乳头状肾细胞癌的影像学诊断价值

Diagnosis of Papillary Renal Cell Carcinoma with CT

目的:探讨乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)的影像表现及其与病理特征之间的关系,以进一步提高影像学诊断PRCC的正确率。方法:回顾分析经病理确诊的17例PRCC患者的影像资料。17例患者中,16例行CT检查,2例行磁共振(magnetic resonance imaging,MRI)检查。结果:17例PRCC中,9例位于右肾,8例位于左肾;肿瘤直径2.0～12.4cm,平均直径5.6cm;肿瘤形状呈圆形或类圆形13例,分叶状4例;肿瘤边界清楚或较清楚13例,不清楚4例;密度或信号均匀4例,不均匀13例;肿瘤发生转移3例;病理分型Ⅰ型3例,Ⅱ型9例,未分型5例。平扫CT值为17.8～35.5HU,平均26.1HU;动态增强后皮髓交界期CT值为27.3～57.5HU,平均37.8HU;实质期CT值为35.0～71.2HU,平均47.8HU。PRCC的MRI影像学表现中,T1WI、T2WI信号特点取决于其成分,动态增强方式与CT增强检查相似。结论:PRCC的影像学表现有一定的特异性,CT及MRI动态增强检查对PRCC具有较高的诊断和鉴别诊断的价值。

Objective：To assess the value of CT in the diagnosis of papillary renal cell carcinoma（PRCC）.Methods：Imaging findings of 17 patients with PRCC confirmed by surgery and pathology were reviewed retrospectively.Sixteen patients underwent spiral CT without and with contrast enhancement.Two patients underwent plain and dynamic enhanced magnetic resonance imaging（MRI）.Results： Tumors were located in the right kidney in 9 patients and in the left kidney in 8 patients.The mean diameter of tumors was 5.6 cm（range 2.0-12.4 cm）.The shapes of tumor were round or oval in 13 patients and lobulate in 4 patients.The margins of tumors were distinct in 13 cases and indistinct in 4 cases.The density of tissue at the tumor site was heterogeneously dense in 13 cases and homogeneously dense in 4 cases.CT values of the plain scans,corticomedullary phase and nephrographic phase were 17.8-35.5HU（mean 26.1HU）,27.3-57.5HU（mean 37.8HU） and 35.0-71.2HU（mean 47.8HU）,respectively.The signal characteristics of MRI abnormalities both on T1WI and T2WI depended on the composition of PRCC.The paterns of MRI dynamic enhancement were similar to those of CT.Conclusions： Dynamic contrast-enhanced CT and MRI can provide valuable information for the diagnosis and differential diagnosis of PRCC.