肾嫌色细胞癌、嗜酸性细胞瘤与透明细胞癌的多层螺旋CT征象对比研究

摘要

目的 探讨肾嫌色细胞癌(CCRC)、嗜酸性细胞瘤(RO)与透明细胞癌(CCRCC)的多层螺旋CT (MSCT)表现特点,提高肿瘤诊断及鉴别诊断的准确性.资料与方法 回顾性分析东华医院2012年10月-2016年4月经手术病理证实的15例CCRC、8例RO、29例CCRCC的MSCT表现,比较不同肿瘤之间CT征象的特点.结果 CCRCC囊变多见,与CCRC、RO差异有统计学意义(P＜0.05);RO星芒状瘢痕多见,与CCRCC差异有统计学意义(P＜0.05);增强扫描CCRC多数呈明显均匀强化,与CCRCC差异有统计学意义(P＜0.05).CCRCC皮质期、实质期、排泄期病灶-肾皮质密度比值(LKR)与CCRC差异均有统计学意义(P＜0.05);CCRCC皮质期LKR与RO差异有统计学意义(P＜0.05),CCRC三期LKR与RO差异均有统计学意义(P＜0.05).CCRCC的比值差(△LKR)均值与CCRC、RO差异均有统计学意义(P＜0.05),三者△LKR值分布区间存在一定程度的差异.以CCRCC为对象,当皮质期LKR=0.693或△LKR=0.068时,与CCRC及RO鉴别的敏感度均达93.3％、特异度达72.2％或88.9％;以RO为对象,当皮质期LKR=0.656或实质期LKR=0.595时,与CCRC鉴别的敏感度分别达83.3％、91.7％,特异度分别达75.0％、58.3％.结论 MSCT多期增强,尤其是LKR及△LKR值的测算,有助于CCRC、RO、CCRCC的诊断及鉴别诊断.%Purpose To investigate the multi-slice spiral CT (MSCT) features ofchromophobe renal cell carcinoma (CCRC),renal oncocytoma (RO) and clear-cell renal cell carcinoma (CCRCC) for the improvement of its diagnostic accuracy.Materials and Methods The MSCT data of 15 CCRC cases,8 RO cases,and 29 CCRCC cases confirmed by surgery or pathology at Dong H ua Hospital from October 2012 to April 2016 were retrospectively studied.The CT signs of different tumors were compared.Results Most CCRCC cases had cystic degenerations,which showed significant difference with CCRC and RO cases (P＜0.05);RO cases were found mostly with star-shaped scars,which had significant difference with CCRCC cases (P＜0.05);the enhanced scanning showed most of CCRC were enhanced homogeneously,which presented significant difference from CCRCC (P＜0.05).The lesion-kidney-ration (LKR) of CCRCC at cortical phase,parenchymal phase or excretory phase was significantly different from that of CCRC (P＜0.05);the LKR of CCRCC at cortical phase was significantly different from that of RO (P＜0.05);the LKR of CCRC at the three phases were all significantly different from that of RO (P＜0.05).The average △ LKR value of CCRCC was significantly different from that of CCRC and RO (P＜0.05);there was a certain degree of difference distribution of their △ LKR among the three kinds of cases.Taking CCRCC as object,when the LKR at cortical phase was 0.693 or △ LKR was 0.068,the sensitivity reached 93.3％ and the specificity reached 72.2％ or 88.9％ respectively in evaluating the differential diagnosis of CCRC and RO.Taking RO as object,when the LKR was 0.656 at cortical phase or was 0.595 at parenchymal phase,the sensitivity reached 83.3％ and 91.7％ respectively,and the specificity was 75.0％ and 58.3％ respectively,in evaluating the differential diagnosis of CCRC.Conclusion Enhanced MSCT at different phases,especially the calculation of LKR and △ LKR value,can benefit the diagnosis of CCRC,RO and CCRCC.