双皮质期扫描对肾细胞癌亚型诊断和鉴别诊断的影响

Study of dual cortical phase imaging scanning in the diagnosis and differential diagnosis of different histologic subtypes of renal cell carcinoma

目的：探讨双皮质期扫描对常见肾细胞癌不同亚型鉴别诊断和病理分型的价值。方法：回顾性分析经手术病理证实的49例肾细胞癌的影像资料,并与手术病理作对比分析。49例术前分别行MSCT或MR平扫、皮质早期、皮质期和实质期扫描。结果：49例肾细胞癌中透明细胞癌39例,乳头状细胞癌6例,嫌色细胞癌4例。病灶直径〈3 cm 9例,3-5 cm 32例,〉5 cm 8例。根据肿瘤强化程度和峰值出现时间分成4型,Ⅰ型：强化峰值在皮质早期,强化程度与皮质相仿,共25例,病理类型全部为透明细胞癌;Ⅱ型：强化峰值在皮质期,强化程度与皮质相仿,共11例,病理类型全部为透明细胞癌;Ⅲ型：强化峰值在皮质期,强化程度与髓质相仿,共6例,其中,透明细胞癌1例,乳头状肾细胞癌2例,嫌色细胞癌3例;Ⅳ型：强化峰值在实质期,强化程度最低,共7例,其中,肾透明细胞癌2例,乳头状肾细胞癌4例,嫌色细胞癌1例。结论：透明细胞癌强化峰值和峰值出现时间差异很大,嫌色细胞癌和乳头状肾细胞癌强化曲线相对一致,乳头状肾细胞癌强化程度最轻。双皮质期扫描能更准确显示肿瘤的血液动力学,减少不同亚型之间的误诊,显示肾细胞癌更多恶性征象,对肾癌的定性和组织分型具有一定价值。

Objective：To study the value of dual cortical phase imaging scanning in the diagnosis and differential diagnosis of different histologic subtypes of renal cell carcinoma（RCC）.Methods：Imaging manifestations of 49 patients with surgery and pathology proven RCC were retrospectively analyzed and correlated with pathology.All of the 49 patients underwent MR or multi-detector CT（MDCT） plain and post-contrast scanning of early cortical phase（ECP）,cortical phase（CP） and nephrographic phase（NP） before surgery.Results：Of the 49 patients,there were clear cell RCC（CCRCC,39 patients）,papillary RCC（PRCC,6 patients） and chromophobic RCC（CRCC,4 patients）.The diameter of the lesions were 3cm（9 lesions）,3~5cm（32 lesions）,and 5cm（8 lesions）.There were four types of tumor enhancement according to its enhancing peak time and degree.Type Ⅰ：Peak enhancement appeared at ECP,the enhanced degree was similar to that of renal cortex（25 patients,all were CCRCC）.Type Ⅱ：Peak enhancement occured at CP,the degree was similar to cortex（11 patients,all were CCRCC）.Type Ⅲ：Peak enhancement at CP,the degree was similar to medulla（6 patients,with CCRCC,1 case;PRCC 2 patients;CRCC 3 patients）.Type Ⅳ：Peak enhancement at NP and with the least enhancement（7 patients,with CCRCC,2 patients;PRCC,4 patients;CRCC,1 patient）.Conclusion：The hemodynamics of RCC could be more accurately assessed on dual cortical phase enhanced imaging scanning,misdiagnosis of sub-type of RCC could be reduced by using this technique,more malignant signs of RCC could be revealed and was significant in the characterization and sub-type classification of RCC.