） can show the entire course of the urinary tract. Among 6 cases of pT3 stage, CT diagnosed accurately in 1 case. For 2 cases of pT4 stage, CT diagnosis was right. Conclusion： The carcinomatous lesions spread along the ureter. The longitudinal length were longer than the transverse diameters, but tumor cannot be staged merely according to the diameter and length. For stage T0-T3, CT differentiation was difficult, for stage T4, all CT diagnosis were accurate. Contrast enhancement CT scanning plays an important role in confirming and differentiating diagnosis. CPR offered a direct and easy observing images for clinical doctors.