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《中国中西医结合影像学杂志》2016,(6):726-728
目的 :探讨肾透明细胞癌的MSCT表现,以提高其诊断水平。方法 :回顾性分析我院经手术病理证实的23例肾透明细胞癌的MSCT表现,所有患者均行平扫、皮髓交界期、实质期和排泄期增强扫描。结果:23例中,单发21例,多发2例(1例为单侧2个病灶,1例为双侧7个病灶)。23例共30个病灶,左侧10个,右侧20个。肿瘤呈圆形或类圆形,直径1~12 cm,平均4.6cm,其中≤3 cm 12个。CT平扫病灶呈等密度4个,囊性低密度3个,混杂密度23个;钙化6个。增强扫描:除2个较小肿瘤呈均匀强化外,28个强化不均匀;皮髓质期25个病灶明显强化,强化最明显区高于邻近皮质者15个,相似或略低于邻近皮质者10个;实质期肿瘤强化程度降低;排泄期肿瘤与肾实质相比呈明显低密度,病灶边界更清楚;25个病灶内见不同程度坏死、囊变。13个有假包膜。3个囊性肾透明细胞癌,平扫病灶呈囊状,2个表现如单纯性肾囊肿,1个可见网格状分隔;增强扫描1个肾透明细胞癌明显囊变,囊壁及分隔明显不规则强化;2个多房囊性肾透明细胞癌分隔不规则强化。结论:肾透明细胞癌血供丰富,瘤内可有出血、坏死、囊性变、钙化及假包膜,CT表现具有一定特征,大多可准确诊断。 相似文献
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目的:探讨多层螺旋CT(MDCT)动态增强扫描CT对肾透明细胞癌(CCRCC)的诊断价值。方法:回顾性分析103例手术病理证实的CCRC的多期MDCT表现。结果:103例CCRC共有病灶111个,MDCT平扫100个(100/111,90.1%)瘤灶表现为不均匀的等、稍低或高密度,增强扫描皮髓期102个(102/111,91.9%)肿瘤明显不均匀强化,强化最明显处与临近肾皮质相似或高于正常肾皮质,肾实质期病变强化程度降低。结论:CCRCC为富血供肿瘤,动态增强CT皮髓期肿瘤强化与肾皮质相仿或高于肾皮质,具有一定特征性,可与其他亚型肾细胞癌鉴别。 相似文献
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目的探讨分析肾透明细胞癌与嗜酸细胞腺瘤的CT表现及鉴别诊断。方法选取我院收治并经手术病理证实为肾透明细胞癌(20例)及肾嗜酸细胞腺瘤(15例)的CT表现,分析两者病灶的大小、形态、密度、CT值及强化方式等。结果肾透明细胞癌与肾嗜酸细胞腺瘤病灶的直径差异不明显(P> 0.05),差异无统计学意义;肾透明细胞癌与嗜酸细胞腺瘤CT平扫均多数为等或稍低密度,增强期多表现为明显强化,但肾透明细胞癌的强化特点为快进快出型,而肾嗜酸细胞腺瘤为快进慢出型,且肾透明细胞癌可有淋巴结转移,而肾嗜酸细胞瘤可有中央瘢痕。结论综合分析肾透明细胞癌与肾嗜酸细胞腺瘤的CT平扫及增强扫描的影像学特点,有助于两者的鉴别诊断。 相似文献
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目的分析肾透明细胞癌的CT影像特点。方法回顾性分析经病理证实的肾透明细胞癌16例,从病灶数目、大小、形态、强化方式及与邻近结构关系等方面总结其CT影像特点。结果本组16例均为单发病灶,多位于肾皮质,形态多为圆形或类圆形,多凸出肾轮廓之外,平均4.7cm(2.2~10cm不等),伴或不伴邻近结构受累;增强扫描大多数(12例)动脉期明显不均质强化,静脉期及分泌期强化程度降低,低于周围肾实质,即典型的"快进快出"式强化,1例动脉期中等度强化,2例仅轻度强化,1例肿瘤内形成动静脉瘘。本组病例其中1例为囊性肾透明细胞癌,内可见多发点状及条状钙化,增强后呈中等强化,囊内容物不强化。结论 CT扫描是肾透明细胞癌的重要检查手段,其较特征性的动脉期强化方式是与其它类型肾癌相鉴别的重要参考依据。 相似文献
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目的:探讨多层螺旋CT(MSCT)三期增强扫描对最大径≥5cm巨大肾细胞癌的鉴别诊断价值。方法回顾性分析本院经手术病理证实的50例最大径≥5cm巨大肾细胞癌患者行M SC T平扫加皮质期、髓质期及排泄期扫描的影像学特征性表现,重点分析CT动态增强扫描技术的应用及强化特点,寻找各病理亚型的影像学异同。结果巨大肾细胞癌出血、坏死囊变明显。透明细胞癌最常见,坏死较多甚而较大,以结节堆积样强化及片样强化为主,强化程度大多高于嫌色细胞癌及乳头状癌、集合管癌等非透明细胞癌;巨大乳头状癌坏死区较小,强化程度较低,相对均匀;嫌色细胞癌密度明显不均匀,强化明显但程度低于透明细胞癌、高于乳头状癌,可见逐渐填充中央疤痕;嫌色细胞癌及乳头状癌很少周围侵犯及转移;集合管癌恶性程度最高,缺乏特异强化形式,强化程度低,极具周围侵犯及淋巴结转移,预后极差。结论巨大肾细胞癌病理亚型的三期增强CT表现各具特征,具有鉴别诊断价值。 相似文献
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目的探讨肾透明细胞癌与乏脂性肾血管平滑肌脂肪瘤的CT特征,提高诊断准确率。方法回顾性分析18例肾透明细胞癌与5例乏脂性肾血管平滑肌脂肪瘤的CT表现,所有病例均进行多层螺旋CT多期扫描。结果 18例肾透明细胞癌平扫表现为肾实质内均匀或不均匀的等、稍低或稍高混杂密度肿块,增强皮质期或实质期明显不均匀强化,强化程度等于或高于肾皮质,髓质期强化程度迅速下降,其中16例出现不同程度的囊变、坏死和/或出血,钙化1例。5例乏脂性肾血管平滑肌脂肪瘤平扫表现为肾实质内均匀的稍高密度肿块,增强后皮质期强化程度等于、低于或高于肾皮质,髓质期强化程度有所下降。5例均未见坏死、囊变、出血及钙化。结论肾透明细胞癌与乏脂性肾血管平滑肌脂肪瘤CT表现具有一定特征,术前大部分可准确诊断。 相似文献
