7类不同病理亚型肾细胞癌MRI及MSCT影像学表现分析

目的探讨7类不同病理亚型肾细胞癌MRI及MSCT影像学表现。方法选取我院2015年1月至2019年1月收治的肾细胞癌患者64例,收集64例患者各项临床资料、影像学资料,总结不同病理亚型肾细胞癌MSCT及MRI影像学表现。结果64例患者中透明细胞癌37例(57.81%),MSCT平扫中多数患者呈现等密度影,强化不均匀,T₁WI序列为等信号,于T₂WI序列呈现稍高信号者,早期强化均匀,中晚期呈现逐渐降低;嫌色细胞癌15例(23.43%),CT值23~35HU,动态增强皮髓交界期平均CT值为44HU,实质期平均CT值为54HU,T₁WI序列为稍低信号,T₂WI为稍高信号,强化均匀;乳头状肾细胞癌6例(9.37%),乳头状肾细胞癌在MSCT呈等密度,MRI增强过程中持续性较均匀强化,少数患者后期可见"假包膜征";肉瘤样肾癌2例(3.12%),1例MSCT平扫肉瘤样肾癌呈等、稍高密度,T₁WI序列为等信号,T₂WI稍高信号,可见以"条带样"强化;黏液性小管状和梭形肾细胞癌1例(1.56%),MSCT增强方式为进行性轻-中度强化,未见肾静脉受侵;DWI序列中病灶区域出现环形高信号;Xp11.2易位/TFE3基因融合相关性肾癌1例(1.56%)典型特征为增强扫描囊壁强化明显;杂合性嗜酸细胞/嫌色细胞肾癌2例(3.12%),病灶内可见明显血管样强化,强化表现,强化区域呈现稍高密度。结论MRI及MSCT可有效显示不同病理亚型肾细胞癌影像学表现,可为临床准确诊断提高可靠影像学资料。

MRI and MSCT Imaging Features of Seven Different Pathological Subtypes of Renal Cell Carcinoma

Objective To investigate the MRI and MSCT imaging features of seven different pathological subtypes of renal cell carcinoma.Methods 64 patients with renal cell carcinoma admitted to our hospital from January 2015 to January 2019 were enrolled.The clinical data and imaging data of 64 patients were collected.The MSCT and MRI features of different pathological subtypes of renal cell carcinoma were summarized.Results In the 64 patients,37(57.81%)had clear cell carcinoma.Most of the patients in MSCT scan showed equal density shadow,uneven enhancement,T₁WI sequence was equal signal,and patients with a slightly higher signal in the T₂WI sequence showed uniform enhancement in the early stage and gradual decreasing in the middle and late stages.There were 15 cases of chromophobe cell carcinoma(23.43%),the CT value was 23 to 35HU,the average CT value in corticomedullary phase enhanced dynamically was 44HU,the average CT value in nephrographic phase enhanced dynamically 54HU,the The T₁WI sequence was a slightly lower signal,and the T₂WI was a slightly higher signal,and the enhancement was uniform.There were 6 cases(9.37%)with papillary renal cell carcinoma,papillary renal cell carcinoma showed equal density in MSCT,and sustained uniform enhancement during MRI enhancement.A few patients showed pseudo-envelope sign in the later stage.There were 2 cases(3.12%)with sarcomatoid renal carcinoma,and sarcomatoid renal carcinoma of 1 case scaned by MSCT showed equal,slightly high density,T₁WI sequence was equal signal,T₂WI was slightly higher signal,and it can be seen as"stripe-like"enhancement.There were 1 case(1.56%)with mucinous tubular and fusiform renal cell carcinoma.The MSCT enhancement mode was progressive light-moderate enhancement,and no renal vein was invaded.Ring-shaped high signal appeared in the lesion area of DWI sequence.There was 1 case(1.56%)with Xp11.2 translocation/TFE3 gene fusion-related renal cell carcinoma,which was characterized by obvious enhancement of cyst wall after enhanced scanning.There were 2 cases(3.12%)with heterozygous acidophilic cells/chromophobe renal cell carcinoma.Significant vascular-like enhancement was observed in the lesion,and the enhanced area showed a slightly higher density.Conclusion MRI and MSCT can effectively display the imaging features of different pathological subtypes of renal cell carcinoma,and can improve reliable imaging data for clinical accurate diagnosis.