64层螺旋CT肾脏占位性病变灌注特征

Perfusion Characteristics of Renal Mass with 64-slice Spiral Computed Tomography

目的应用64层螺旋计算机体层摄影(CT)研究肾脏占位病变灌注特征。方法对91例肾脏占位患者进行64层螺旋CT肾脏灌注扫描,造影剂注射量为50ml(370mgI/ml),注射速度5ml/s。使用西门子BodyPCT(VB20B)灌注软件测量占位病变实质、患者正常肾皮质及健侧肾皮质灌注参数,包括血流量(BF)、血容量(BV)和渗透性(PM)。比较不同病理类型肾脏占位病变实质间灌注特征的差异,以及占位病变实质、患侧正常肾皮质及健侧肾皮质灌注特征的差异。结果术后病理显示40例肾透明细胞癌(RCCC)、21例肾盂移行细胞癌(RPTCC)、16例肾血管平滑肌脂肪瘤(RAML)、14例肾单纯性囊肿(RSC)。1例灌注扫描失败。RCCC实质灌注特征:BF(93.7±20.2)ml.(100ml)-1.min-1、BV(182.0±46.6)1000:1、PM(115.7±30.2)0.5ml.(100ml)-1.min-1;RPTCC实质灌注特征:BF(48.0±21.2)ml.(100ml)-1.min-1、BV(82.4±29.7)1000:1、PM(65.7±17.2)0.5ml.(100ml)-1.min-1;RAML实质灌注特征:BF(52.6±18.5)ml.(100ml)-1.min-1、BV(110.1±45.9)1000:1、PM(60.1±23.0)0.5ml.(100ml)-1.min-1;RSC实质灌注特征:BF(7.0±6.5)ml.(100ml)-1.min-1、BV(16.2±9.7)1000:1、PM(12.0±7.2)0.5ml.(100ml)-1.min-1。占位病变实质与患侧正常肾皮质灌注特征差异具有显著性(P<0.01),患侧正常肾皮质与健侧肾皮质间灌注特征差异无显著性(P>0.05)。4种占位病变实质的灌注参数显著低于患侧及健侧正常肾皮质,除RPTCC与RAML实质灌注特征差异无显著性(P>0.05)外,其余任意两种占位实质的灌注特征差异均有显著性(P<0.05)。结论4种不同病理类型肾脏占位病变灌注参数特征互不相同,多层螺旋CT灌注成像对肾脏占位病变鉴别诊断具有潜在的临床应用价值。

Objective To investigate the perfusion characteristics of renal mass parenchyma on 64- slice spiral computed tomography （CT）. Methods Totally 91 patients with renal mass were enrolled. Sixty- four slice spiral CT was used for renal perfusion scan that began with a contrast bolus injection of 50 ml （ 370 mgI/ml） at a rate of 5 mL/s. Perfusion characteristics, including blood flow （BF） , blood volume （BV）, and permeability （PM） of renal mass parenchyma and renal cortex in affected and normal kidneys were calculated from Siemens Body PCT （VB20B） software, and the perfusion characteristics among renal mass parenchyma and renal cortex in affected and normal kidneys were compared. Results Renal clear cell carcinoma （ RCCC）, renal pelvic transitional cell carcinoma （RPTCC）, and renal angiomyolipoma （RAML） was pathologically confirmed in 40, 21, and 16 patients, respectively, while the remaining 14 patients were diagnosed as with renal simple cyst （RSC）. Technical failure was experienced in 1 （ 1.1% ） patient. Perfusion parameters of tumor parenchyma were measured as follow： RCCC, BF （93.7 ±20.2）ml·（100ml）^-1·min^-1 BV （182.0±46.6） 1000：1, PM （115.7±30.2） 0.5ml·（100ml）^-1·min^-1; RPTCC, BF （48.0±21.2）ml·（100ml）^-1·min^-1, BV （82.4±29.7） 1000：1, PM （65.7±17.2） 0.5 ml·（100ml）^-1·min^-1; RAML, BF （52.6±18.5）ml·（100ml）^-1·min^-1, BV （110.1±45.9）1000：1, PM （60.1±23.0） 0.5 ml·（100ml）^-1·min^-1; RSC, BF （7.0±6.5）ml·（100ml）^-1·min^-1, BV （16.2±9.7） 1 000：1, PM （12.0 ±7.2） 0. 5 ml·（100ml）^-1·min^-1. In all pathological groups, perfusion parameters showed significant differences （ P 〈 0. 01 ） between mass parenchyma and renal cortex in affected kidney, while there were no significant differences （ P 〉 0.05 ） in perfusion characteristics between renal cortex in affected and normal kidneys. Aslo, the perfusion characteristics were significantly different between parenchyma in any two kinds of renal masses （P 〈 0.05 ）, except for RPTCC and RAML （P 〉 0. 05 ）. Conclusions Different pathological types of renal mass have different perfusion characteristics. Perfusion imaging with multi-slice CT is potentially useful in the differential diagnosis of renal mass.