CT三期动态增强扫描在肾癌诊断中的临床价值研究

Clinical Value of CT Three Phase Dynamic Enhanced Scan in the Diagnosis of Renal Cell Carcinoma

目的旨在探讨CT三期动态增强扫描在肾癌诊断中的临床价值。方法选取我院2015年1月-2017年1月收治的肾癌患者58例,收集58例患者的临床资料、影像学资料等,分析58例肾癌患者CT平扫及CT三期增强扫描的图像表现,并以手术或病理学活检结果为标准,比较CT平扫与CT三期增强扫描对肾癌的检出率及诊断准确率。结果 CT平扫准确诊断患者例数为43例,准确诊断率为74.13%,明显低于三期动态增强扫描98.27%(57/58)差异具有统计学意义(χ2=1 4.2 1 0,P<0.0 0 1);C T平扫中5 8例肾癌患者平均CT值(32.17±8.54)HU,平均病灶直径(4.95±4.30)cm;多数病灶呈等密度状态密度较均匀,主要表现为病灶旁肾周间隙内出现"毛刺"、"线状"结构。三期动态增强扫描中,动脉期平均CT值(85.11±30.44)HU,实质期平均CT值(62.10±21.64)HU,多数患者病灶外观呈个类圆形,6例患者呈不规则形;动脉期均出现不同程度的中-高度强化,其中49患者增强后可见清晰边界,多数患者可见假包膜、"短刺"征,中心区出血、坏死、囊变及钙化未出现明显强化;实质期强化程度逐渐减弱,病灶区域呈现"快进快退"特征,静脉期扫描强化程度减弱明显。结论 CT三期动态增强扫描对肾癌准确诊断率高,可清晰显示病灶情况,为临床治疗提供可靠影像学资料。

Objective To investigate the clinical value of CT three phase dynamic enhanced scan in the diagnosis of renal cell carcinoma.Methods Select 58 patients with renal cell carcinoma treated in our hospital from January 2015 to January 2017,collect the clinical data and imaging data of 58 patients,image analysis of plain scan and CT three phase enhanced scan in 58 patients with renal cell carcinoma(CT),the detection rate and diagnostic accuracy of CT plain scan and compare the CT three phase enhanced scan with the results of operation or pathological biopsy.Results 43 cases were diagnosed by CT plain scan,the accurate diagnosis rate was 74.13%,which was significantly lower than three phase dynamic enhanced scan 98.27%(57/58),the difference was statistically significant(χ2=14.210,P<0.001).The mean CT value(32.17±8.54)HU and mean lesion diameter(4.95±4.30)cm in 58 patients with renal cell carcinoma were detected by CT scan.The density of most lesions was homogeneous,with the appearance of"burr"and"linear"structure in the perirenal space of the lesion.The three phase dynamic enhanced scan,the mean CT value(85.11±30.44)HU in the arterial phase,and the mean CT value(62.10±21.64)HU in the parenchymal phase,most of the lesions showed a round shape,and 6 patients showed irregular shape.The arterial phase showed varying degrees of height enhancement,of which 49 patients with enhanced visible boundary,the majority of patients with pseudocapsule,"short thorn"syndrome,central area of hemorrhage,necrosis and cystic change and calcification showed no obvious enhancement.Parenchymal enhancement degree gradually weakened,"fast"lesions showed features,venous phase scanning enhancement decreased significantly.Conclusion CT three phase dynamic enhanced scan is of high accuracy in diagnosis of renal cell carcinoma,and can clearly display the lesion,providing reliable imaging data for clinical treatment.