MSCT多期扫描在肾癌亚型诊断中的应用价值

The Value of Multi-slice Helical CT in the Diagnosis of Different Subtypes of Renal Cell Carcinoma

目的:探讨肾癌(RCC)常见亚型多排螺旋CT(MSCT)多期增强扫描表现,提高诊断准确率。方法:回顾性分析44例经手术病理证实的肾癌的MSCT强化特点。测量CT平扫及多期增强的肿瘤CT值及邻近肾皮质的CT值,对多期相的肿瘤CT值及肿瘤/肾皮质CT值之比值进行比较分析。结果:肾癌3种亚型CT平扫值在统计学上无显著性差异,非透明细胞癌(乳头状肾癌和嫌色细胞癌)在多期增强的皮质期、实质期及延迟期的CT值要低于透明细胞癌(各期P值均为0.000),非透明细胞癌在皮质期、实质期及延迟期的肿瘤/肾皮质CT值的比值与透明细胞癌间有统计学差异(各期P值均为0.000),乳头状肾癌与嫌色细胞癌在增强扫描各期的CT绝对值间比较无统计学差异(P值分别为0.376、0.315、0.382),但在皮质期、实质期及延迟期肿瘤/肾皮质CT值之比值上乳头状肾癌与嫌色细胞癌之间有统计学差异(各期P值分别为0.046、0.031、0.048)。结论:MSCT增强多期扫描有助于鉴别透明细胞癌与其他亚型,但不典型的乳头状肾癌与嫌色细胞癌的鉴别较难。

Objective： To evaluate MSCT features in the diagnosis of renal cell carcinoma. Methods： MSCT appearance of 44 cases with renal cell carcinoma confirmed by surgery and pathology was retrospectively analyzed. The density of the lesion and the adjacent normal renal cortex were calculated in unenhanced and enhanced phases respectively. The ratios of lesion/renal cortex enhancement were calculated for three phases. Results： CT attenuation in unenhanced scan was not statistically different between three subtypes. In cortical, nephrographic and delayed phase, CT attenuation and the ratios of lesion/renal cortex enhancement of clear cell carcinoma were higher than that of papillary and chromophobe renal cells respectively（P value was 0.000 in different phase）. There was no statistically significant difference between CT attenuation of papillary carcinoma and that of chromophobe cell carcinoma in different enhanced phase（P value was 0.376, 0.315, 0.382 respectively）. However, the ratios of lesion/renal cortex enhancement of chromophobe renal cells were higher than that of papillary renal cells carcinoma in cortical, nephrographic and delayed phase respectively（P value was 0.046, 0.031, 0.048 respectively）. Conclusion： Dynamic enhanced CT scan is good for differentiating clear cell carcinoma from other subtypes, but it is hard to discriminate between atypical papillary carcinoma and chromophobe carcinoma.