多层螺旋CT检查在肾癌分期及分型中的应用价值

目的 探讨多层螺旋CT(SCT)检查在肾癌分期分型中的应用价值.方法 回顾性分析64例肾癌患者术前肾脏SCT资料和术后病理结果.男44例,女20例.年龄33～78岁,平均54岁.通过平扫期、皮髓期CT值及强化模式,依据2005年CUA制定标准对肾癌进行分期分型,并与术后病理结果 进行对比.结果 SCT检查发现透明细胞癌38例、乳头状癌14例、嫌色细胞癌12例,病理结果 为透明细胞癌40例、乳头状癌16例、嫌色细胞癌8例.肾癌SCT与病理分型和分期结果 差异无统计学意义(P＞0.05),SCT分型准确性为88%,分期准确性为89%.平扫期以CT值40 HU为标准鉴别乳头状癌与透明细胞癌和嫌色细胞癌的敏感性、特异性和准确性分别为75%、79%和78%;皮髓期以CT值90 HU为标准鉴别透明细胞癌与乳头状癌和嫌色细胞癌的敏感性、特异性和准确性分别为90%、88%、89%;均匀强化在嫌色细胞癌的比率显著高于透明细胞癌及乳头状癌.结论 多层SCT检查诊断肾癌准确性较高,是术前评估肾癌分型和分期较理想的手段之一.

Abstract：

Objective To analyze the value of multi-slice spiral CT (SCT) scan in staging and subtyping of renal cell carcinoma (RCC). Methods The preoperative kidney SCT data and postoperative pathology results of 64 patients with RCC were retrospectively analyzed. The patients′ ages ranged from 33-78 years (average 54 years). There were 44 males and 20 females in the study group. According to the CUA Guidelines, the staging and subtyping of RCC were performed through the combined information of preoperative SCT attenuation in unenhanced, corticomedullary phase and enhancement pattern. The results were compared with the postoperative histopathological results. Results The SCT results showed 38 cases were clear cell RCC, 14 cases were papillary RCC and 12 cases were chromophobic cell RCC. Histopathological results showed that 40 cases were clear cell RCC, 16 cases were papillary RCC and 8 cases were chromophobic cell RCC. According to the standard of 40 HU of CT attenuation value, the sensitivity, specificity and accuracy were 75%, 79% and 78% for diagnosis of papillary RCC in the unenhanced phase. The sensitivity, specificity and accuracy by the standard of 90 HU of CT attenuation value was 90%, 88% and 89% for diagnosis of clear cell RCC in the corticomedullary phase. In chromophobic RCC, homogeneous enhancement was more common than in papillary RCC and clear cell RCC. There was no significant difference of staging and subtyping of RCC between SCT and pathological results (P>0.05). The accuracy of SCT in staging and subtyping of RCC was 88% in staging, and 89% in subtyping. Conclusions SCT is a useful preoperative tool to stage and subtype RCC

Value of SCT in staging and subtyping of renal cell carcinoma

Objective To analyze the value of multi-slice spiral CT (SCT) scan in staging and subtyping of renal cell carcinoma (RCC). Methods The preoperative kidney SCT data and postoperative pathology results of 64 patients with RCC were retrospectively analyzed. The patients′ ages ranged from 33-78 years (average 54 years). There were 44 males and 20 females in the study group. According to the CUA Guidelines, the staging and subtyping of RCC were performed through the combined information of preoperative SCT attenuation in unenhanced, corticomedullary phase and enhancement pattern. The results were compared with the postoperative histopathological results. Results The SCT results showed 38 cases were clear cell RCC, 14 cases were papillary RCC and 12 cases were chromophobic cell RCC. Histopathological results showed that 40 cases were clear cell RCC, 16 cases were papillary RCC and 8 cases were chromophobic cell RCC. According to the standard of 40 HU of CT attenuation value, the sensitivity, specificity and accuracy were 75%, 79% and 78% for diagnosis of papillary RCC in the unenhanced phase. The sensitivity, specificity and accuracy by the standard of 90 HU of CT attenuation value was 90%, 88% and 89% for diagnosis of clear cell RCC in the corticomedullary phase. In chromophobic RCC, homogeneous enhancement was more common than in papillary RCC and clear cell RCC. There was no significant difference of staging and subtyping of RCC between SCT and pathological results (P>0.05). The accuracy of SCT in staging and subtyping of RCC was 88% in staging, and 89% in subtyping. Conclusions SCT is a useful preoperative tool to stage and subtype RCC