多层螺旋CT增强扫描及后处理技术对肾癌及肾癌亚型的诊断价值

摘要

Objective To evaluate the contrast enhancement and post-processing techniques in multi-slice spiral CT in the diagnosis of renal cell carcinoma and renal cell carcinoma subtype. Methods 35 cases of renal cell carcinoma proved pathologically by operation were retrospectively analyzed. Results 35 patients were single lesions, including 28 cases of clear cell carcinoma, of which 2 cases were combined sarcoma-like cells, 1 case of clear cell and granular cell carcinoma, 5 cases of papillary renal cell carcinoma cell, 1 case of ehromophobe cell renal cell carcinoma, and 1 case of multilocular cystic renal cell carcinoma. In 28 patients the lesion were seen as medium density, low density, minimal high density or mixed density mass and all lesions showed marked enhancement in cortical phase. The degree of enhancement in 10 cases was lower than the renal cortex yet the degree of 18 cases was higher than the renal cortex. The tumor density dropped rnpromptly in parenchymal phase. Necrosis and cystic degeneration with hemorrhage appeared in 17 cases. Papillary renal cell carcinoma and chromophobe cell type renal cell carcinoma scan showed low density mass with no enhancement phase enhanced. Conclusion Different enhancement method and imaging findings of subtypes of renal cell carcinoma is correlated with the pathologic type. Multi-phase enhanced helical CT scan has great value in the diagnosis of renal cell carcinoma and renal cell carcinoma subtype.%目的 探讨多层螺旋CT增强扫描及后处理技术对肾癌及肾癌亚型的诊断价值.方法 对经手术病理和临床证实的资料完整的35例肾癌结合文献复习进行回顾性分析.结果 35例患者均为单发病变,包括透明细胞癌28例,其中合并肉瘤样细胞2例,透明细胞与颗粒细胞癌1例；乳头状细胞型肾癌5例,嫌色细胞型肾癌1例,多房囊性肾癌1例.28例肾透明细胞癌平扫表现为均匀或不均匀的等、低、稍高或混杂密度肿块,增强皮质期明显不均匀强化,皮质期强化程度10例低于肾皮质,18例高于肾皮质,髓质期强化程度均迅速消退；伴出血坏死及囊变17例.肾细胞癌中乳头状细胞型肾癌和嫌色细胞癌表现为平扫低密度肿块,三期增强无明显强化.结论 肾癌亚型增强扫描不同强化方式和影像表现与病理类型具有相关性,多层螺旋CT三期增强扫描在肾癌及肾癌亚型诊断中具有重要价值.