黄色肉芽肿性肾盂肾炎的CT诊断和鉴别诊断

目的 探讨黄色肉芽肿性肾盂肾炎（XGPN）的CT表现及其与肾癌和肾脓肿的鉴别诊断。材料与方法 XGPN 5例,肾癌15例,肾脓肿12例,前两组病例经手术病理证实,后一组经手术或临床资料证实。32例均于平归后再行增强扫描,回顾性分析三者的CT表现及其不同点。结果 （1）XGPN的CT表现为肾实质内的囊／囊实性占位,增强后实性部分强化;多合并结石（3例）和肾周受累（4例）;患肾不同程度功能减退（3例）。（2）3例XGPN和12例肾脓肿增强后边界清晰,呈缓慢强化;肾癌组9例边界清晰,增强早期一过性显著强化;XGPN和肾脓肿与肾癌的肾周受累有显著性差异;XGPN与脓肿的囊腔和囊性肾癌不同;4例肾癌（26％）有钙化,3例（20％）肾周有赘状突起／结节,6例（40％）有转移。结论 CT对XGPN的诊断和鉴别诊断有一定价值。

CT Diagnosis and Differentiation of Xanthogranulomatous Pyelonephritis

Objective To study CT features of xanthogranulomatous pyelonephritis (XGPN) and to discuss its differentiation with renal cancer and renal abscess.Materials and Methods This study included 5 cases of XGPN, 15 cases of renal cancer and 12 cases of renal abscess. The diagnoses were confirmed with pathology, surgery or clinical data. Both plain and enhanced CT scans were performed in all 32 patients. CT findings of three groups were retrospectively analyzed.Results On CT scan, XGPN showed the following four characteristics: (1) The lesion presented as soft tissue density space-occupying lesion in renal parenchyma, showing partial enhancement after contrast administration. (2) Renal calculus was a frequent finding, usually located in renal pelvis or calyces. (3) Extensive infiltration of perirenal and pararenal space, regardless of the lesion's size. (4) Impaired renal function to varying degrees. The following signs were helpful in differentiating XGPN from renal carcinoma: the lesion's margin, present and location of renal calculus or calcification, signs of cystic area, marked enhancement after contrast administration.Conclusion CT scan is of great value to the diagnosis and differentiation of XGPN.