肾脏偶发癌的影像学诊断

目的 探讨肾脏偶发癌（incident renal carcinom，IRCC）的影像学表现。方法 对1996—2004年间我院54例经手术病理征实的肾脏偶发癌影像学资料进行回顾分析B超检查52例，其中2O例同时行彩色多普勒血流成像（CDFI），CT检查45例，MRI及DSA检查各6例．结果 在B超检查组中，32例（61．5%）肿物表现为低回声，19例（36．5%）肿物表现为强回声，29例（78．4％）肿物周缘显示低或高回声光晕，彩超捡查显示10例（50%）肿物内有丰富血供，9例（36．5％）血滴增加并呈动脉频谱RI 10．49-0.73，超声正确诊断率82．7%。在CT检查组中，45例均行平扫和强化扫描，11例（24．4%）平扫显示肿物内含钙化成分，1例（2．2%）平扫显示肿物内含假性囊肿，42例（93．3%）肿物低于肾实质强化，2例（4．4%）肿物周缘分别显示弧形低密度影和环形等密度影，2例（4．4％）肿物周缘显示增生血管围绕，CT正确诊断率93．3％。在MRI检查组中，1例（16．7%）T1WI肿物周缘显示低信号环，5例（83．3%）T2WI肿物周缘显示低信号环，MRI正确诊断率100%。在DSA检查组中，4例（66．7％）在动脉期显示肿瘤内血管增多、周缘血管呈“抱球”状环绕，1例（16．7％）周缘显示透明晕，5例在实质期显影时间延长，染色不均匀，DSA正确诊．断率83.3%。结论 综合应用影像学检查对IRCC的早期诊治有重要意义。

The imaging diagnosis of incident renal carcinoma

Objective To explore characteristics of incident renal carcinoma (IRCC)on imaging. Methods 54 patients with IRCC admitted during 1996~2004 and proved by surgical pathology examination were retrospectively studied with their data of imaging. 52 patients were examined with B ultrasound, among whom 20 being concomitantly examined with Color Doppler flow imaging(CDFI); 45 were examined with CT, 6 were examined with MRI, and 6 with DSA. Results In the B-US group, 32 patients (61.5%) showed hypoechoic mass, 19(36.5%)showed hyperechoic mass, 29 (78.4%) manifested hypoechoic or hyperechoic rims around the masses. Of those who underwent CDFI, 10 (50%)showed abundant blood-supply to tumors, 9 (36.5%) showed accelerated artery flow and spectrum RI 10.49~0.73. Diagnostic accuracy rate of B-US was 82.7%. In the CT group, 45 patients underwent plain scan and contrast-enhanced scan. 11 (24.4%)showed calcification inside the mass on plain scan, 1 (2.2%) showed pseudocyst inside the mass on plain scan, 42(93.3%)showed that the renal masses were enhanced inferior to normal renal parenchyma, 2 (4.4%) showed rim-like hypointensity or ring- like isointensity around the masses, 2(4.4%)showed hyperplasic blood vessels around the masses. The accuracy rate of CT group was 93.3%. In the MRI group, 1(16.7%) showed hypointensity ring around the mass on T1WI, 5 (83.3%)showed hypointensity ring around the mass on T2WI. The accuracy rate of MRI was 100%. In the DSA group, 4 (66.7%), on arterial phase, showed hyperplasic blood vessels, clawing the masses, 1 (16.7%)showed transparent halo, 5 (83.5%) , on parenchymal phase, showed elongated developing time and inhomogeneous stain. The accuracy rate was 83.3%. Conclusion A comprehensive manipulation of imaging techniques is helpful for early diagnosis of IRCC.