实体性肾肿瘤的CT诊断（附30例分析）

目的：探讨不同类型实体性肾肿瘤的CT表现特征。方法：回顾性分析30例经手术病理证实的实体性肾肿瘤的CT表现,其中肾透明细胞癌24例,肉瘤样癌1例,肾盂癌2例,嗜酸细胞瘤2例,血管瘤1例。所有病例均行CT平扫和多期增强扫描。结果：2例肾盂癌和1例肾血管瘤主体位于肾髓质,其余肾肿瘤主体均位于肾皮质。增强扫描24例透明细胞癌中21例在动脉期呈不均质显著强化,类似DSA中见到的“肿瘤染色”,而在静脉期和排泄期则呈低密度。3例Ⅰ级透明细胞癌和2例嗜酸细胞瘤类似肾脏的强化形式,即动脉期周边部与肾皮质同等强化,而中央部强化较晚,强化程度也较低。2例肾盂癌1例在动脉期呈不均质明显强化,另1例则始终无明显强化。1例血管瘤在3期均强化不明显。1例肉瘤样癌呈延迟强化,以周边部及类似房隔处强化明显。结论：不同类型的实体性肾肿瘤在CT上有其特殊的表现形式,但分化程度好的透明细胞癌与良性肾肿瘤鉴别较困难,有待于进行更深入细致的研究。

CT diagnosis of the solid renal tumors: analysis of 30 cases

Objective: To investigate the CT manifestations of the different pathological types of the solid renal tumors.Methods: Thirty cases of pathologically proved solid renal tumors were retraspectively analyzed,which comprised of 24 clear-cell carcinoma(CCC),1 carcinoma sarcomatodes(CS),2 renal pelvic carcinoma(RPC),2 oncocytoma and 1 angioma.All of the cases were underwent CT plain scanning and multiphase contrast enhanced scanning.Results: Two cases of RPC and 1 case of angioma located in the medulla zone,all the other tumors located in the cortical zone.On enhanced scanning,21 of the 24 cases of CCC enhanced markedly during the artery phase with inhomogeneous density,similar to the appearance of "tumor stain" seen on DSA,and with low density in the venous and secretary phases.3 cases of grade 1 CCC and 2 cases of oncocytoma showed an enhancement pattern like that of the kidney,namely the peripheral part enhanced the same degree with the renal cortex during the artery phase,while the central part enhanced late and in a lower degree.1 of the 2 cases of RPC enhanced markedly during the artery phase,while the other 1 case almost showed no enhancement during all the 3 phases.1 case of angioma showed no enhancement during all the 3 phases either.1 case of CS showed a delayed enhancement,with a higher enhancing degree in the peripheral part and in the septum.Conclusion: Each kind of solid renal tumors has its own characteristics on CT scannings.At present,it is difficult to distinguish the well-differentiated CCC from the benign renal tumors.Further research is needed in this aspect.