肾嗜酸性细胞腺瘤的MSCT表现与病理对照研究

Renal Oncocytoma: MSCT Findings and Pathologic Correlation

目的探讨肾嗜酸性细胞腺瘤的MSCT表现,旨在提高对其诊断的准确性及认识水平。方法回顾性分析21例经手术病理证实的肾嗜酸性细胞腺瘤CT、病理及临床资料,分析比较其CT表现与病理特征。结果 21例肾嗜酸性细胞腺瘤(1例伴发同侧肾血管平滑肌脂肪瘤),9例位于左肾,12例位于右肾。病灶呈圆形或椭圆形,边界清楚,长径1.6-13.5cm,平均6.7cm,其中<4cm者8例,≥4cm者13例。18例平扫呈等或稍高密度,14例见中央星状瘢痕组织,4例瘢痕内显示斑点状钙化。动态增强扫描皮质期及髓质期肿瘤实质均呈轮辐状明显强化,其中15例皮质期实质部分强化高于髓质期,6例髓质期实质部分强化高于皮质期,8例见粗大迂曲血管影,12例表现为由肿瘤周边向中心推进的渐进性强化,4例出现节段性强化逆转,12例中央瘢痕延迟呈轻度强化,13例有假包膜并见延迟强化。结论肾嗜酸性细胞腺瘤是一种富血供肿瘤,MSCT表现具有一定特征性,结合中央星状瘢痕,瘢痕内钙化、假包膜、肿瘤实质轮辐状强化及瘢痕延迟强化等特点有助于肾嗜酸性细胞腺瘤的诊断。

Objective To investigate the MSCT manifestations of renal oncocytoma in order to improve the level of diagnosis and recognition. Methods The MSCT imaging, pathological features and clinical data of renal oncocytoma in 21 patients which had been proved by pathology were retrospectively reviewed. Results CT scans were performed on 21 lesions of renal oncocytoma, one of which accompanied with ipsilateral renal angiomyolipoma. Nine lesions located in the left kidney and 12 in the right kidney. The shape of all lesions appeared round or oval with clear boundaries, The diameters of these lesions ranged from 1.6 cm to 13.5 cm,with a mean of 6.7 cm,Eight lesions were less than 4.0 cm and 13 lesions were greater than or equal to 4.0 cm in diameter. On CT plain scan,8 lesions showed iso-density or slightly hyper-density. A stellate central scar was detected in 14 lesions and punctate calcifications were found in 4 lesions. Dynamic enhancement scan showed spoke-wheel-like enhancement in all lesions in the corticomedullary phase. Fifteen lesions in cortical phase showed higher enhancement than that in parenchymal phase, while 6 lesions in parenchymal phase showed higher enhancement, Eight lesions had thick and tortuous vessels, twelve lesions appeared progressive enhancement from periphery to center,4 lesions presented segmental enhancement inversion and 12 lesions with central stellate scar had light enhancement, enhanced pseuedocapsule was observed around the margin in 13 lesions in the excretory phase. Conclusion MSCT multiphase scanning provides valuable features for the diagnosis of renal oncocytoma.