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肾皮髓期增强扫描对肾细胞癌亚型的鉴别诊断价值 总被引:1,自引:2,他引:1
目的 评价CT、MRI肾皮髓期增强扫描对肾细胞癌亚型的鉴别诊断价值。方法 对 96例肾细胞癌患者的肾脏行CT和 /或MRI肾皮髓期增强扫描。结果 肿瘤直径为 2~9cm,经手术病理证实为肉瘤样肾细胞癌 1例、透明细胞癌 78例、颗粒细胞癌 5例、混合细胞癌 8例和乳头状癌 4例。肾皮髓期增强扫描,肉瘤样肾细胞癌、混合细胞癌、97. 4% (76 /78)的透明细胞癌和 75. 0% (3 /4)的乳头状癌呈不均匀强化,而颗粒细胞癌强化较均匀。51. 3% (40 /78)的透明细胞癌及 37. 5% (3 /8)的混合细胞癌强化程度强于邻近肾皮质;肉瘤样肾细胞癌、44. 9% (35 /78)的透明细胞癌和 50. 0% (4 /8)的混合细胞癌强化程度与邻近肾皮质相仿; 3. 8% (3 /78)的透明细胞癌、12. 5% (1 /8)的混合细胞癌及所有乳头状癌和颗粒细胞癌强化程度明显弱于邻近肾皮质。结论 各型肾细胞癌在CT/MRI肾皮髓期增强扫描上有不同的表现,有助于鉴别诊断。 相似文献
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目的探讨乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)的动态增强CT表现及特点,以提高对本病变的诊断认识。方法回顾性分析17例经手术、病理证实的PRCC的动态增强CT表现。观察瘤体的部位、大小、形态、钙化、包膜、CT密度、强化形式及程度等特点。结果 17例PRCC,16例为单发病灶,1例为两肾多发病灶。肿瘤直径1.9~8.7cm(4.9±2.6)cm。瘤体位于肾髓质13例,位于肾皮质4例。肿瘤形态呈类圆、椭圆形15例,不规则形2例,肿瘤有包膜或假包膜15例,无包膜2例。囊变7例,钙化灶2例,无腹膜后淋巴结转移。CT平扫,PRCC密度稍高于正常肾皮质和肾髓质(40.6±4.3vs 33.7±3.5or 30.3±3.1,P<0.05);增强扫描,皮质期、皮髓质期、肾盂期,PRCC强化程度均低于肾皮质(P<0.05);皮质期、皮髓质期,PRCC强化程度高于肾髓质(P<0.05),但肾盂期低于肾髓质强化(P<0.05)。结论 PRCC的动态CT表现具有一定的特点,综合分析该肿瘤的CT特点,有助于提高该肿瘤的诊断准确率。 相似文献
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不同分组肾透明细胞癌CT灌注成像的差异 总被引:4,自引:0,他引:4
目的 探讨不同分组肾透明细胞癌CT灌注成像的差异.资料与方法 经手术病理证实为肾透明细胞癌的患者40例,术前应用多层螺旋CT(MSCT),选择肿瘤最大层面进行灌注扫描.用去卷积法灌注软件获取肿瘤内多个不同密度感兴趣区(ROI)及双侧肾皮质的血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)及时间-密度曲线(TDC)图.40例肿瘤按是否可见新生血管、肾盂肾盏受累程度及是否有癌栓分组,统计分析比较不同分组肿瘤间的灌注差异.结果 可见新生血管的肿瘤表面通透性低于未见新生血管肿瘤(P<0.05);肾盂肾盏受压肿瘤同侧肾脏皮质血流量(C-BF)高于肾盂肾盏无影响肿瘤(P<0.01);有癌栓肿瘤双侧皮质及最高密度点BV均低于无癌栓肿瘤(P<0.05).结论 CT灌注成像能从血流动力学和血管功能上为评价肾透明细胞癌进展和预后带来帮助,具有一定的临床应用价值. 相似文献
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目的 评价多层CT(MSCT)对肾细胞癌(RCC)进行术前肿瘤TNM分期的准确性.方法 回顾性分析38例RCC患者的术前CT图像并按TNM分期标准进行肿瘤分期,应用Kappa(κ)检验比较MSCT与手术-病理分期结果 的一致性.结果 MSCT对RCC的肿瘤(T)分期与手术病理结果 具有很好的一致性(κ=0.867),而在RCC的淋巴结(N)分期中的一致性一般(κ=0.404).肿瘤(T)分期中,MSCT准确评价了32例RCC(占84.2%),另外5例肿瘤(占13.2%)被高估,1例(占2.6%)被低估.MSCT准确评价了所有(7例)下腔静脉瘤栓.淋巴结(N)分期中,MSCT准确评价了28例RCC(占73.7%)淋 巴结受累状况,但有8例患 者(占21.1%)淋巴结受累被高估,2例患者(占5.3%)被低估.对于肝脏和毗邻腹腔脏器转移瘤的检查,MSCT和术中超声检查具有非常好的一致性(κ=1).结论 多层CT结合三维重建后处理技术能显示肿瘤范围、静脉内瘤栓、区域性淋巴结及远处器官转移,从而有助于RCC术前分期. 相似文献
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多层螺旋CT扫描在结肠癌术前分期中的应用 总被引:26,自引:0,他引:26
