肾实质型肾盂癌多层螺旋CT增强扫描的影像表现

The Imaging Manifestations of Enhanced Multi-slice Spiral CT in Renal Parenchymal Renal Pelvis Carcinoma

目的探讨肾实质型肾盂癌多层螺旋CT增强扫描的表现,提高对其诊断水平,减少误诊率。方法收集我院2016年6月~2019年12月经手术病理证实为肾盂癌且术前均行多层螺旋CT平扫加增强扫描的65例患者影像资料,回顾分析其CT影像表现,根据有无肾实质受侵分为实质型16例,肾盂型49例,再将实质型按有无肾盂内肿块分为A型伴有肾盂(盏)内肿物11例,B型肾盂(盏)内无明显肿物5例,比较不同亚型的术前误诊率及其特征性CT表现。结果实质型肾盂癌16例中A型术前CT诊断误诊率为45.45%,B型术前CT诊断误诊率为80.00%;两种亚型主要CT表现:A型平扫瘤体呈稍低密度2例、等密度6例、稍高密度3例;B型平扫瘤体呈稍低密度1例、等密度3例、混杂密度1例。A型肾局部强化减低9例,2例全肾强化减低;B型肾局部强化减低4例,1例全肾强化减低。A型皮髓质及瘤肾分界不清各有10例;B型皮髓质及瘤肾分界不清各有4例,B型仅有1例与肾实质分界清。A型和B型各有1例其内见坏死;A型有7例局部肾窦脂肪模糊,B型均无肾窦脂肪模糊。A型患侧肾积水8例,B型患肾积水1例。A型5例肾周脂肪受侵及,B型4例肾周脂肪受侵及。A型和B患肾伴有肾结石各1例,B型1例肿瘤内伴钙化。A型淋巴结转移及脉管受侵2例,B型无明显淋巴结转移及脉管受侵。结论实质型肾盂癌术前CT诊断的误诊率高,以B型最为显著,但其多层螺旋CT多期增强扫描有特征性表现;应加强对实质型肾盂癌CT表现的认识,以期提高对实质型肾盂癌的诊断准确率,为临床治疗及手术提供更精准指导。

0bjective To explore the performance of enhanced multi-slice spiral CT scanning of renal parenchymal renal pelvis cancer,improve the diagnosis level and reduce the misdiagnosis rate.Methods Collecting the imaging data of 65 patients with renal pelvic cancer confirmed by surgery and pathology in our hospital from June 2016 to December 2019 and underwent multi-slice spiral CT plain scan plus enhanced scan before the operation,and retrospectively analyzed their CT imaging performance.Parenchymal invasion was divided into 16 cases of parenchymal type and 49 cases of renal pelvis type.According to the presence or absence of intrarenal pelvic masses,the substantive type was divided into 11 cases with renal pelvis(calyx)tumors and 5 cases with no obvious tumors in the renal pelvis(calyx)type B.The preoperative misdiagnosis rates of different subtypes were compared and Its characteristic CT appearance.Results Among 16 cases of solid renal pelvis cancer,the misdiagnosis rate of preoperative CT diagnosis of type A was 45.45%,and the misdiagnosis rate of preoperative CT diagnosis of type B was 80.00%;the main CT manifestations of the two subtypes:type A plain scan tumors showed slightly low density 2 There were 6 cases of iso-density,3 cases of slightly higher density;Type B plain scan tumor body was 1 case of slightly lower density,3 cases of iso-density,and 1 case of mixed density.There were 9 cases of type A renal local enhancement,2 cases of total renal enhancement;type B renal local enhancement of 4 cases,1 case of total renal enhancement.There were 10 cases of type A cortical medulla and unclear tumor-kidney boundaries;4 cases of type B cortical medulla and tumor-kidney boundaries were unclear,and only 1 case of type B was clearly separated from renal parenchyma.There were 1 case of type A and type B each with necrosis;type A had 7 cases of local renal sinus fat obscuration,and type B had no renal sinus obscuration.There were 8 cases of type A with hydronephrosis and 1 case of type B with hydronephrosis.There were 5 cases of type A with perirenal fat invasion,and 4 cases of type B with perirenal fat invasion.Type A and type B had kidney stones in 1 case each,and type B had 1 case of tumor with calcification.There were 2 cases of type A lymph node metastasis and vascular invasion,while type B had no obvious lymph node metastasis and vascular invasion.Conclusion The preoperative CT diagnosis of solid renal pelvis cancer has a high rate of misdiagnosis,with type B being the most significant,but its multi-slice spiral CT multi-phase enhanced scan has characteristic manifestations.The understanding of CT manifestations of solid renal pelvis cancer should be strengthened in order to improve the The diagnostic accuracy of parenchymal renal pelvis cancer provides more accurate guidance for clinical treatment and surgery.