MR对肾癌Ⅰ期瘤栓的诊断价值

目的评价MR对肾癌1期瘤栓的诊断价值。方法22例经手术病理证实的肾癌患者,均于术前行MR检查,观察肾静脉内和下腔静脉内有无瘤栓及瘤栓的范围,并与手术结果进行对照。评价MR对肾静脉和下腔静脉的显示情况及对肾癌I期瘤栓的诊断准确性。结果22例患者,均为单侧肾癌。手术病理共发现8处肾静脉瘤栓,无下腔静脉内瘤栓。MR对肾癌的检出率为100%。MR对21支肾静脉显示清楚,1支肾静脉显示不清。在显示清楚的21支肾静脉中,MR诊断8支肾静脉内有瘤栓,13支肾静脉内无瘤栓,均与手术病理符合。1支显示不清的肾静脉内,手术未见瘤栓。MR对22支下腔静脉均显示清楚,未见瘤栓。22例肾癌中,9例行增强CT检查,对瘤栓的诊断正确7例,漏诊1例,误诊1例。16例行超声检查,对瘤栓的诊断正确13例,误诊2例,漏诊1例。4例行DSA检查,诊断正确4例。结论MR对肾癌Ⅰ期瘤栓的诊断准确性高,当术前MR对肾静脉显示清楚时,MR可作为术前I期瘤栓评价的金标准。

MR Diagnosis of Stage Ⅰ Tumor Thrombus in Renal Cell Carcinoma

Objective To evaluate the accuracy of MR in the diagnosis of tumor thrombus in renal cell carcinoma.Methods 22patients with renal cell carcinoma proved pathologically were recruited in this study.All the patients underwent MR examination beforesurgery.The results of the MR were correlated with that of the operation.Results 8 renal veins could be found tumor thrombus during the surgery,and the other 14 renal veins and 22 inferior vena cava were absent of tumor thrombus.MR could found all of the 8 tumor thrombithat detected by the surgeons.In the other 14 cases,13 of them could be excluded of tumor thrombus by MR.Only in 1 patient,the MRresult was equivocal.CT was performed in 9 patients,the diagnosis was accurate in 7 cases,and was inaccurate in 2.Ultrasound wasperformed in 16 patients,the diagnosis was accurate in 13 cases,and was inaccurate in 3.Digital subtraction angiography was performed in 4 cases,the diagnosis was correct in all of them.Conclusion MR is perfect in the diagnosis of tumor thrombus in renal cell carcinoma oncondition that the renal vein is clearly defined by MR.It can be considered as the method of choice in the evaluation of tumor thrombus inrenal cell carcinoma.