XP11.2/TFE易位基因融合相关性肾癌与乳头状肾细胞癌的CT和MRI鉴别诊断

Differential diagnosis between renal cell carcinoma associated with XP11.2 translocation/TFE gene fusion and papillary renal cell carcinoma based on CT and MRI findings

目的 探讨XP1 1.2/TFE易位基因融合相关性肾癌（XP11.2 RCC）与乳头状肾细胞癌（PRCC）的CT及MRI鉴别诊断.方法 回顾性分析经1997年3月至2013年1月江苏省苏北人民医院经手术病理证实的12例XP1 1.2 RCC和18例PRCC的CT和MRI表现并与病理对照.采用单因素方差分析和x2检验进行比较.结果 12例XP11.2 RCC和18例PRCC,瘤内囊变（2例比11例,P＜0.05）,钙化（0例比6例,P＜0.05）,出血（9例比5例,P＜0.05）,均质强化（10例比7例,P＜0.05）,腹膜后淋巴结转移（3例比0例）或肝脏转移（1例比0例）（P＜0.05）.CT平扫,XP1 1.2 RCC密度高于PRCC、肾皮质及肾髓质（P＜0.05）.CT增强,XP11.2RCC和PRCC均呈渐进性延迟强化;XP11.2 RCC及PRCC强化程度低于正常肾皮质（P＜0.05）,PRCC强化程度低于XP11.2 RCC（P＜0.05）.皮质期及皮髓质期,XP1 1.2 RCC强化高于肾髓质,肾盂期强化低于肾髓质（P＜0.05）.6例XP1 1.2 RCC MRI扫描,T1WI肿瘤呈等信号,T2WI呈低信号.11例PRCC MRI扫描,T1WI肿瘤呈低或等信号,T2WI呈等信号.MRI增强扫描,XP11.2RCC和PRCC均呈渐进性延迟强化,XP11.2RCC呈轻～中度强化,PRCC强化较XP11.2RCC轻.结论 XP11.2 RCC和PRCC的CT、MRI扫描有一定的特征性表现,在两者的鉴别诊断中有较高的价值.

Objective To comparative study of CT and MRI appearances in renal cell carcinoma associated with XP11.2 translocation/TFE gene fusion （XP11.2 RCC） and papillary renal cell carcinoma （PRCC）.Methods 12 patients with XP11.2 RCC and 18 patients with PRCC were retrospectively studied,and the data was analyzed by AVONA and chi-square text.Results 12 patients with XP11.2 RCC and 18 patients with PRCC,cystic components （2 vs 11,P 〈 0.05）,calcification （0 vs 6,P 〈 0.05）,hemorrhage （9 vs 5,P 〈 0.05）,homogeneous enhancement （10 vs 7,P 〈 0.05） and had lymph node （3 vs 0） or hepatic metastasis （1 vs 0） （P 〈 0.05）.On unenhanced CT,the density of XP11.2 RCC was greater than PRCC,normal renal cortex or medulla （P 〈 0.05）.Their degree of enhancement were less than normal renal cortex on all enhanced phases （P 〈 0.05）.The enhancement degree of XP11.2 RCC was higher than PRCC （on all phases） and renal medulla （on cortical and medullary phase） （P 〈 0.05）,but less than normal renal medulla on the delayed phase （P 〈 0.05）.The enhancement degree of PRCC was lower than renal medulla on all phases （P 〈 0.05）.The XP11.2 RCC was isointense on T1-weighted imaging,hypointense on T2-weighted imaging.The PRCC was isointense or hypointense on T1-weighted imaging,isointense on T2-weighted imaging.Conclusion The CT and MRI could show imagings features of XP11.2 RCC and PRCC,and these features were helpful in predicting a specific subtype of renal cell carcinoma.