乳头状肾细胞癌的影像学表现

Imaging Diagnosis of Papillary Renal Cell Carcinoma

目的:研究乳头状肾细胞癌(RCC)的影像学表现,以提高对其诊断的准确性。方法:回顾性分析经手术病理证实的8例乳头状肾细胞癌的患者的影像资料。结果:8例患者共13个肿瘤病灶,7例12个病灶位于右肾,1例位于左肾。肿瘤均呈膨胀性生长,最大径为0.2～8.0cm,8个病灶≤4cm者。CT、MRI表现为平扫肿瘤密度/信号较均匀,内有灶状出血(4/13)、坏死(4/13)和钙化(1/13),增强扫描肿瘤呈较均匀或不均匀强化,肾皮髓期、实质期和排泄期强化程度明显弱于肾皮质,弱于或相仿于肾髓质。4个病灶显示完整或较完整的假包膜。结论:乳头状肾细胞癌的影像学表现有一定特征性,膨胀性生长方式,瘤内可有灶状出血、坏死和钙化,CT和MRI增强扫描肿瘤边缘清楚,持续轻度强化,增强三期扫描中其强化程度均弱于或相仿于肾髓质,有助于同其它类型RCC鉴别。

Objective： To study the imaging features of papillary renal cell carcinoma （PRCC） and to improve the diagnostic accuraey. Methods：The imaging features of 8 cases with PRCC proved by surgery and pathology were reviewed retrospectively. Results：Eight cases had 13 PRCC lesions,in which 7 cases with 12 lesions were in the right kidney and 1 case was in the left kidney. All of them manifested as expansion growth type and the maximum dimension of them ranged from 0.2-8.0cm and 8 of them were not more than 4.0cm. These lesions showed homogenous or inhomogenous density/ signal in non-enhancement CT/MRI scan. Some of them had hemorrhage （4/13）,necrosis （4/13） and calcification （1/13）. All lesions exhibited homogenous or inhomogenous continuous mild enhancement after administration of contrast media,and showed hypodensity/hypointensity comparing with renal cortex and hypodensity/bypointensity or isodensity/isointensity comparing with renal medulla in corticomedullary phase, parenchymal phase and excretory phase. 4 lesions had intact or nearly intact psudocapsule. Conclusion： The PRCC in our study group showed certain imaging characteristics which were helpful to the differential diagnosis of subtypes of renal cell carcinoma,including expansion growth type,focal hemorrhage or/and necrosis or/and calcification in the lesion,well-defined shape,homogenously or inhomogenously continuous mild enhancement which was not stronger than that of renal medulla on three phases of post-contrast CT and MRI images.