肾癌不同亚型CT表现的对照研究

Comparative study on CT features of subtype of renal cell carcinoma

目的探讨肾癌亚型的影像学特征,提高诊断的准确率。方法回顾性分析48例经手术和病理证实的肾细胞癌,其中透明细胞癌28例,乳头状癌12例,嫌色细胞癌8例,均行多层螺旋CT平扫及增强检查,比较平扫、皮髓质期、实质期和排泄期各肾癌亚型坏死、囊变发生率及肿瘤的强化形式及强化幅度。结果透明细胞癌与乳头状癌、嫌色细胞癌在强化幅度上差异有统计学意义(P<0.05),而乳头状癌与嫌色细胞癌强化幅度差异无统计学意义(P>0.05)。透明细胞癌的坏死、囊变发生率显著高于其他两种亚型。动态增强各期透明细胞癌强化程度最高,强化形式呈"快进快出"表现,乳头状癌轻至中度强化,嫌色细胞癌强化最轻,两者均呈渐进性延迟强化;85%透明细胞癌显示不均匀强化或主要周边强化,而41%乳头状癌、87%嫌色细胞癌显示较均匀的强化,三者之间差异有统计学意义(P<0.05)。结论不同的肾癌亚型影像学表现具有一定的特征性,螺旋CT动态增强扫描对诊断有帮助。

Objective To study CT features of renal cell carcinoma of subtype so that to improve the diagnostic accuracy.Methods 48 cases of RCC proved by surgery and pathology were performed by CT.These included 28 clear cell carcinoma,12 papillary carcinoma,8 chromophobe carcinoma.All the patients were analyzed enhancement degrees and patterns in enhanced plain CT scan,cortical-medullary phase,parenchyma phase and excretory phase were compared.Results The degree of enhancement was significantly statistical difference among the 3 subtypes in the cortical-medullary parenchymal and excretory phases（P〈0.05） cystic degeneration was more evident in the clear cell carcinoma than that in the other subtypes regardless of tumor size.On the cortical-medullary,parenchyma and excretory phase images,clear cell carcinoma showed greater signal intensity change and papillary carcinoma showed intermediate change and chromophobe carcinoma showed lowest change.A phenomenon of quick staining and quick fainting was observed in clear cell carcinoma.Both of chromophobe carcinoma and papillary carcinoma showed delayed enhancement.The chromophobe carcinoma showed homogeneous enhancement in 87 of cases in comparison to 3.5 and 41 of clear cell carcinoma and papillary carcinoma（P〈0.05）.Conclusion Different subtypes of renal cell carcinoma have different CT features and dynamic enhanced CT scan is helpful in diagnosing the subtype of renal cell carcinoma.