肾透明细胞癌、嫌色细胞癌及嗜酸细胞腺瘤的MSCT鉴别诊断

摘要

Purpose:To explore the differential diagnostic value of three-phase dynamic enhanced scan of multislice spiral CT (MSCT) in clear cell renal cell carcinoma (CCRCC),chromophobe renal cell carcinoma (CRCC) and oncocytomas (OA).Methods:Double blind methods were used to analyze the CT images of 55 cases of CCRCC,16 cases of CRCC and 9 cases of OA which were confirmed by surgery and pathology results retrospectively.The tumor size,component (solid,cystic-solid and cystic),corrected enhancement CT value (plain and corticomedullary phase,parenchymal phase,excretory phase) and enhancement pattern (homogeneous enhancement,heterogeneous enhancement and peripheral enhancement) were compared among the three kinds of tumors.Results:① There was no statistical significant difference of the maximum diameter among the three groups.② The component of CRCC was mainly solid,while CCRCC was mainly cystic-solid.The proportion of the solid and cystic-solid component was similar in OA.The difference of component among the three groups was with statistical significance (x2=14.10,P ＜0.001).③ The corrected enhancement CT value of CCRCC was higher than that of CRCC and OA in the corticomedullary phase,the difference was statistical significance (P ＜0.001),but there was no statistical significant difference between CRCC and OA (P ＞0.05).The corrected enhancement CT value of CCRCC was higher than that of CRCC in the parenchymal phase,the difference was with statistical significance (P ＜0.001),but there was no statistical significant difference between CCRCC and OA,CRCC and OA (P ＞0.05).The corrected enhancement CT value of OA was between that of CCRCC and that of CRCC.The corrected enhancement CT value of CRCC was lower than that of CCRCC and OA in the excretory phase,the difference was with statistical significance (P ＜0.05),but there was no statistical significant difference between CCRCC and OA (P ＞0.05).) The difference of enhancement pattern between CCRCC and CRCC,CCRCC and OA was with statistical significance (x2=15.89,P ＜0.001 and x2=1 1.15,P ＜0.05 respectively),but there was no statistical significant difference between CRCC and OA (P ＞0.05).Conclusion:The corrected enhancement CT value is an important index in differential diagnosis of renal tumors.The tumor component and enhancement pattern also have certain differential diagnostic significance.%目的:探讨多层CT (MSCT)三期动态增强扫描对肾透明细胞癌(CCRCC)、嫌色细胞癌(CRCC)及嗜酸细胞腺瘤(OA)的鉴别诊断价值.方法:采用双盲法回顾性分析经手术及病理证实的55例CCRCC、16例CRCC及9例OA患者的CT图像,比较三者在肿瘤大小、性质(实性、囊实性及囊性)、校正强化CT值以及强化形式(均匀强化、不均匀强化及周边强化)等方面的差异.结果:①三组肿瘤最大径无显著性差异.②CRCC以实性为主,CCRCC以囊实性为主,OA实性与囊实性所占比例相仿,三者间有显著性差异(x2=14.10,P＜0.001).③皮髓质期CCRCC校正强化CT值高于CRCC及OA(P＜0.001),而CRCC与OA间无显著性差异(P＞0.05);实质期CCRCC校正强化CT值高于CRCC(P＜0.001),而CCRCC与OA及CRCC与OA间无显著性差异(P＞0.05),OA校正强化CT值介于CCRCC与CRCC之间;排泄期CRCC校正强化CT值低于CCRCC与OA (P＜0.05),而CCRCC与OA间无显著性差异(P＞0.05).④强化形式比较,CCRCC与CRCC及CCRCC与OA间差异具有统计学意义(x2=15.89,P＜0.001和x2=11.15,P＜0.05),而CRCC与OA间差异无统计学意义(P＞0.05).结论:肿瘤的校正强化CT值是鉴别肾肿瘤类型的一个重要指标,而肿瘤的成分性质及强化形式也具有一定的鉴别意义.