肾嗜酸细胞腺瘤与嫌色细胞癌的MDCT表现及鉴别

Imaging features and differential diagnosis of renal oncocytoma and chromophobe cell carcinoma on MDCT

目的:探讨肾脏嗜酸细胞腺瘤(Renal oncocytoma,RO)与嫌色细胞癌(Chromophobe renal cell carcinoma,ChRCC的多层螺旋CT(MDCT)表现,提高术前诊断准确率。方法:回顾性分析经病理证实的33例RO(33个病灶)和65例ChRCC患者(66个病灶)的临床及影像资料,并比较两组肿瘤的MDCT特征,各影像特征的比较采用卡方检验,CT强化值及相对强化率间比较采用两独立样本t检验。所有病例术前均行MDCT平扫及三期增强扫描。结果:RO和ChRCC二组之间的肿瘤内中央瘢痕、实性部分强化CT值和相对强化率、肿瘤侵犯被膜均有明显统计学意义(P<0.001);发病年龄、肿瘤内节段反转征象、肾盂肾盏受压(伴或不伴侵犯)及瘢痕的强化CT值和相对强化率两组间比较均有统计学意义(P<0.05);两者在性别、有无血尿及腰痛、肿瘤部位、形状、最大径、钙化、囊变及肾门血管侵犯等方面差异无统计学意义(P>0.05)。结论:肿瘤MDCT征象如中央瘢痕、节段反转征象、肿瘤实性部分及瘢痕在增强各期的强化程度及相对强化率、肿瘤侵犯被膜、肾盂肾盏受压(伴或不伴侵犯)对RO及ChRCC有重要的鉴别价值。

Objective:To investigate the multi-detector spiral computed tomography(MDCT)imaging findings of renal oncocytoma(RO)and chromophobe renal cell carcinoma(ChRCC)to improve the accuracy of preoperative diagnosis.Methods:The clinical and imaging data of 33 cases of RO(33 tumors)and 65 cases of ChRCC(66 tumors)confirmed by pathology were retrospectively analyzed,and the MDCT features of two groups were compared.The Chi square test was used to compare the image features,and T-test was used to compare CT enhancement value and relative enhancement rate.All patients underwent MDCT plain scan and three-phase enhanced scan before operation.Results:There were significant differences in the central scar,solid partial enhancement CT value,relative enhancement rate and tumor invasion of capsule between RO and ChRCC groups(P<0.001).Besides,there were significant differences in age,the segmental inversion sign,compression of renal pelvis and calyces(with or without invasion)and scar enhancement CT value and relative enhancement rate between the two groups(P<0.05).There were no significant differences in gender,clinical symptoms,tumor location,shape,maximum diameter,calcification and cysts between the two groups.Conclusion:The MDCT features of the tumor,such as central scar,segmental inversion sign,solid part of the tumor and scar in each phase of enhancement and relative enhancement rate,tumor invasion of capsule,compression of renal pelvis and calyces(with or without invasion)have important differential value for RO and ChRCC.