肾细胞癌多层螺旋CT多期扫描:评价皮髓交界早期和皮髓交界期的价值

目的 探讨肾细胞癌多层螺旋CT皮髓交界双期扫描的影像学特征和各自诊断价值。资料与方法 经手术病理证实的肾细胞癌31例，术前均经多层螺旋CT平扫、皮髓交界早期、皮髓交界期和实质期扫描，注射对比剂1．5～2．0ml／kg体重，流率为5ml/s。仔细复习CT扫描结果并和手术病理作回顾性对照分析。结果 31例均为单个肾细胞癌。21个病灶皮髓交界早期强化最为显著，6个病灶皮髓交界期强化最为显著，4个病灶实质期强化最显著；三期扫描强化不均匀依次为23、12和7例。平扫＋皮髓交界早期发现29个病灶，定性诊断26个；平扫＋皮髓交界期发现25个病灶，诊断21个；平扫＋皮髓交界早期＋实质期发现30个病灶，诊断28个；平扫＋皮髓交界期＋实质期发现30个病灶，诊断23个。结论 与皮髓交界期相比，皮髓交界早期可以发现更多的病灶，显示肾细胞癌更多的恶性征象，因而定性价值更高。我们建议采用平扫＋皮髓交界早期＋实质期扫描取代传统平扫＋皮髓交界期＋实质期扫描，而平扫＋皮髓交界早期＋皮髓交界期＋实质期扫描更能充分显示肾细胞癌的血液动力学。

Comparison of Renal Cancer Enhancement During Early Corticomedullary,Corticomedullary and Nephrographic Phase with Multiphasic Renal MSCT

Objective To discuss the features of renal cell cancer in MSCT multiphasic scans and evaluate it's diagnostic value.Materials and Methods 31 cases with renal cancer confirmed by surgical and pathology were underwent with three phases MSCT scanning of early corticomedullary phase(ECMP), corticomedullary phase(CMP) and nephrographic phase(NP) before operation, the CT data were reviewed and analyzed retrospectively in comparison with surgical and pathological results.Results The attenuation of 21 on ECMP images, 6 on CMP images, 4 on NP images were much more obvious than the other two phases. 23 on ECMP images, 12 on CMP images, 7 on NP images were enhanced inhomogeneously. 29 lesions were detected and diagnosis of 26 were definite on plain scan and ECMP images, while 25 lesions were detected and 21 were definite on plain scan and CMP images. 30 lesions were detected and 28 were definite on plain scan, ECMP and NP images, while 30 lesions were detected and only 23 were definite on plain scan, CMP and NP images.Conclusion ECMP scans is enable to detect more lesions and show more characterizations of renal cancers than that on CMP scans, so we recommend the plain, ECMP and NP phase scans to replace the traditional plain, CMP and NP phase scans, hemodynamic features of renal cell cancer is more depicted on NP phase.