不同肾细胞癌病理亚型影像学特点

目的分析肾细胞癌不同亚型影像学特点,提高诊断水平。方法对37例肾细胞癌（其中透明细胞癌29例、乳头状癌7例、嫌色细胞癌1例）的B超、CT、MRI影像学差异进行比较分析。结果32例实性肾癌B超示：透明细胞癌多表现为低回声（20／26）,乳头状癌多为等或弱强回声（4／5）,嫌色细胞癌呈中强回声,透明细胞癌与非透明细胞癌差异有统计学意义（P=0．005）。29例实性肾癌行CT检查：透明细胞癌（23例）和非透明细胞癌（6例）平扫均显示软组织密度影,但强化后透明细胞癌表现出明显的不均匀强化,增强幅度明显高于非透明细胞癌（P=0．004）。17例实性肾癌行MRI检查,透明细胞癌T2WI多为高信号（10／11）,与乳头状癌的T2WI等／低信号（5／5）比较差异有统计学意义（P〈0．01）。结论综合术前B超、CT、MRI影像学检查结果,有助于肾细胞癌亚型的术前诊断。

To analyze the characteristic imagery of renal cell carcinoma with distinct histological subtypes

OBJECTIVE: To analyze characteristic imagery of renal cell carcinoma with distinct histological subtypes and to increase the level of the diagnose and treatment in renal cell carcinoma. METHODS: 32 cases of parenchymatous renal cell cancer consisting of 26 conventional clear cell renal cell carcinoma, 5 cases of indolent papillary and 1 case of chromophobe carcinomas were compared with the different imagery features. RESULTS: All parenchymatous renal cell cancer patients underwent ultrasound, renal lesions showed parenchymatous echo of cortex renis. Most of the clear-cell carcinoma (20/26) demonstrated a low echo-level, papillary carcinoma (4/5) showed an ambly-high-level echo, chromophobe carcinoma showed a high-level echo. There was a significant differences the echo level between the conventional clear cell renal cell carcinoma and nonconventional clear cell RCC (P=0.005). 29 of 32 case, including 23 cases of conventional clear cell tumors and 6 cases of nonconventional clear cell RCC, underwent CT scanning: all renal lesions showed soft tissue density, but there was a significant difference between conventional and nonconventional clear cell renal cell carcinoma in contrast enhancement in either inhomogeneous enhancement (22/23 vs 3/6, P=0.004). 17 cases (11 with conventional clear cell renal cell carcinoma, 1 with chromophobe carcinoma and 5 with papillary carcinoma) underwent MRI. 10 of the conventional clear cell renal cell carcinoma showed hyperintense on T2WI (10/11) cases papillary tumor showed hypointensity on T2WI (5/5) them (P<0.01). CONCLUSION: The different imagery features in conventional and nonconventional clear cell renal cell carcinoma according to preoperative imaging examination (ultrasound and computed tomography and magnetic resonance imaging) are helpful in the diagnosis and treatment of renal cell carcinoma.