动态增强CT扫描对常见肾细胞癌亚型的鉴别诊断价值

The value of dynamic contrast CT on differential diagnosis of the most common subtypes of renal cell carcinoma

目的研究三种常见肾细胞癌(RCC)亚型在动态增强CT扫描中的异同点,以提高CT扫描对于常见RCC亚型的诊断价值。方法回顾性分析141例经手术病理证实的RCC患者的CT平扫及双期扫描的影像资料,测量瘤灶平扫和动态增强扫描的CT值、记录平扫CT表现、强化方式,重点分析CT动态增强扫描中各种亚型之间的异同。结果透明细胞癌(CCRCC)101例,乳头状肾细胞癌(PRCC)27例,嫌色细胞癌(CRCC)13例。CCRCC不均匀强化多于其他两种亚型的RCC(P<0.05),强化程度明显高于其他两种亚型的RCC(P<0.05),转移及形成癌栓的比例较大;PRCC及CRCC强化程度均较低,二者强化程度有类似(P>0.05),但CRCC钙化率较CCRCC和PRCC高,中心无强化瘢痕及轮辐状强化仅见于5个PRCC和1个PRCC。结论皮髓期强化能区别透明细胞癌和非透明细胞癌,结合其他征象有助于鉴别PRCC和CRCC。

Objective To study the difference of the CT performance of three common subtypes of renal cell carcinoma（RCC）.Methods We retrospectively analyzed plain CT and bi-phase contrasting images of 141 renal cell carcinomas proved by pathology.We measured CT values of the tumors on contrast and non-contrast CT images and recorded the size,shape,calcification and the manifestation of enhancement.Results Totally we get 101 clear cell renal cell carcinoma（CCRCC）,27 papillary renal cell carcinoma（PRCC）,13 chromophobe renal cell carcinoma（CRCC）.The rate of heterogeneous enhancement in CCRCC is higher than that in PRCC and CRCC（P〈0.05）.The degree of enhancement in CCRCC is stronger than that in PRCC and CRCC（P〈0.05）.The degree of enhancement of PRCC and CRCC is similar（P〈0.05）.The rate of matestasis and tumor＇s thrombus is higher than that in PRCC and CRCC.The rate of calcification is higher in CRCC than in CCRCC and PRCC,central scar and spoke-wheel pattern of contrast enhancement is only seen in 5 and 2 PRCC.Conclusion The enhancement on corticomedullary phase is valuable for differentiating CCRCC and non-CCRCC.Combined with other signs,PRCC and CRCC may be differentiated.