肾癌少见亚型的多层螺旋CT特征

CT features and comparative study of the rare pathological subtypes of renal cell carcinoma

目的探讨多层螺旋CT(MSCT)对肾癌少见亚型的诊断价值。方法收集第三军医大学大坪医院经病理证实的除透明细胞癌外的所有肾癌资料,包括嫌色细胞癌(Ch RCC)14例,乳头状癌(PRCC)Ⅰ型10例,PRCCⅡ型15例,黏液样小管状和梭形细胞癌(MTSCC)7例,对比分析所有CT征象和强化特点。结果 4种肾癌亚型在强化均匀度、边界、有无侵犯肾盂、肿瘤内血管影等指标上的差异有统计学意义,Ch RCC在三期增强扫描的CT值均高于其他3种肾癌亚型,分别与PRCCⅠ型、PRCCⅡ型和MTSCC的差异有统计学意义(P<0.05)。仅MTSCC在增强各期的强化程度都低于肾髓质,其余亚型在皮质期的强化程度均高于肾髓质。结论 MSCT结合增强扫描在上述4种肾癌亚型的鉴别诊断中有着较高的临床应用价值。

Objective To investigate the differential MSCT diagnostic features and comparative study of subtypes of renal cell carcinoma （RCC）. Methods All of the renal cell carcinomas including 14 chromophobe RCCs （ChRCC）, 10 papillary RCCs type 1（PRCC Ⅰ）, 15 papillary RCCs type 2 （PRCC Ⅱ）, 7 mucinous tubular and spindle cell carcinomas （MTSCCs） were investigated except for clear cell RCC. Dynamic contrast-enhanced CT was conducted in each case after intravenous administration of contrast agent, and the data including all the CT manifestations and the enhancement features were analyzed and contrasted together. Results The indexes including enhancement homogeneity, border of the tumor, renal pelvis violation, blood vessel in tumor showed statistically significant difference between the 4 subtypes （P〈0.05）, but no difference in the calcification of the tumor. Only the enhancement degree of MTSCC was lower than the kidney medulla in all of the three enhancement scanning phases, while the other 3 tumors＇ enhancement degree was higher than the kidney medulla in the cortical phase. Peak contrast enhancement of ChRCC was located in the cortical phase, however, peak contrast enhancement of the others did in the nephrographic phase. Conclusions Enhancement characteristics combined CT features is of great help in differential diagnosis of 4 subtypes of RCC.