多排螺旋CT对不同亚型肾癌、肾血管平滑肌脂肪瘤和肾嗜酸细胞腺瘤的诊断价值

Diagonstic value of multislice spiral CT in different subtypes of renal cell carinama,renal angiomyolipoma,and renal oncocytoma

目的探讨不同亚型肾癌、肾血管平滑肌脂肪瘤(RAML)和肾嗜酸细胞腺瘤(RO)的影像学特征,评估分析多排螺旋CT对其准确诊断的价值。方法回顾性收集分析200例经手术病理证实不同类型肾脏肿瘤患者的一般资料和影像学资料,其中肾透明细胞癌(CCRCC)142例,乳头状肾细胞癌(PRCC)15例,肾嫌色细胞癌(CRCC)9例,MiT家族易位性肾细胞癌(MiTFT-RCC)6例,RAML 22例,RO 6例。比较分析不同亚型肾细胞癌、RAML和RO的CT征象、平扫及动态扫描表现,采用卡方检验和单因素方差分析比较。结果 CCRCC和PRCC男性多发,RAML和RO女性发病率较高,MiTFT-RCC发病年龄较早,各组出现肉眼血尿及腰部不适等临床表现之间没有显著差异(P>0.05)。肾脏肿瘤的发病位置、肿块形状、最大横截面长径以及是否发生转移或癌栓等表现均无显著统计学差异(P>0.05),而对于肿块的异质性、囊变坏死、钙化以及脂肪的发生率上均存在一定的显著差异(P<0.05)。肾癌中的MiTFT-RCC平扫的CT值要显著高于其他各组,CCRCC强化方式呈"快进快出";PRCC、CRCC和MiTFT-RCC增强扫描主要呈"渐进性"的延迟强化;RAML含有脂肪成分,其强化与CCRCC类似,RO强化方式呈"早进晚出"方式,肿块中心有星芒状瘢痕。

Objective To explore the diagonstic value of multislice spiral CT by investigating the imaging features of four subtypes of renal cell carcinoma,renal angiomyolipoma,and renal oncocytoma. Methods The retrospective study collected the demographic and CT data of 200 patients with renal tumors proved by postoperative pathology,including 142 cases of clear cell renal cell carcinoma（CCRCC）,15 cases of papillary renal cell carcinoma（PRCC）,9 cases of chromophobe renal cell carcinoma（CRCC）,6 cases of MiT Family Translocation-Associated Renal Cell Carcinoma（MiTF-RCC）,22 cases of renal angiomyolipoma（RAML）,and 6 cases of renal oncocytoma（RO）. All subjects were conducted the dynamic contrast-enhanced CT and the data were analyzed by chi-square test and one-way analysis of variance. Results The incidences of CCRCC and PRCC were high among male,while RAML and RO were higher among female. And the onset age of MiTF-RCC was earlier than others in this study. There was no significant difference in the presence of gross hematuria and lumbar discomfort among all groups（both P〈0. 05）. Besides,the incidence location,tumor shape,long diameter,metastasis or tumor thrombi of renal tumors showed no significant difference（all P〈0. 05）. While the tumor heterogeneity,cystic necrosis,calcification,and fat composition showed significant difference（all P〈0. 05）. MiTFT-RCC showed significant higher CT values than other groups in plain CT scan. The enhancement degree of CCRCC was highest among all groups with ＂early into quick out＂. The enhancement degrees of PRCC,CRCC,and MiTFT-RCC were lower than CCRCC,RAML,and RO,and they showed delayed enhancement. Most RAML contains fat composition and the enhanced pattern were similar to CCRCC. The enhancement of RO showed＂early into late out＂pattern with stellate scar in the center of mass. Conclusion The different features of multislice spiral CT in different types of renal tumors have significant values for accurate diagnosis.