螺旋CT对肾细胞癌亚型的鉴别诊断价值

Value of Spiral CT in the Differentiation of Renal Cell Carcinoma Subtypes

目的:探讨CT动态增强扫描对肾细胞癌病理亚型的鉴别诊断价值。方法:87例经手术病理证实的肾细胞癌患者,包括50例透明细胞癌、17例乳头状癌、8例嫌色细胞癌和2例集合管癌,术前行CT平扫和双期动态增强扫描(肾皮髓期和肾实质期),测量肿瘤、腹主动脉及邻近正常肾实质的CT值,并计算肿瘤与主动脉、肾实质的强化比值,同时评价肿瘤的强化方式,对不同病理亚型肿瘤的各项指标进行统计学分析。结果:透明细胞癌在皮髓期和实质期增强扫描时肿瘤与主动脉、肾实质的强化比值均高于乳头状癌和嫌色细胞癌(P<0.01),而乳头状癌和嫌色细胞癌间差异均无统计学意义(P>0.05)。不均匀强化常见于透明细胞癌(92%)、乳头状癌(82.4%)和集合管癌(100%);而均匀强化常见于嫌色细胞癌(62.5%),其与透明细胞癌(P=0.010)和乳头状癌(P=0.017)间差异有显著性意义。结论:CT增强扫描时分析肿瘤与主动脉和肾实质的强化比值及强化的均匀度对肾癌病理亚型的鉴别诊断有重要价值。

Objective：To study the value of dynamic enhanced spiral CT in the differentiation of renal cell carcinoma subtypes. Methods：Biphasic contrast enhanced CT scans of 77 cases with surgery and pathology proven renal cell carcinoma including clear cell carcinoma （n=50）, papillary carcinoma （n= 17）, chromophobe cell carcinoma （n= 8） and collecting duct carcinoma （n= 2） were reviewed. Before surgery, plain CT scan and biphasic （cortico-med ullary phase, paranchymal phase） dynamic contrast enhanced scan were undertaken. The attenuation of each tumor, abdominal aorta and normal renal paren- chyma after enhancement were measured using region of interesting （ROD, tumor-to-aorta ratio （RTA） and tumor to normal kidney parenchyma ratio （RTK） were calculated and pattern of enhancement were evaluated. Results：On enhanced images of both phases,the RTA and RTK of clear cell carcinoma were higher than that of papillary carcinoma （P〈0.01） and chromophobe cell carcinomas （P〈0.01） respectively,but there was no significant statistical difference between chromophobe cell carcinoma and papillary carcinomas （P〉 0.05）. Heterogeneous enhancement was frequently seen in clear cell carcinoma （92%）, papillary carcinoma （82.4 % ） and collecting duct carcinoma （ 100%）, whereas homogeneous enhancement was commonly noted in chromophobe cell carcinoma （62.5%）. The frequency of homogeneous enhancement was higher in chromophobe cell carcinoma than that in clear cell carcinoma （P= 0.01 ） and papillary carcinoma （P= 0.017）, and significant statistical differences were existed. Conclusion：RTA and RTK and patterns of enhancement were useful to differentiate subtypes of renal cell carcinoma.