CT对肾脏嫌色细胞癌、嗜酸细胞瘤、乏脂肪血管平滑肌脂肪瘤的诊断价值

Clinical value of CT in differential diagnosis of chromophobic renal cell carcinoma,renal oncocytoma and lack-fat angiomyolipoma

目的探讨CT对肾脏嫌色细胞癌、嗜酸细胞瘤、乏脂肪血管平滑肌脂肪瘤的鉴别诊断价值。方法回顾性分析经过手术病理证实的16例嫌色细胞癌、12例嗜酸细胞瘤、9例乏脂肪血管平滑肌脂肪瘤的CT表现,并对三种肿瘤的增强扫描皮髓质期、实质期、排泄期的CT值和肿瘤-肾皮质强化指数进行比较,探讨三种肿瘤的影像差异。结果 1)嫌色细胞癌43.7%(7/16)皮髓质期均匀强化,与另外两组差异有统计学意义(P<0.05)。嗜酸细胞瘤33.3%(4/12)出现"星芒状瘢痕",与另外两组差异有统计学意义(P<0.05);2)增强扫描皮髓质期、实质期和排泄期嫌色细胞癌的CT值及肿瘤-肾皮质强化指数分别为71.6±18.2及0.43±0.16、75.3±15.4及0.43±0.18、65.5±16.3及0.53±0.15,嗜酸细胞瘤为93.1±17.3及0.58±0.17、85.1±24.8及0.54±0.21、63.8±7.4及0.51±0.09,乏脂肪血管平滑肌脂肪瘤分别为87.3±31.5及0.58±0.20、84.5±29.3及0.55±0.25、83.4±26.5及0.69±0.22,皮髓质期嫌色细胞癌与另外两组肿瘤病灶CT值和强化指数差异有统计学意义(P<0.05),排泄期乏脂肪血管平滑肌脂肪瘤与另外两组CT值和强化指数差异有统计学意义(P<0.05)。结论 CT检查对于三种肿瘤的鉴别诊断有一定价值,特别是增强扫描皮髓质期和排泄期肿瘤CT值和肿瘤-肾皮质强化指数有助于三种肿瘤的鉴别。

Objective To explore the clinical value of CT in the differential diagnosis among chromophobic renal cell carcinoma （CRCC） , renal oncocytoma （RO） and lack-fat angiomyolipoma （AML）. Methods CT manifestations of 16 patients with CRCCs, 12 patients with ROs, and 9patients with lack -fat AMLs, who were all confirmed by surgical pathology, were retrospectively analyzed in this work. And then, the CT values of three types of disorders at corticomedullary phase, nephrographic phase and excretory phase as well as the enhancement index （ EI ） of Cancer-renal cortex were compared so as to determine imaging differences of three types of lesions. Results 1 ） Both 43.7% of CRCCs （7/16） were shown homogeneous enhancement on corti- comedullary phase, which had statistical difference （ P 〈 0.05 ） in eomparision to that of the other two tumors. 33.3% of ROs （4/12） appeared ＂Central stellate star scars＂, which had statistical difference （ P 〈 0.05 ） rin comparision to that of the othe two tumors ; 2） CT values of CCRC on corticomedullary phase, nephrographic phase and excretory phase as well as EI of cancerrenal cortex at the enhanced phase were 71.6 ±18.2, 0.43 ±0.16, 75.3 ±15.4, 0.43 ±0.18, 65.5 ± 16.3, and 0.53 ±0. 15, respectively; CT values of ROs were 93.1 ±17.3,0.58 ±0.17, 85.1 ±24.8, 0.54 ±0.21,63.8 ±7.4, and 0.51 ±0.09, respectively; CT values of lack-fat AMLs were 87.3 ±31.5, 0.58 ±0.20, 84.5 ± 29.3, 0.55 ±0.25, 83.4 ±26.5, and 0.69 ±0.22, respectively. CT values and EI at corticomedullary phase of CRCCs showed statistical difference in comparision to those of the other two tumors （ P 〈 0.05 ）. CT values and EI at excretory phase of lack-fat AMLs showed statistical difference in comparision to those of the other two tumors （ P 〈 0.05 ）. Conclusion Imaging features of CT, especially, the CT values and EI at corticomedullary phase and excretory phase, can provide more useful information in the differential diagnosis among CRCC, RO, and lack-fat AML.