螺旋CT在小肾癌诊断中的应用

目的 评价螺旋CT多期扫描在小肾癌诊断中的价值。方法 分析15例小肾癌的螺旋CT表现及其病理基础。结果 小实性肾癌13例，增强扫描皮质期9例呈明显强化，4例呈轻中度强化；小囊性肾癌2例，增强后皮质期囊壁、壁结节、囊内分隔明显强化。实质期及肾盂期强化迅速减退，呈快进快退改变。病理上所有病例血窦丰富（2例小囊性肾癌囊变明显，但实性部分血窦丰富）。结论 螺旋CT多期扫描在小肾癌的诊断中较常规CT有明显优越性；多数小肾癌皮质期强化明显、实质期强化迅速减退，呈“快进快退”表现，这一强化形式有定性意义；皮质期扫描应纳入小肾癌CT检查的常规步骤。

Helical CT scan: application in the diagnosis of small renal cell carcinoma

Objective To evaluate helical CT scan in the diagnosis of small renal cell carcinoma (RCC). Methods Helical CT features and pathologic findings of 15 patients with small RCC are analyzed. Results Of 13 cases of small solid RCC, 9 showed marked tumor enhancement in cortical phase, in another 4 cases the enhancement was slight to moderate. Two cases of small cystic RCC, presented enhancement of wall with nodules and the partition in cortical phase. Enhancement faded away in the following parenchymal phase and pyelographic phase. All cases had hypervascular appearance pathologically. Two cases of small cystic RCC showed clear cystic degeneration, but the solid portion was rich in vascularity. Conclusion The multi phasic helical CT scan is superior to the conventional CT in the diagnosis of small RCC. In most cases, tumor enhancement was strong in cortical phase but weak in parenchymal phase, they demonstrated some degree of fast wash out phenomenon, which is a characteristic pattern of enhancement. And we believe this has diagnostic significance. Therefore, the acquisition of a cortical phase scan should be part of the routine helical CT protocal of small RCC.