16层螺旋CT三期动态扫描对肾癌亚型的诊断价值初探

Diagnostic Value of Triphasic Dynamic Enhanced 16-slice Spiral CT in Subtype of Renal Cell Carcinoma

目的探讨16层螺旋CT三期动态增强扫描对肾癌亚型的鉴别诊断价值。资料与方法回顾性分析52例肾癌患者的三期动态CT扫描资料,对经手术病理证实的透明细胞癌、乳头状癌、嫌色细胞癌3种肾癌亚型图像进行双盲法对比分析,比较肿瘤的大小、强化程度与模式(均匀、不均匀及主要周边强化)、有无钙化、出血、坏死与囊变、肿瘤扩散及淋巴结转移等情况,同时结合患者的性别和年龄,分析3种亚型肾癌之间的影像学差异。结果透明细胞癌与乳头状癌、嫌色细胞癌在强化程度上差异有统计学意义(P<0.05),而乳头状癌与嫌色细胞癌强化程度差异无统计学意义(P>0.05)。透明细胞癌的坏死、囊变率显著高于其他两种亚型,3种亚型肾癌观察到血管成分的比例分别为21.6%、10%、0%。80%的嫌色细胞癌显示均匀强化,而乳头状癌占40%,透明细胞癌占2.7%,三者之间差异有统计学意义(P<0.05)。而肿瘤内的钙化成分所占比例三者之间差异无统计学意义(P>0.05)。结论肿瘤的强化程度是区别肾癌的亚型最有价值的参数,而肿瘤有无钙化、出血、坏死及囊性、血管状况及强化模式对区别肾癌亚型有一定的作用。

Objective To investigate the differential diagnostic value of subtypes of renal cell carcinoma using triphasic dynamic enhanced 16-slice computed tomography （CT） . Materials and Methods The triphasic dynamic enhanced CT findings of 52 patients with renal cell carcinoma （RCC） were reviewed. Three subtypes of renal cell carcinoma were analyzed by double blind method and diagnosed by pathology, including clear cell RCC in 37 cases, papillary RCC in 10 and chromophobe RCC in 5. Tumor size, enhancement degree and pattern （homogeneous, heterogeneous and predominantly peripheral） , the presence or absence of calcification or cystic degeneration （necrotic or hemorrhagic areas within the tumor） and tumor spreading patterns, including perinephric change, venous invasion and lymphadenopathy were compared among the 3 subtypes combined with age and sex of patients. Statistical analysis was done on imaging difference of subtypes of renal cell carcinoma, Results The degree of enhancement was significantly statistical difference among the 3 subtypes in the corticomedullary, parenchymal and excretory phases （ P 〈 0.05）. Cystic degeneration was more evident in the clear cell RCC than that in the other subtypes regardless of tumor size （ P 〈 0.05）. A hypervascular pattern was noted in 21.6% of clear cell RCC in comparison to 10% of papillary RCC and 0% of chromophobe RCC （ P 〈 0.05） . The chromophoha RCC showed homogeneous enhancement in 80% of cases in comparison to 2.7 % and 40% of clear cell RCC and papillary RCC （ P 〈 0.05） . Calcification was evident in 21.6% , 20% and 20% of clear cell RCC, papillary RCC and ehromophobe RCC, respectively （ P 〉 0.05 ）. Conclusion The degree of enhancement is the most valuable parameter to differentiate the subtypes of renal cell carcinoma. The presence or absence of cystic degeneration, vaseularity and enhancement patterns can be supplement in differentiating subtypes of renal cell carcinoma.