多层螺旋CT多期增强扫描对小肾癌诊断价值的临床研究

Clinical Study of Multi-phase Enhanced Scan of Multi-slice Spiral CT(MSCT) for Diagnosis of Small Renal Cell Carcinoma

目的探讨多层螺旋CT(MSCT)多期增强扫描在小肾癌诊断中的临床研究。方法回顾性分析21例经手术病理证实的小肾癌(≤3.0cm)术前MSCT多期扫描的影像特征,并与病理对照。结果 21例患者中平扫病灶高密度2例,等密度15例,低密度或略低密度4例,所有病例均未见钙化;增强扫描皮质期14例明显强化,高于正常肾皮质,6例中度强化,1例轻度强化,均匀强化5例,不均匀强化16例,21例患者中检出率为100%;手术及病理示,左肾12例,右肾9例,最大直径2.8cm,最小直径1.0cm;肾透明细胞癌10例,颗粒细胞癌5例,乳头状细胞癌2例,透明细胞与颗粒细胞混合癌2例,嫌色细胞癌1例,肉瘤样细胞癌1例;19例为单发病灶,1例为单侧2个病灶,1例为双侧各1个病灶;实性肿块17例,囊实性4例;有假包膜13例,无假包膜8例;病理分期:Ⅰ期10例,Ⅱ期9例,Ⅲ期2例。结论 MSCT多期增强扫描是小肾癌诊断及其亚型鉴别诊断的可靠检查方法。

Objective To discuss the multi - phase enhanced scan of evaluate multi - slice spiral CT （MSCT） in the diagnosis of small renal cell carcinoma. Methods We retrospectively analyzed imaging features of multi - phase scan of MSCT in 21 cases with small renal cell carcinoma （~〈3.0cm） who were confirmed by pathology of surgery. Results Two cases were plain lesions high - density, 15 cases equal density and 4 cases low - density or slightly low - density in 21 patients. All cases showed no calcification. In enhanced scan cortex phase, 14 cases were significantly enhanced which was higher than normal renal cortex, 6 cases moderately enhanced, 1 case mild enhanced, 5 cases homogeneous enhanced, 16 cases heterogeneous enhanced. The detection rate of the 21 patients was 100%. Surgery and pathology showed left kidney were in 12 cases and right kidney in 9 cases, with the maximum diameter of 2.8cm while minimum diameter of 1.0cm. Renal cell carcinoma was in 10 cases, 5 cases with granular cell carcinoma, 2 cases with papillary carcinoma and 2 cases mixed clear cell and granular cell carcinoma, 2 cases with chromophobe cell carcinoma and 1 case with sarcoma - like cells carcinoma. There were 19 cases with single lesion,of which 1 case with unilateral 2 lesions, 1 case with bilateral 1 lesion. Solid mass was in 17 cases, and cystic was in 4 cases. Pseudocapsule was in 13 cases. For pathological stage, I stage had 10 cases, II stage 9 cases and III stage 2 cases. Conclusion Multi - phase enhanced scan of MSCT is an effective method to diagnose small renal cell carcinoma and its subtypes.