CT对肾脏占位性病变的定性诊断误诊分析

Analysis of misdiagnosis of CT in the differential diagnosis of renal masses

目的分析CT对肾脏占位性病变定性诊断的误诊原因。方法63例肾脏占位性病变患者，53例经手术病理证实，10例经随访证实。全部病例均行CT检查，评价CT对这些疾病的定性诊断价值。结果63例患者中，肾癌42例，肾孟癌3例，肾转移癌1例；肾囊肿7例，肾错构瘤5例，肾脓肿3例，肾血肿2例。CT对肾脏恶性占位性病变的定性诊断准确率为84．8％（39／46），其中肾癌误诊5例，肾盂癌误诊1例，肾脏转移瘤误诊1例。CT对肾脏良性占位性病变的定性诊断准确率为76．5％（13／17），其中肾脓肿误诊2例，肾脏慢性血肿误诊2例。CT对肾脏占位性病变总的定性诊断准确率为82．5％（52／63）。CT共误诊11例，误诊的原因有：病变体积较小误诊3例，CT表现不典型误诊4例，两者均有2例，过分强调CT征象，未密切结合病史误诊2例。结论CT可用于肾脏占位性病变的定性诊断，病变体积较小，病变强化特征不典型、未密切结合病史是CT误诊的主要原因。

Objective To analyse the reason for CT in the misdiagnosis of renal masses. Methods Sixty -three patients with pathologically proved diseases（53 cases） and follow -up records（ 10 cases） were examined with CT. The utility of CT in the differential diagnosis was analyzed. Results The final diagnosis of the 63 patients was as following：42 renal cell carcinomas ,3 carcinomas of renal pelvis, 1 metastasis, 7 cysts, 5 angiomyolipomas, 3 abscess, and 2 chronic hematomas. For the malignant lesions, the qualification accuracy of CT was 84.8% （39/46）. The misdiagnosed cases were 5 renal cell carcinemas, 1 renal pelvis carcinoma and 1 metastasis. For the benign lesions, the qualification accuracy of CT was 76.5% （13/17）. The misdiagnosed cases were as following： 2 abscess, 2 chronic hematomas. The total accurate rate of CT in the qualification diagnosis of the renal masses was 82.5% （52/63）. The reason for misdiagnosis was because of the small size of the lesions （3 cases） , or because of the atypical density （4 cases） , or because of the both above reasons （2 cases）. The other reason for misdiagnosis of CT was because of the atypical marginal features of the masses and no in combination with history （2 cases）. Conclusions CT is useful in the qualification of renal masses. The masses of small size with atypical density and border features are likely to be misdiagnosed.