动态增强CT扫描对乳头状肾细胞癌的诊断价值

目的探讨乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)的动态增强CT表现及特点,以提高对本病变的诊断认识。方法回顾性分析17例经手术、病理证实的PRCC的动态增强CT表现。观察瘤体的部位、大小、形态、钙化、包膜、CT密度、强化形式及程度等特点。结果 17例PRCC,16例为单发病灶,1例为两肾多发病灶。肿瘤直径1.9～8.7cm(4.9±2.6)cm。瘤体位于肾髓质13例,位于肾皮质4例。肿瘤形态呈类圆、椭圆形15例,不规则形2例,肿瘤有包膜或假包膜15例,无包膜2例。囊变7例,钙化灶2例,无腹膜后淋巴结转移。CT平扫,PRCC密度稍高于正常肾皮质和肾髓质(40.6±4.3vs 33.7±3.5or 30.3±3.1,P<0.05);增强扫描,皮质期、皮髓质期、肾盂期,PRCC强化程度均低于肾皮质(P<0.05);皮质期、皮髓质期,PRCC强化程度高于肾髓质(P<0.05),但肾盂期低于肾髓质强化(P<0.05)。结论 PRCC的动态CT表现具有一定的特点,综合分析该肿瘤的CT特点,有助于提高该肿瘤的诊断准确率。

Value of dynamic enhanced CT in doagnosis of papillary renal cell carcinoma

Objective The dynamic enhanced CT features of the papillary renal cell carcinoma(PRCC) were studied for the purpose to improving the diagnosis of the disease.Methods 17 cases of PRCC,confirmed by surgery and pathology,were retrospectively analyzed.The tumor features of position,size,appearance,density,cystic or solid,calcication,capsules,degree,and pattern of enhancement were observed.These tumor features were made a contrast analysis with the pathology.Results Of 17 cases of PRCC,16 were solitary lesion,1 was multiple lesion,with the tumor diameter ranged from1.9 to 8.7 cm(mean diameter,4.9±2.6 cm).CT scan showed that 13 lesions were located in medulla and 4 were in cortex.15 lesions were round or oval,2 lesion was irregular shape.15 cases had capsule or pseudo-capsule,and 2 had no capsule.7 lesions had cystic components,2 had calcification,without lymph node metastasis.On unenhanced CT,their attenuation was greater than normal renal cortex or medulla(40.6±4.3 vs 33.7±3.5 or 30.3±3.1,P<0.05);Their degree of enhancement was less than normal renal cortex on all enhanced phases(P<0.05),and higher than normal renal medulla on cortical and medullary phases(P<0.05),but less than normal renal medulla on the delayed phase(P<0.05).Conclusion The PRCC had some characteristic MSCT features.Aggregating analysis of the dynamic enhanced CT features of the carcinoma was important for improving the accuracy of diagnosing.