螺旋CT三期动态扫描技术对肾癌的诊断价值

目的:探讨螺旋CT三期动态扫描技术对肾癌的诊断价值。方法:搜集2002年以来26例行CT检查并经病理证实为肾癌患者的病例资料,在CT平扫及三期动态增强扫描图像上对肿瘤的大小、强化模式、肾周改变、邻近脏器及静脉的受侵情况和淋巴结转移等征象进行分析和评价。结果:6例小肾癌多呈较均匀等密度灶,其余20例直径>3 cm的肿瘤多呈混杂密度。6例小肾癌中4例于增强扫描时呈快进快出表现。余20例肾癌的强化模式有2种:①肿瘤于CMP 强化明显,NP强化减弱(n=15);②肿瘤于CMP和NP强化程度相近,EP强化程度明显减弱(n=5)。6例小肾癌均无肾周侵犯,其余20例肾癌出现肾周、邻近脏器和静脉的侵犯及淋巴结转移。结论:应用螺旋CT三期动态增强扫描技术能更加准确地对肾癌进行术前诊断和分期。

Value of Three Phase Dynamic Enhanced Technique by Spiral CT in the Diagnosis and Staging of Renal Carcinoma

Objective:To evaluate the value of three phase dynamic enhanced technique by CT in the diagnosis and staging of renal carcinoma. Methods:26 cases of renal carcinoma proved by surgery and pathology had three phase dynamic enhanced CT examination before surgery. The morphologic features including tumor size,contrast enhanced pattern,invasion of perinephric fat,renal vein and inferior vena cava as well as lymphadenopathy were evaluated. Results:6 small renal carcinomas appeared as iso-density and homogeneous,the other tumors with the dimension larger than 3 cm were heterogeneous in density. After contrast enhancement,4 small renal carcinomas enhanced markedly during cortex-medullary phase (CMP) and wash-out quickly;the other 20 cases showed different enhanced patterns,including markedly enhanced in CMP and decreased in nephrographic phase (NP) , the other type showed degree of enhancement similar in CMP and NP,but markedly decreased in excretory phase(EP) ,the cases were 15 and 5 respectively. There were no adjacent perinephric invasion in the 6 small renal carcinomas,yet the other large tumors showed invasion of perinephric fat, renal vein and inferior vena cava as well as lymphadenopathy. Conclusion:Three phase dynamic enhanced CT plays an important role in the improvement of accuracy for the diagnosis and staging of renal carcinoma.