动态增强多排螺旋CT对乳头状肾细胞癌的诊断价值

The value of dynamic enhanced MDCT in diagnosis of papillary renal cell carcinoma

目的探讨乳头状肾细胞癌(PRCC)多排螺旋CT(MDCT)动态增强的表现及特点,以提高对本病的术前诊断。方法回顾性分析经手术、病理证实并有完整临床和MDCT检查资料的17例PRCC。重点分析肿瘤的部位、形态、大小、肿瘤实质成分、MDCT平扫和多期增强肿瘤实质的密度变化、肿瘤强化方式等。结果17例PRCC均为单侧肾脏肿块,左肾10例,右肾7例;肿瘤呈类圆、椭圆形12例,巨大不规则形5例。肿块最大直径为1.7~13.0 cm,平均长径为(6±4)cm。4例为实性结节,13例肿瘤内出现不同程度的囊变,其中小囊变9例;5例肿瘤内见钙化、出血灶,6例有临近组织侵犯或淋巴结转移。PRCC非囊变、坏死区MDCT平扫、增强皮质期、髓质期及分泌期CT值分别为33~43 Hu、40~97 Hu、50~84 Hu、51~72 Hu。对应CT值均数分别为(38±3)Hu、(64±17)Hu、(67±11)Hu及(64±6)Hu。肿瘤实质多期增强CT值差异无统计学意义(P>0.05)。肿瘤实质呈轻-中度强化,呈"慢进缓出"改变。结论 PRCC的动态增强MDCT表现具有一定的特点,有助于提高该肿瘤的术前诊断准确率。

Objective To explore the significance of dynamic enhanced multi-detector CT（MDCT） in diagnosis of papillary renal cell carcinoma. Methods A retrospective analysis of 17 cases of PRCC which were confirmed by surgery and pathology with complete clinical and MDCT findings. The analysis majorly focused on the location, shape,size and CT value change of parenchyma component about MDCT plain scan and multi-phase enhancement. Results Seventeen cases of papillary renal cell carcinoma were all single, in which 10 cases were in left kidney, 7 cases were located in right kidney, with 12 cases were round and 5 cases were big irregular tumors. The tumor maximum size was1.7-13.0 cm,The mean tumor size（6±4）cm. Tumors showed homogeneous in 4, inhomogeneous with cystic degeneration and necrosis in 13, calcification and hemorrhage in 5,local invasion or lymphatic metastasis in 6.The CT value of parenchymal of tumors in MDCT plain scan,enhancement CT（cortex phase, medullary phase and secretory phase）were respectively 33-43 Hu、40-97 Hu、50-84 Hu、51-72 Hu. The mean CT values were respectively（38±3）Hu、（64±17）Hu、（67±11）Hu、（64±6）Hu. The CT values in multi-phase enhancement had no significant difference（P0.05）. The parenchyma component of tumors exhibited mild-moderate enhancement, showed ＂slow in and out ＂. Conclusion The dynamic enhanced MDCT features of papillary renal cell carcinoma showed some specific findings which may be useful to improve the diagnostic accuracy.