多排螺旋CT动态增强扫描在浸润型肾盂癌诊断和鉴别诊断中的应用价值

目的探讨多排螺旋CT动态增强扫描对侵犯肾实质而肾盂占位不明显的肾小管逆行浸润型肾盂癌的诊断和鉴别诊断价值，以期提高临床诊断准确性。方法对经手术病理学检查确诊的9例浸润型肾盂癌患者的术前多排螺旋CT平扫、皮髄交界期和实质期动态增强扫描结果进行分析，并与病理学检查结果作对比。结果本组患者的患肾位于右侧6例，左侧3例；8例患肾形态无明显改变，另1例患肾隐约隆起；浸润型肾盂癌病灶形态均不规则，肾盂壁与肾实质分界不清，肾窦脂肪均消失。CT平扫病灶呈等高密度5例，等或稍低密度4例；有钙化或结石3例，出血2例，肾盂内均无明显肿块；CT值17.6~31.5Hu，平均24.6Hu。CT动态增强扫描皮髓交界期呈相对较低密度，CT值29.4~55.2Hu，平均39.8Hu；实质期呈相对低密度，CT值38.2~73.2Hu,平均51.0Hu。结论浸润型肾盂癌从肾盂壁向肾实质浸润生长，患肾肾盂、肿瘤和肾实质分界不清，占位效应不明显，病灶呈轻中度进行性持续强化。多排螺旋CT动态增强扫描对该病诊断和鉴别诊断有重要价值。

Dynamic multi-slice helical CT scan in diagnosis of retrograde invasion of renal pelvis carcinoma

Objective To assess the dynamic multi-slice helical CT scan in diagnosis of retrograde invasion of renal pelvis carcinoma. Methods Nine cases with invasive carcinoma of the renal pelvis with intratubular spread confirmed by surgical pathology underwent multiple helical CT plain scanning and dynamic enhancement scanning before operation, the CT findings were reviewed and analyzed retrospectively in comparison with surgical and pathological results. Results In 9 cases (3 on left and 6 on right side), the shape of kidney was normal in 8 cases and slightly irregular in 1 case. The margin of lesion was not clear between wall of the renal pelvis and renal parenchyma and the fat on renal sinus was not shown. On CT plain scan, the tumor was presented as high density in 5 cases, equal or slightly lower density in 4 cases; and the calcification or stone were shown in3 cases, hemorrhage in 2 cases. The CT value of the plain scans, corticomedullary phase and nephrographic phases was 24.6 Hu (17.6~31.5 Hu), 39.8 Hu(29.4~55.2 Hu) and 51.0 Hu (38.2~73.2 Hu), respectively. Conclusion Dynamic multi-slice helical CT scan can show characteristic images of invasive carcinoma of the renal pelvis with intratubular spread, and can be used for diagnosis.