多发肾透明细胞癌11例磁共振影像分析

MR Appearance of multifocal clear cell renal cell carcinoma

目的描述多发肾透明细胞癌的MR影像表现。方法回顾性分析2008年1月至2010年12月解放军总医院共11例经病理证实的多发肾透明细胞癌的MR影像资料及临床资料，重点分析病灶的分布、大小、外形、信号，增强特点。结果11例多发肾细胞癌患者，其中6例女性，5例男性，年龄36～69岁，平均50．6岁，共发现24个病灶。9例患者为双肾多发病变，单侧肾多发病变为2例。T：加权图像高信号的有16个病灶（16／24），所有病变均可见假包膜，出血的有4例（4／24），含有脂质的为12例（12／24），囊变的有18例（18／24），动态增强扫描各期持续强化的有22例（22／24），快进快出的有2例（2／24）。所有病变呈现中度至明显强化。5例患者的多发病变MR表现一致，6例患者的多发病变MR表现并不一致。结论多发肾细胞癌通常为两肾多发。同一患者的多发病变即使病理类型一致，MR表现可能不同。

Objective To document the magnetic resonance （MR） imaging features of muhifocal clear cell renal cell carcinoma （ RCC ）. Methods The MR findings of 11 cases of pathologically-proved multifocal clear cell RCCs were reviewed retrospectively from January 2008 to December 2010. All patients underwent MR in a 1.5 T or a 3.0 T scanner. The MR features of the lesions were analyzed, with emphasis on the location, the signal intensity on T2-weighted imaging （T2WI）, in regards to pseudocapsule, lipid component, hemorrhage, cystic degeneration, and enhancement pattern. Meanwhile, from these six aspects, the MR appearance of renal cell carcinomas occurring in the same patient were compared. Results 24 tumors （ mean diameter, 3.1 cm） in the 11 patients （6 men, 5 women; age range, 36 - 69 years ; mean age, 50.6 years） were detected. Multiple lesions in bilateral kidneys were found in 9 patients （9/11）, while in unilateral kidney 2 patients （2/11）. Hyperintensity on T2WI were observed in 16 lesions （ 16/24）, while hypointensity 8 lesions （8/24） ; pseudocapsule was seen in all lesions; hemorrhage in 4 lesions （4/ 24）, lipid component in 12 lesions （12/24） and cystic degeneration in 18 lesions （18/24）, persistent enhancement in 22 lesions （22/24） and rapid wash-out pattern in 2 lesions （2/24）. All lesions showed moderate or intense enhancement. The MR appearances of lesions in the same patient were identical in 5 cases （5/11 ）, different in 6 cases （6/11）. Conclusion Multifocal clear cell RCCs occur more commonly in bilateral kidneys simultaneously than in unilateral kidney. The lesions in the same patient can show different MR imaging features, which probably facilitate the preoperative determination.