肾脏嫌色细胞癌影像分析(附20例报告)

Imaging Features of Chromophobe Renal Cell Carcinoma(Report of 20 Cases)

目的探讨肾脏嫌色细胞癌(chromophobe renal cell carcinoma,CRCC)的超声与CT影像特点,提高其影像诊断及鉴别诊断能力。方法回顾分析20例经手术病理证实的CRCC的超声及CT表现,常规超声检查及CT平扫及增强检查20例,超声造影检查15例。结果常规超声:肿块以低回声(15/20,75%)为主,病灶内回声以均匀多见(16/20,80%)。超声造影:肿块均匀强化9例,不均匀强化6例,皮质期同步强化10例,缓慢强化5例。达峰值时肿块呈低增强11例,等增强4例。CT检查:平扫显示病灶等密度16例,稍高或稍低密度各2例,80%(16/20)密度均匀,20%(4/20)密度不均匀,肿块中央点片状钙化7例。CT增强扫描CRCC多表现为皮质期、实质期呈轻到中度强化,皮质期强化达峰值11例,实质期达峰值9例,病灶中央显示瘢痕3例。结论 CRCC的超声及CT表现具有一定特征,依据肿瘤均质、轻到中度强化的特点,大多数患者术前能得到正确诊断。

Objective To study the ultrasonic and CT features of chromophobe renal cell carcinoma （CRCC）.Methods Twenty cases of postoperative pathologically confirmed CRCCs were retrospectively analyzed. All the patients underwent conventional ultrasonography （US）, plain and contrast enhanced CT （CECT） scanning, and 15 of them received contrast enhanced US （CEUS）.Results In US, CRCCs usually showed hypoechoic （15/20, 75%） and homogeneous echo （16/20, 80%）. In CEUS, 9 cases showed homogeneous enhancement and 6 appeared heterogeneous enhancement. And 10 cases showed isochronous enhancement and 5 demonstrated delayed enhancement in the cortical phase of CEUS. And 11 cases manifested low enhancement and 4 showed equal enhancement compared with the renal cortex at the peak time. On plain CT scan, CRCCs showed iso- （n=16）, hypo- （n=2） and hyperattenuations （n=2） respectively. CRCCs showed homogeneous （16/20, 80%） and heterogeneous density （4/20, 20%） on plain CT scan. Seven cases （7/20, 35%） contained punctate or patchy calcifications in the center of tumor. On CECT scan, all CRCCs showed mildly to moderately homogeneous enhancement. The enhancement of 11 and 9 CRCCs peaked in the cortical and parenchymal phases respectively. In addition, 3 cases demonstrated stellate scar in the central area.Conclusion Correct preoperative diagnosis of CRCC could be made based on ultrasonic and CT findings, especially tumor homogeneity and mildly to moderately homogeneous enhancement on CECT and CEUS.