目的 评估结肠充气多层螺旋CT扫描(MSCT)在结肠癌术前分期中的应用价值。方法 对36例临床高度怀疑或内镜活检证实的结肠癌患者进行MSCT检查,并利用工作站进行后处理以获取CT仿真内镜(CTVE)、多平面重建(MPR)、表面阴影成像(SSD)和透明显示(Raysum)图像,并结合横断面图像,进行肿瘤原发灶、淋巴结和转移情况分期(TNM分期),然后与术后病理对照。结果 MSCT术前T分期敏感度为96 .97% (32 /33),阳性诊断准确度为87 .88% (29 /33 );N分期灵敏度为73 .91% (17 /23),阳性诊断准确度为69. 57% ( 16 /23 )。转移淋巴结平扫CT值为( 38 .57±5.02)HU, 增强后CT值为(59.51±5 .35)HU,差异有统计学意义(t=3 .963,P<0. 05);未发生转移的淋巴结平扫CT值为(29 .16±3 .66)HU,增强后CT值为(47 30±1 70)HU,差异有统计学意义(t=4 997,P<0 05)。5例肝脏转移的患者均被CT检查发现。结论 MSCT可以有效地显示肿瘤的形态、大小和部位,确定肿瘤的侵犯范围、淋巴结转移和远处转移等,从而更准确地进行术前分期。不受肠管狭窄程度的限制,可以显示气体能够通过的任何部位,从而弥补了肠镜检查的不足。但术前对于早期病变T1 ~T3 分期还有一定限度;N分期较困难,必须综合其大小、形态、密度及其生物学行为进行全面的判断。 相似文献
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Objective:
To study the accuracy of CT for staging T3a (TNM 2009) renal cell carcinoma (RCC).Methods:
Unenhanced and nephrographic phase CT studies of 117 patients (male:female = 82:35; age range, 21–86 years) with T1–T3a RCC were independently reviewed by 2 readers. The presence of sinus or perinephric fat, or renal vein invasion and tumour characteristics were noted.Results:
Median (range) tumour size was 5.5 (0.9–19.0) cm; and 46 (39%), 16 (14%) and 55 (47%) tumours were pT1, pT2 and pT3a RCC, respectively. The sensitivity/specificity for sinus fat, perinephric fat and renal vein invasion were 71/79%, 83/76% and 59/93% (Reader 1) and 88/71%, 68/72% and 69/91% (Reader 2) with κ = 0.41, 0.43 and 0.61, respectively. Sinus fat invasion was seen in 47/55 (85%) cases with T3a RCC vs 16/55 (29%) and 33/55 (60%) for perinephric fat and renal vein invasion. Tumour necrosis, irregularity of tumour edge and direct tumour contact with perirenal fascia or sinus fat increased the odds of local invasion [odds ratio (OR), 2.5–3.7; p < 0.05; κ = 0.42–0.61]. Stage T3a tumours were centrally located (OR, 3.9; p = 0.0009).Conclusion:
Stage T3a RCC was identified with a sensitivity of 59–88% and specificity of 71–93% (κ = 0.41–0.61). Sinus fat invasion was the most common invasive feature.Advances in knowledge:
Centrally situated renal tumours with an irregular tumour edge, inseparable from sinus structures or the perirenal fascia and CT features of tumour necrosis should alert the reader to the possibility of Stage T3a RCC (OR, 2.5–3.9).Current guidelines1 recommend nephron-sparing procedures (either partial nephrectomy or ablation) for Stage T1a (<4 cm) renal cell carcinomas (RCCs), but the indications for nephron-sparing procedures are widening.2 Successful surgical series have been reported with Stage T1b (<4–7 cm) tumours and even Stage T2 RCCs.3 Central location is not necessarily a barrier to good clinical outcome after partial nephrectomy,3 but nephron-sparing procedures are contraindicated for stage ≥T3a renal cancers.1 Thus, prior accurate recognition of T3a stage is important, especially