多层螺旋CT鉴别肾癌WHO病理类型的应用价值

目的：探讨多层螺旋CT鉴别不同类型肾癌的价值。方法：回顾性分析经病理证实的92例肾癌的CT表现，依据WHO病理分类包括透明细胞癌54例、乳头状癌25例、嫌色细胞癌13例。比较平扫、皮髓质期、肾实质期及排泄期各类肾癌的CT值及强化模式。结果：3种肾癌在平扫的CT值无统计学差异。在增强扫描皮髓质期、肾实质期及排泄期，透明细胞癌的CT值均高于乳头状癌和嫌色细胞癌，而后两者在增强各期均无统计学差异。均匀强化最常见于嫌色细胞癌，不均匀强化最常见于透明细胞癌。螺旋CT鉴别透明细胞癌与非透明细胞癌的准确性在皮髓质期、肾实质期、排泄期分别为93.5%、86.9%、81.5%。结论：多层螺旋CT鉴别透明细胞癌与非透明细胞癌有应用价值，但较难鉴别乳头状癌和嫌色细胞癌。

Diagnostic value of multi-slice helical CT for differentiating WHO subtypes of renal carcinoma

Objective:To evaluate the efficacy of multi-slice helical CT for differentiating subtypes of renal carcinoma(RC).Methods:Ninty-two RCs confirmed by pathology according to WHO classification including 54 clear cell carcinomas,25 papillary and 13 chromophobe RCs,were retrospectively analyzed.CT attenuation in unenhanced,corticomedullary,nephrographic and excretory phase,and pattern of enhancement were compared.Results:CT attenuation on unenhanced scan was not statistically different.CT attenuation of clear cell carcinoma was higher than that of papillary and chromophobe RCs in corticomedullary,nephrographic and excretory phase,while that of papillary and chromophobe RCs was not statistically different in all three phases.Homogeneous and heterogeneous enhancement was most commonly seen in chromophobe RC and clear cell carcinoma,respectively.Accuracy of CT for differentiating clear cell and non-clear cell carcinoma in three enhanced phases was 93.5%,86.9% and 81.5%,respectively.Conclusion:Multi-slice helical CT was effective for differentiating clear cell from non-clear cell carcinoma,but has little value in differentiating papillary from chromophobe RC.