CT三期增强扫描对T1a期肾透明细胞癌的诊断价值

The diagnostic value of triple-phase enhanced CT scan for T1a clear cell renal cell carcinoma

目的 探讨CT三期增强扫描对T1a期肾透明细胞癌的诊断价值。方法 回顾性分析2013年12月至2020年2月合肥市第二人民医院22例经手术病理证实为T1a期肾透明细胞癌病人的CT平扫及三期增强图像,其中男12例,女10例,年龄范围为41~78岁。观察病灶部位、大小、形态、平扫密度、有无钙化;三期增强扫描病灶的强化时相和强化程度,及其皮质期CT值/腹主动脉CT值,以及病灶的皮质期CT值/同层肾皮质CT值;病灶有无假包膜、劈裂征、转移等征象。在同一扫描层面病灶内的同一区域分别测三期CT值,并在皮质期测腹主动脉CT值和病灶邻近正常肾皮质CT值。结果 22例中共有23个病灶,13例位于左肾,8例位于右肾,1例左右肾各1个;其中22个病灶骑跨肾皮质,1个位于肾髓质内,1个病灶内有钙化。病灶多为类圆形或椭圆形,平扫病灶平均CT值多低于邻近正常肾实质,密度为较均匀、欠均匀或不均匀。三期增强扫描多呈减退性不均匀明显强化表现,且多有假包膜。皮质期病灶/同层主动脉CT值(0.447±0.166),皮质期病灶/同层肾皮质CT值(0.805±0.232),两组比值的数值虽差异明显,却有显著的正相关(相关系数0.61,P=0.002)。结论 T1a期肾透明细胞癌以骑跨肾皮质多见,三期增强扫描是肾癌早期诊断的必要检查手段,对于手术种类的选择提供有力的依据。

Objective To investigate the diagnostic value of triple-phase enhanced CT scan for T1a clear cell renal cell carcinoma(ccRCC).Methods A total of 22 patients(12 males,10 females,age ranging from 41 to 78 years old),who underwent unenhanced and triple-phase enhanced CT and with pathology were confirmed of T1a ccRCC in Hefei Second People's Hospital from December 2013 to February 2020,were retrospectively enrolled in the study.The location,size,shape,CT attenuation and calcification of the lesions were analyzed and recorded.The most enhancement phase of the lesion and enhanced grade were observed by triple-phase enhanced CT scan.In cortical phase,CT value ratio between lesion and abdominal aorta,and CT value ratio between lesion and renal cortex at the same slice were measured and calculated.The lesions characteristics like pseudocapsule,angular interface,metastasis and others were recorded.The CT values from the same area of the lesion were measured by triple-phase enhanced CT scan and CT values of abdominal aorta and renal cortex near the lesion were also measured in cortical phase.Results A total of 23 lesions from 22 patients were en‐rolled for further analysis(13 lesions located in the left kidney,8 in the right and 1 in both).Twenty-two lesions straddled the renal cor‐tex,one located in the renal medulla,and one had calcification.Most of the lesions were round or oval.The average CT value of the le‐sions from unenhanced scan was lower than that of adjacent normal renal parenchyma,and the lesions presented as relatively uniform,hypouniform or uneven.From triple-phase enhanced CT scan,most lesions showed decreased uneven enhancement and mostly with false pseudocapsules.The CT value of cortical lesions/aorta in the same layer was(0.447±0.166),and that of cortical lesions/renal cor‐tex in the same layer was(0.805±0.232).Although there was a significant difference between the two groups,there was a significant pos‐itive correlation(correlation coefficient of 0.61,P=0.002).Conclusions Most of early stage T1a clear cell renal cell carcinoma would straddle renal cortex.The triple-phase enhanced CT scan demonstrates promising diagnostic value for early stage renal cell carcinoma and provides powerful evidence for surgical options.