多层螺旋CT鉴别肾透明细胞癌和乳头状癌

Multi-slice helical CT scanning in differential diagnosis of renal clear cell carcinoma and renal papillary carcinoma

目的:探讨多层螺旋CT鉴别肾透明细胞癌和乳头状癌的价值。方法:47名肾癌患者的CT图像,分别为透明细胞癌37例,乳头状癌10例。所有患者均行平扫和三期增强扫描。比较患者的性别与年龄、肿瘤大小、增强程度与增强模式、有无钙化、出血、坏死及囊变、肿瘤的扩散情况包括肾周变化、静脉侵犯及淋巴结转移。结果:皮髓期、实质期及排泄期,透明细胞癌与乳头状癌增强程度有显著性差异(P<0.05),透明细胞癌的坏死、囊性率显著高于乳头状癌,明显看到血管在透明细胞癌占21.6%,乳头状癌占10%。40%乳头状癌、2.7%透明细胞癌显示均匀强化,有显著性差异(P<0.05)。透明细胞癌有明显钙化占21.6%,乳头状癌占20%,没有显著性差异。结论:肿瘤的增强程度是鉴别肾透明细胞癌和乳头状癌最有价值的参数,而肿瘤的有无钙化、出血、坏死及囊性、血管状况及增强模式对鉴别透明细胞癌和乳头状癌有一定的作用。

Objective：To evaluate the value of muhi-slice computed tomography （CT） in differential diagnosis of renal clear cell carcinoma and renal papillary carcinoma. Methods： The CT images of 47 patients with renal cell carcinoma （RCC） were reviewed. The RCC patients were divided into 2 groups pathologically, including 37 cases of clear cell RCC and 10 cases of papillary RCC. Plain scan and three phase （corticomedullary, nephrographic and excretory phases） CT were performed in all patients. Age and sex of patients, tumor size, enhancement degree and pattern （homogeneous, heterogeneous and predominantly peripheral）, the presence of calcification or cystic degeneration （necrotic or hemorrhagic areas within the tumor） and tumor spreading （including perinephric change, venous invasion and lymphadenopathy） were compared between the 2 subtypes. Results： The degrees of enhancement were significantly different between the 2 subtypes in the corticomedullary, parenchymal and excretory phases （P〈0.05）. Necrosis and cystic degeneration were more evident in the clear cell RCC than in papillary RCC regardless of tumor size （P〈0.05）. A hypervascular pattern （higher tumor enhancement after contrast material injection due to higher vascularity） was noted in 21.6% of clear cell RCC cases and in 10% of papillary RCC （P〈0.05）. Half of the clear cell RCC and 2.7% of papillary RCC patients showed homogeneous enhancement （P〈0.05）. Calcification was evident in 21.6% of clear cell RCC patients and 20% of papillary RCC patients. Conclusion： The degree of enhancement is the most valuable parameter for differentiation of clear cell RCC and papillary RCC. The presence of cystic degeneration, hemorrhage, vascularity and enhancement patterns can also contribute to the differentiation of the 2 subtypes.