肾乳头状细胞癌的多层螺旋CT诊断

Multi-slice Spiral CT in Diagnosis of Papillary Renal Cell Carcinoma

目的分析肾乳头状细胞癌的CT表现,评价CT在肾乳头状细胞癌中的诊断价值。资料与方法回顾性分析15例经手术病理证实为肾乳头状细胞癌的CT特点,分析肿瘤的生长部位、生长方式、是否有假包膜、肿瘤平扫密度特点和增强扫描后强化方式、强化程度、强化时相及肿瘤是否侵袭周围组织、淋巴结转移等。结果15例患者中,12例病灶位于肾皮质,3例位于肾实质;肿瘤呈膨胀性生长14例,浸润型生长1例;12例有完整或不完整包膜,3例无包膜。平扫肿块实质部分稍高密度9例,等密度4例,稍低密度2例。密度均匀1例,不均匀14例,其中斑片状、大片状坏死14例,斑片状、条片状钙化5例,灶性出血2例。动态增强扫描:肾皮髓质期肿块实质部分呈轻中度强化,实质期呈轻度持续强化,坏死灶无强化。肿块侵袭肾盂2例,侵袭肾窦脂肪1例,肾门、腹主动脉旁淋巴结无肿大。结论肾乳头状细胞癌CT平扫实质部分多为稍高密度,常有坏死、囊变,增强扫描呈轻中度持续强化,有助于本病的诊断。

Purpose To analyze the CT findings of papillary renal cell carcinoma, and to evaluate its significance. Materials and Methods CT manifestations of 15 cases with papillary renal cell carcinoma confirmed by pathology were retrospectively analyzed, including location of the tumors, growth pattern, pseudocapsule, pre-contrast density, enhancement pattern, invasion of the tumor and metastasis lymph node. Results Twelve of fifteen lesions located in the renal cortex, and the other 3 lesions located in the renal parenchyma. The tumors showed expansive growth in 14 cases, and infiltrative growth in 1 case. 12 cases showed complete or incomplete capsule, while 3 cases without capsule. On non-contrast CT scan, tumors showed slightly hyperdensity in 9 lesions, iso-density in 4 lesions, and slightly hypodensity in 2 lesions. Homogeneous density was revealed in 1 case and heterogeneous in 14 cases, with calcification in 5 cases and focal hemorrhage in 2 cases. On dynamic enhanced scan, the mass showed mild to moderate enhancement in the cortical and medullary phase, and mild persistent enhancement in the parenchymal phase. The necrosis showed no enhancement. The tumors invaded into the renal pelvis in 2 cases, into the renal sinus fat in 1 case. There was no lymph node enlargement at the renal hilum and para-aortic. Conclusion CT manifestations of papillary renal cell carcinoma are helpful for the diagnosis, which included slightly hyperdensity on pre-contrast CT scan, necrosis and cystic degeneration, and mild to moderate persistent enhancement on postcontrast CT scan.