with central renal masses, as any pre-operative suspicion of local invasion should contraindicate nephron-sparing surgery or ablation.In the most recent TNM iteration, Stage T1 and T2 tumours are defined by tumour diameter (T1a, ≤4 cm; T1b, 4–7 cm; T2a, 7–10 cm; and T2b, ≥10 cm) and the absence of any local invasion. Stage T3a RCC was redefined to include invasion of either renal sinus or perinephric fat.4 Renal vein invasion [main renal vein and/or segmental (muscle-containing) branch invasion], without caval involvement, was downgraded from Stage T3b to Stage T3a, whilst adrenal invasion was upgraded from Stage T3a to Stage T4. Size is not a governing factor with ≥T3a tumours, and some renal masses <7 cm in diameter will be locally advanced. Nearly half of all pT3a RCCs (n = 309/623) in one study were <7 cm in diameter.5 Other studies have confirmed the poor prognostic significance of sinus fat or venous invasion in masses <7 cm, with a 4–6 times increased risk of cancer-related death.6,7 Centrally located masses are more likely to demonstrate local invasion with positive surgical resection margins after partial nephrectomy,8,9 and unrecognized sinus invasion may explain the recurrence of cancer, and subsequent death from metastatic disease, in some cases of presumed T1 RCCs.8However, in previous studies, CT staging has been variably accurate10–18 for RCCs, and staging inaccuracies, usually understaging, are said to be most common with Stage T3a disease.12,17 For venous invasion, the specificity and sensitivity have ranged between 58–97% and 32–96%,10,14–16 and for perinephric infiltration, the figures have been 32–96% and 85–93%,14–16 respectively. The CT accuracy for sinus fat invasion has not been previously investigated. The primary aim of this study was to define the accuracy of contrast-enhanced CT for identifying any of the three defining features of Stage T3a RCC, that is, sinus or perinephric fat invasion, or renal vein invasion. Secondary study objectives were to identify any tumour characteristics that increase the odds of T3a disease and may be used as accessory CT signs to alert the reader to an increased likelihood of local invasion by RCC. 相似文献14.
目的:评价多层螺旋CT平扫及三期增强扫描在胃癌诊断和T分期中的价值,探讨胃癌的CT征象与其手术病理结果的关系。方法:搜集90例经胃镜证实为胃癌的患者资料,均于术前1周内行多层螺旋CT检查,并将检查结果与术后病理结果对照分析。结果:MSCT能够显示粘膜和粘膜下层、肌层、浆膜层的侵犯程度,判断浆膜层受侵的准确率为73%。对胃癌T1期、T2期、T3期、T4期的准确率分别为33.3%、42.9%、66.7%、85.2%,T分期总体准确率为62.2%。结论:MSCT常规平扫加三期增强扫描及多种图像处理技术,能够准确地对胃癌作出诊断,并提高T分期的准确性,是胃癌术前分期的可靠方法,有利于临床制订合理的手术方式和治疗方案。 相似文献
15.
