增强CT及其后处理技术对肾嗜酸细胞腺瘤和嫌色细胞肾癌的鉴别诊断

Differentiation of oncocytoma and renal cell carcinoma by contrasted CT and its post-processing techniques

目的肾嗜酸细胞腺瘤(renal oncocytoma,RO)和嫌色细胞肾癌(chromophobe cell renal carcinoma,CCRC)术前鉴别困难,文中探讨增强CT及其后处理技术对两者的鉴别诊断价值。方法回顾性分析经手术病理证实的8例(9个)RO(RO组)和15例CCRC(CCRC组)患者的CT增强扫描影像资料,并在工作站上采用多平面重建(multi-plannar reformation,MPR)、最大密度投影(maximum intensity projection,MIP)等技术行图像后处理,应用SPSS16.0软件对2种肿瘤的影像学表现进行统计学处理。结果肿瘤的强化形式及中央星状瘢痕在RO组和CCRC组间差异有统计学意义(P<0.05);肿瘤大小、各期的强化程度以及出现辐轮状强化、节段性增强反转等征象的比较,差异无统计学意义(P>0.05);50%(2/4)的辐轮状强化、33%(3/10)的中央星状瘢痕经MPR重建后明确显示。结论肿瘤强化形式和中央星状瘢痕有助于RO和CCRC的鉴别,增强CT及其后处理技术在术前准确评价RO和CCRC的特征、指导鉴别诊断中具有重要价值。

Objective It is difficult to differentiate preoperatively renal oncocytoma （RO） from chromophobe cell renal carcinoma （CCRC）. This study was to investigate the value of contrasted CT and its post-processing techniques in distinguishing these two entities. Methods We retrospectively analyzed the contrasted CT data of 9 cases of RO and 15 cases of CCRC confirmed pathologically. The multi-planar reformation （MPR） images of the abdomen and maximum intensity projection （MIP） images of intratumoral vessels were reconstructed at the workstation. The CT findings were analyzed and processed by SPSS16.0 software. Results Statistically significant differences between RO and CCRC were shown in enhancement patterns and central scars （P 〈 0.05 ） , but not in the average size of the tumors, degrees of enhancement in individual contrast phases, spoke-wheel-like enhancement and segmental enhancement inversion （P 〉0. 05 ）. MPR images revealed spoke-wheel-like enhancement in 50% of the cases （2/4）, and central scars in 33% （3/10）. Conclusion The enhancement patterns and central scars help to differentiate RO from CCRC. Contrasted CT and its post-processing techniques have an important value in the preoperative accurate assessment of the characteristics of RO and CCRC as well as in the differential diagnosis of these two entities.