多模态影像技术联合对肾集合管癌诊断价值的研究

Study on the Diagnostic Value of Multimodal Imaging Technology in Collecting Duct Carcinoma

目的探讨多层螺旋CT(MSCT)、MRI、氟代脱氧葡萄糖(^(18)F-FDG)PET/CT多模态影像学检查对肾集合管癌(CDC)诊断的价值,提高术前诊断准确率。方法回顾性分析经手术病理证实的CDC患者15例,术前均行多期增强CT扫描,其中3例行MRI增强扫描,3例行^(18)F-FDG PET/CT扫描。通过影像与病理对照,并复习文献,总结多模态影像检查对CDC的诊断价值。结果病灶位于左肾8例,右肾6例,1例左肾CDC并发右肾透明细胞癌,其中12例呈实性,3例囊实性。CT表现:5例主要累及肾髓质区域,肾脏轮廓改变不明显,4例向肾包膜外隆起或侵犯肾筋膜囊,4例侵犯肾盂,2例肾盂、实质及肾筋膜囊广泛受累。9例可见肾门和/或后腹膜淋巴结肿大,4例可见肾静脉癌栓。增强CT显示病灶均呈轻-中度渐进性强化,5例增强图像出现“犬牙交错”征象。MRI表现:3例病灶T_(1)WI为等或稍高信号,T_(2)WI为稍低信号,扩散加权成像(DWI)呈明显高信号,表观扩散系数(ADC)值平均为0.975×10^(-3)mm^(2)/s。PET/CT表现:肿瘤实质^(18)F-FDG高摄取,最大标准摄取值(SUV_(max))平均为7.41。病理检查显示瘤体细胞乳头状、腺腔样排列,间质中纤维组织增生明显,可见大量炎症细胞浸润。结论CT对病变部位、大小形态显示良好,动态增强扫描可反映血供特征;MRI对肿瘤纤维成分及囊变坏死的显示清晰,^(18)F-FDG PET/CT对淋巴结及全身转移显示更佳,三者联合应用更有助于全面反映CDC的病理基础及生物学特征。

Objective To explore the MSCT,MRI and^(18)F-FDG PET/CT imaging manifestations and pathological basis of collecting duct carcinoma(CDC),so as to deepen the imaging understanding of this disease and improve the accuracy of diagnosis.Methods The data of 15 cases of renal collecting duct carcinoma confirmed by surgery and pathology were retrospectively analyzed.All of patients underwent multi-phase enhanced CT scans,of which 3 cases received enhanced MRI scans,and 3 received PET/CT scans.Summarizing the imaging manifestations and discussing the related pathological basis by comparing the imaging with pathology and reviewing literature.Results 8 cases of lesions were located in the left kidney,6 cases were in the right kidney,1 case had left kidney CDC complicated with clear cell carcinoma of the right kidney,among which 12 cases were solid and 3 cases were cystic solid.5 cases mainly involved the renal medulla area,and the renal contour changes were not obvious.4 cases bulged out of the renal capsule or invaded the renal fascia sac,4 cases invaded the renal pelvis,and 2 cases were extensively involved in the renal pelvis,parenchyma and renal fascia sac.9 cases showed enlarged renal hilum and/or retroperitoneal lymph nodes and invaded the perirenal fat space(60%,9/15 cases),renal venous carcinoma thrombus was observed in 4 cases(26.7%,4/15 cases).MRI:3 lesions showed equal or slightly high signal on T_(1)WI,slightly low signal on T_(2)WI,and obvious high signal on DWI with the average ADC value was 0.975×10^(-3)mm^(2)/s.Enhanced scan tumor parenchyma showed light-to-moderate progressive enhancement and“canine staggered”characteristic were observed in 5 cases(33.3%,5/15 cases).PET/CT:high uptake of^(18)F-FDG in tumor parenchyma,and the average SUV_(max)value was 7.41.The pathological examination showed papillary and glandular arrangement of tumor cells,proliferation of fibrous tissue in the stroma and infiltration of inflammatory cells.Conclusion CT shows lesion location,size and morphology well,and dynamic enhancement can reflect the characteristics of blood supply.MRI shows clear fibrous components and cystic necrosis of tumor,^(18)F-FDG PET/CT shows better for lymph node and systemic metastasis.The combined application of these three is more helpful to comprehensively reflect the pathological basis and biological characteristics of renal tubular carcinoma.