增强CT参数在肾癌术前病理分型中的价值

Value of contrast-enhanced CT parameters in preoperative differentiation of pathology subtypes of renal cell carcinoma

目的:探讨肾癌(RCC)在增强CT各期中的表现及增强CT参数在肾癌术前病理分型中的价值。方法:回顾性分析149例肾癌(包括透明RCC 131例、乳头状RCC 12例和嫌色RCC 6例)患者的四期CT(平扫期、皮质期、实质期及排泄期)扫描图像,结合术后病理进行对比分析,比较各期肾癌绝对增强值、病灶强化百分比、峰值出现时相等参数。结果:透明RCC CT值峰值出现于皮质期,且此期透明RCC的CT值明显高于同期的乳头状RCC和嫌色RCC,差异有统计学意义(P<0.05);乳头状RCC及嫌色RCC的CT峰值出现于实质期。皮质期透明RCC的CT绝对增强值、病灶强化百分比均明显高于乳头状RCC及嫌色RCC,差异有统计学意义(P<0.05),而排泄期嫌色RCC绝对增强值高于乳头状RCC,差异有统计学意义(P<0.05)。结论:CT绝对增强值、病灶强化百分比等增强CT参数可与传统CT诊断方法相结合,提高肾癌术前病理分型的诊断准确度。

Objective：To study the value of contrast-enhanced CT manifestations in preoperative differentiation of pathology subtype in renal cell carcinoma（RCC）.Methods：CT manifestations of 149 patients with RCC（including 131 cases of clear cell renal cell carcinoma（ccRCC）,12 cases of papillary renal cell carcinoma（pRCC）and 6cases of chromophobe renal cell carcinoma（cRCC）were retrospectively analyzed.CT enhanced parameters such as absolute enhanced value,percentage of enhancement of lesion,and the phase of peak value were compared.Results：CcRCC reached its peak enhancement in cortical phase and the CT value of ccRCC in this phase was significantly higher than those of pRCC and cRCC,with significant statistic difference（P0.05）.pRCC and cRCC reached their peaks in nephrographic phase.Both the absolute enhancement value and the percentage of enhancement of ccRCC in cortical phase were significantly higher than those of pRCC and cRCC,with significant statistic difference（P0.05）,while the absolute enhancement value of cRCC in excretory phase was higher than that of pRCC,with significant statistic difference（P0.05）.Conclusion：Parameters including absolute CT enhancement value and percentage of enhancement in combination with conventional CT scanning might be helpful to improve the preoperative diagnosis accuracy of pathological type of RCC.