目的:探讨肾癌(RCC)在增强CT各期中的表现及增强CT参数在肾癌术前病理分型中的价值.方法:回顾性分析149例肾癌(包括透明RCC 131例、乳头状RCC 12例和嫌色RCC6例)患者的四期CT(平扫期、皮质期、实质期及排泄期)扫描图像,结合术后病理进行对比分析,比较各期肾癌绝对增强值、病灶强化百分比、峰值出现时相等参数.结果:透明RCC CT值峰值出现于皮质期,且此期透明RCC的CT值明显高于同期的乳头状RCC和嫌色RCC,差异有统计学意义(P<0.05);乳头状RCC及嫌色RCC的CT峰值出现于实质期.皮质期透明RCC的CT绝对增强值、病灶强化百分比均明显高于乳头状RCC及嫌色RCC,差异有统计学意义(P<0.05),而排泄期嫌色RCC绝对增强值高于乳头状RCC,差异有统计学意义(P<0.05).结论:CT绝对增强值、病灶强化百分比等增强CT参数可与传统CT诊断方法相结合,提高肾癌术前病理分型的诊断准确度. 相似文献
16.
C S Ng E M Loyer R B Iyer C L David R A DuBrow C Charnsangavej 《AJR. American journal of roentgenology》1999,172(6):1555-1559
OBJECTIVE: Our goal was to define the lesion enhancement characteristics of renal cell carcinoma metastases to the pancreas using three-phase helical CT. MATERIALS AND METHODS: Thin-section three-phase contrast-enhanced CT scans of nine patients with renal cell carcinoma metastases to the pancreas were evaluated. The helical CT protocol included 3-mm collimation and a 2:1 pitch. Scans through the pancreas were obtained in three series beginning 25, 60, and 120 sec after the start of administration of i.v. contrast material delivered at 3 ml/sec. The Hounsfield densities of the pancreatic lesions and normal pancreatic parenchyma during each of the enhancement phases were recorded and compared. RESULTS: The enhancement patterns of the metastatic deposits and the normal pancreas differed. Thirty-four lesions ranging in size from 6 to 110 mm were identified. All metastases showed rapid enhancement during the early (arterial and portal) phases, resulting in differential attenuations (compared with normal pancreatic parenchyma) of approximately 50-100 H. The differential attenuations were approximately 5-45 H on delayed-phase scans, resulting in poorer conspicuity of the lesions. Multifocal metastases were clearly identified on the early-phase scans in seven patients. CONCLUSION: Renal cell carcinoma metastases to the pancreas enhance most conspicuously during the early phases of helical CT. Such metastases may fail to be appreciated in the delayed phase. In patients with suspected renal cell carcinoma metastases to the pancreas, early-phase scanning after i.v. contrast administration should be performed. 相似文献
17.
目的通过与手术后病理分期对照,比较盆腔CT与MRI对结、直肠癌分期的价值。方法回顾总结经手术治疗的盆腔结直肠癌患者资料51例,术前2-3天内均行盆腔CT与MRI平扫检查。根据CT轴位平扫、增强扫描、冠状位及矢状位重建和MRI中的T2WI、DWI序列轴位、矢状位及冠状位图像进行术前TN分期,并与病理结果比较。结果盆腔CT判断T分期正确40例,总的准确率78.4%,与病理分期比较达到中高度一致,Kappa值=0.642;盆腔MRI判断T分期正确46例,总的准确率90.2%,与病理分期比较达到高度一致,Kappa值=0.808。51例患者N分期为:25例无淋巴结转移,26例有淋巴结转移,盆腔CT与盆腔MRI判断淋巴结转移的准确率为(58.8%vs 66.7%)、敏感性为(53.8%vs 65.4%)、特异性(64%vs 68%)、阳性预测值(53.8%vs 65.4%)、阴性预测值(61.5%vs 68%)都比较相近,盆腔MR对淋巴结转移预测的约等指数高于CT(0.334vs 0.178)。结论 MRI能有效提高结、直肠癌进行术前T分期的准确性,对临床治疗具有指导意义。 相似文献
18.
Eun Young KimWon Jae Lee Dongil ChoiSoon Jin Lee Joon Young ChoiByung-Tae Kim Hyung Sik Kim 《European journal of radiology》2011,79(2):183-188