Hallscheidt P, Schoenberg S, Schenk J P, Zuna I, Petirsch O, Riedasch G
Forschungsschwerpunkt Radiologische Diagnostik und Therapie des Deutschen Krebsforschungszentrums, Heidelberg, Germany.
Rofo. 2002 Jul;174(7):898-903. doi: 10.1055/s-2002-32695.
For nephron sparing surgery of renal cell carcinoma knowledge of the intrarenal extension of the tumor and infiltration of the renal pelvis, the intrarenal vessels and the perinephric fat is essential. This question is much more difficult to answer compared to the description of staging parameters. Aim of this study is to evaluate the value of multi-slice CT in planning of nephron sparing surgery.
In a prospective study 46 patients with suspected renal cell carcinoma underwent a triphasic multi-slice CT (unenhanced, delay 30 s and 120 s). A reconstructed slice thickness of 2 mm in the arterial and parenchymal phase was used to create volume rendered 3D-reconstructions. Based on the source data and multiplanar reconstructed images the extent of the renal cell carcinoma was assessed in terms of size, hilar infiltration, arterial and venous invasions, capsula infiltration and perirenal growth. The results of two blinded readers were correlated with histopathological staging and intraoperative findings.
36 carcinomas were evaluated histopathologically. 10 patients showed no renal cell carcinoma histopathologically. Multi-slice CT allowed us to diagnose the localization and size of all tumors correctly. Infiltration into perinephric fat was correctly excluded in 24/30 and 8/30 cases. Infiltration of the renal pelvis could be excluded in 17/24 and 12/24 cases. The state of venous infiltration could be correctly diagnosed in 29/30 and 27 /30 carcinomas.
Despite of the high temporal and spatial resolution of multi-slice CT, which allows the delineation of intrarenal arteries as well as renal hilus and the veins, the evaluation of tumor infiltration into the renal hilus, the intrarenal vessels and the perinephric fat remains a diagnostic problem. For planning of nephron sparing surgery, a knowledge of the infiltration in these structures is essential.
对于肾细胞癌保留肾单位手术而言，了解肿瘤在肾内的扩展情况以及肾盂、肾内血管和肾周脂肪的浸润情况至关重要。与分期参数的描述相比，这个问题更难回答。本研究的目的是评估多层螺旋CT在保留肾单位手术规划中的价值。
在一项前瞻性研究中，46例疑似肾细胞癌患者接受了三期多层螺旋CT检查（平扫、延迟30秒和120秒）。在动脉期和实质期使用2毫米的重建层厚来创建容积再现三维重建图像。基于原始数据和多平面重建图像，从大小、肾门浸润、动静脉侵犯、包膜浸润和肾周生长等方面评估肾细胞癌的范围。两位盲法阅片者的结果与组织病理学分期及术中发现进行相关性分析。
36例癌进行了组织病理学评估。10例患者组织病理学检查未发现肾细胞癌。多层螺旋CT使我们能够正确诊断所有肿瘤的位置和大小。在30例中的24例和30例中的8例中正确排除了肾周脂肪浸润。在24例中的17例和24例中的12例中排除了肾盂浸润。在30例中的29例和30例中的27例癌中正确诊断了静脉浸润状态。
尽管多层螺旋CT具有高时间和空间分辨率，能够清晰显示肾内动脉以及肾门和静脉，但评估肿瘤对肾门、肾内血管和肾周脂肪的浸润仍然是一个诊断难题。对于保留肾单位手术的规划，了解这些结构的浸润情况至关重要。
