肾癌常见病理亚型的CT表现及强化特点分析

CT features and enhanced features of different pathological subtypes of renal cell carcinoma

目的目前根治性肾切除术是治疗肾癌的金标准,但保留肾单位手术已广泛开展。本研究通过对肾癌CT表现及强化特点的分析,探讨动态增强CT对肾癌常见病理亚型鉴别诊断的价值。方法分析2013-04-10-2015-04-20德州市人民医院收治的136例肾癌患者的动态增强扫描资料,其中透明细胞癌110例,乳头状癌10例,嫌色细胞癌16例。分析不同亚型肿瘤有无钙化、坏死及囊变、边界等方面的差异以及测量增强扫描各期的CT值,计算肿瘤-皮质增强指数,并采用方差分析方法进行比较。结果透明细胞癌出现囊变坏死率(86.4%)、高于乳头状癌(60.0%)及嫌色细胞癌(12.5%)。透明细胞癌、乳头状癌及嫌色细胞癌各期CT值分别为平扫期35.6±5.2、41.2±8.4、36.2±4.6;皮质期118.3±18.4、56.8±7.6、65.5±7.5;实质期106.5±17.6、76.5±9.6、86.2±8.2;排泄期85.6±12.8、75.3±7.4、82.2±6.8。增强各期肿瘤-皮质增强指数:皮质期1.23±0.26、0.38±0.12、0.46±0.14;实质期0.94±0.22、0.41±0.14、0.58±0.18;排泄期0.68±0.21、0.38±0.13、0.61±0.14。各亚型各期CT值进行方差分析,差异均有统计学意义,F值分别为4.91、116.01、23.77和3.71,均P<0.05;各亚型增强各期肿瘤-皮质增强指数进行方差分析,差异均有统计学意义,F值分别为115.42、44.61和10.81,均P<0.05。结论透明细胞癌、乳头状癌及嫌色细胞癌的CT表现及强化参数有一定的特征性表现,与各自的病理特征密切相关,其中强化特征是鉴别3种常见肾癌亚型最重要的参数,不同的CT表现对鉴别诊断有较大的帮助。

OBJECTIVE At present, radical nephrectomy is the gold standard for the treatment of renal cell carcinoma（RCC）, but nephron sparing surgery has been widely carried out. Through the analysis of CT and contrast-enhanced CT of renal cell carcinoma, we aimed to explore the value of dynamic enhanced CT in different subtypes of RCC. METHODS From April 10th 2013 to April 20th 2105, the triphasic dynamic enhanced CT documents of 136 patients with RCC were reviewed. Three subtypes of renal cell carcinoma were analyzed, including 110 cases of renal clear cell carcinoma, 10 cases of papillary RCC and 16 cases of chromophobe RCC. The presence or absence of cystic degeneration or calcification of pattern in different subtypes of RCC were analyzed. The CT values of each stage were measured and the enhancement index of the tumor cortical were calculated. The analysis of variance was used for comparison. RESULTS The frequency of cystic change and necrosis was higher in clear cell carcinoma than in papillocarcinoma and chromophobe renal carcinoma （86.4%〉60.0% 〉12.5%）. Respective stage of CT values of renal clear cell carcinoma, papillary RCC and chromophobe RCC were listed as follows： flat scanning （35.6±5.2,41.2±8.4,36.2±4.6）, cortical phase （118.3± 18.4,56.8±7.6, 65.5 ± 7.5）, parenchymal phase （106.5 ± 17. 6,76.5 ±9.6,86.2 ± 8.2）, excretory phase （85.6 ± 12.8,75.3±7.4, 82.2±6.8）. The enhancement index of tumor in each stage were： cortical phase （1. 23±0. 26,0. 38±0. 12,0. 46± 0.14）, parenchymal phase （0.94±0.22,0.41±0.14,0.58±0. 18） ,excretory phase （0.68±0.21,0.38±0.13,0.61± 0.14）. Variance analysis of CT values in different subtypes of each stage （F values were 4.91, 116.01, 3.71, 23.77, all P〈0.05）. Variance analysis of enhancement index in different subtypes of each stage （F= 115.42, 44.61, 10.81, all P〈0.05）. All the above indexes showed significant statistical difference among the three subtypes. CONCLUSIONS Renal clear cell carcinoma, papillary RCC and chromophobe RCC have their own characteristics in CT features and the parameter of enhancement. These characteristics are closely related to their own pathological features. Enhanced feature is one of the most important parameters to identify three common subtypes of renal cancer and different CT parameters have great help in differential diagnosis.