多层螺旋CT对不典型肾癌的诊断价值

The diagnostic value of MSCT in atypical renal cell carcinoma

目的:探讨不典型肾癌的CT表现及多层螺旋CT的诊断价值。材料与方法:回顾性分析16例经病理证实的不典型肾癌的CT表现,所有病例均采用多层螺旋CT进行平扫、多期增强扫描及三维重建。结果:16例肾癌均为单侧单发,其中实性8例、囊实性6例、囊性2例。10例肾癌表现为相对乏血供。实性乏血供肾癌的强化特点为皮质期呈轻度、轻中度强化或无强化,实质期强化密度略减低或无明显变化,无延迟强化趋势。8例实性病变中5例突入肾窦,2例出现环状钙化。4例囊实性肾癌实性部分及壁结节血供较丰富,强化节律与富血供实性肾癌相近。2例囊性肾癌囊壁厚薄不均,均可见"浅分叶",1例与肾实质交界区可见低强化软组织密度影。弥漫浸润型肾癌1例,边界不清,类似炎性病变,轻度强化,肾脏边缘可见棘状突起,伴肾周筋膜增厚、桥隔增粗及肾门旁淋巴结肿大。结论:不典型肾癌CT表现形式多样,需结合形态和强化特征综合分析;多层螺旋CT可全面显示病变,发现有价值的细节,从而有助于鉴别诊断。

Objective： To study the CT features of atypical renal cell carcinoma（RCC） and the value of MSCT.Materials and Methods： CT findings of 16 cases of atypical RCC confirmed pathologically were analyzed retrospectively.All the cases received plain CT scan and dual-phase contrast-enhanced CT scan by MSCT.Then three-dimensional reconstruction was performed.Results： All of the tumours were single and located in unilateral kidney.Among the 16 cases,8 showed solid appearance,6 showed cystic-solid appearance,and 2 showed cystic appearance;10 cases displayed the characteristic of lack of blood supply.Solid RCC lack of blood supply was slightly-moderately enhanced or not enhanced in cortical phase,then slightly reduced in the following parenchyma phase,and no trend of progressive enhancement was found.Among the 8 cases of solid RCC,5 cases intruded into renal sinus,and 2 cases had circular calcification.The solid portion of 4 cystic-solid RCC were rich in blood supply and enhanced according to the rhythm of solid RCC which was rich of blood supply.The 2 cases of cystic RCC showed uneven thickness of cyst wall with shallow lobulation.In one case,soft tissue with slight enhancement was seen in the junctional zone between the cystic lesion and normal renal parenchyma.The diffuse infiltrative RCC with ill-defined margin was slightly enhanced,which was similar to the inflammatory lesion,and the acanthoid protuberance was found on the edge of kidney,accompanied with thickened perinephric fascia,widened bridge interval and enlarged lymph nodes adjacent to renal hilus.Conclusion： Atypical RCC shows various forms and must be analyzed comprehensively according to shape and pattern of enhancement.The lesion can be displayed well by MSCT which has the advantage in showing the detail of lesions and contributes to differential diagnosis.