螺旋CT在多种病理亚型肾癌中的诊断价值

Diagnostic value of spiral CT in multiple pathological subtypes of renal cell carcinoma

目的探讨多层螺旋CT多期增强扫描对不同病理亚型肾癌的临床诊断价值。方法回顾性分析我院118例经病理证实的肾癌患者,术前均行多层螺旋CT平扫及三期增强扫描,比较各肾癌亚型CT分期和病理分期的区别,平扫及各期增强的CT值、强化程度、方式,评价螺旋CT多期增强扫描对肾癌分期、分型的诊断价值。结果螺旋CT肾癌分期Ⅰ期77例,Ⅱ期9例,Ⅲ期19例,Ⅳ期13例,与术后病理分期比较,差异无统计学意义(P>0.05)。不同病理亚型肾癌患者CT平扫期、动脉期、实质期、排泄期CT值不同。乳头状癌平扫期CT值明显高于透明细胞癌和嫌色细胞癌(P<0.05)。透明细胞癌增强扫描各期CT值均明显高于嫌色细胞癌及透明细胞癌(P<0.05)。透明细胞癌以不均匀强化为主,而乳头状癌和嫌色细胞癌强化形式较混合。结论不同病理亚型肾癌在多层螺旋CT平扫、增强具有各自特征,多层螺旋CT对肾癌诊断分期及分型准确率较高。

Objective To investigate the clinical value of multi-slice spiral CT multi-phase enhanced scan in different pathological subtypes of renal cell carcinoma.Methods 118 patients with renal cell carcinoma confirmed by pathology in our hospital were retrospectively analyzed.The patients underwent multi-slice spiral CT and three-phase enhanced scan before surgery.The differences between CT staging and pathological staging of renal cell carcinoma,plain and each phase enhanced CT value,degree of enhancement,and methods were compared.The diagnostic value of multi-phase spiral CT scan on staging and classification of renal cell carcinoma were evaluated.Results There were 77 cases of stageⅠ,9 cases of stageⅡ,19 cases of stageⅢ,and 13 cases of stageⅣby spiral CT renal cell staging.There was no significant difference between spiral CT renal cell staging and postoperative pathological stage(P>0.05).The CT values of CT plain scan period,arterial period,parenchymal and excretory periods were different in patients with different pathological subtypes of renal cell carcinoma.The plain scan period CT value of papillary carcinoma was significantly higher than that of clear cell carcinoma and chromophobe cell carcinoma(P<0.05).The CT values of transparent cell carcinoma enhanced scan periods were significantly higher than those of chromophobe cell carcinoma and clear cell carcinoma(P<0.05).Clear cell carcinoma was dominated by uneven enhancement,while papillary carcinoma and chromophobe cell carcinoma were more mixed.Conclusion Different pathological subtypes of renal cell carcinoma have different characteristics in multi-slice spiral CT plain scan and enhancement.Multi-slice spiral CT has higher accuracy in diagnosis and classification of renal cell carcinoma.