术前 CT 多期增强扫描对≤4cm 小肾脏肿块的强化模式：有助于鉴别肾细胞癌、血管平滑肌脂肪瘤和嗜酸细胞瘤的亚型。
Multiphasic enhancement patterns of small renal masses (≤4 cm) on preoperative computed tomography: utility for distinguishing subtypes of renal cell carcinoma, angiomyolipoma, and oncocytoma.
机构信息
James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA.
出版信息
Urology. 2013 Jun;81(6):1265-71. doi: 10.1016/j.urology.2012.12.049. Epub 2013 Apr 17.
OBJECTIVE
To analyze the enhancement patterns of small renal masses (SRMs) during 4-phase computed tomography (CT) imaging to predict histology.
METHODS
One-hundred consecutive patients with SRMs and 4-phase preoperative CT imaging, who underwent extirpative surgery with a pathologic diagnosis of renal cell carcinoma (RCC), angiomyolipoma (AML), or oncocytoma, were identified from a single institution. An expert radiologist, blinded to histologic results, retrospectively recorded tumor size, RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor, and the location relative to polar lines) nephrometry score, tumor attenuation, and the renal cortex on all 4 acquisitions (precontrast, corticomedullary, nephrogenic, and delayed density).
RESULTS
Pathologic diagnoses included 48 clear-cell RCCs (ccRCCs), 22 papillary RCCs, 10 chromophobe RCCs, 13 oncocytomas, and 7 AMLs. There was no significant difference in median tumor size (P = .8), nephrometry score (P = .98), or anatomic location (P >.2) among histologies. Significant differences were noted in peak enhancement (P <.001) and phase-specific enhancement (P <.007) by histology. Papillary RCCs demonstrated a distinct enhancement pattern, with a peak Hounsfield unit (HU) of 56, and greatest enhancement during the NG and delayed phases. The highest peak HU were demonstrated by ccRCC (117 HU) and oncocytoma (125 HU); ccRCC more often peaked in the corticomedullary phase, whereas oncocytoma peaked in the nephrogenic phase.
CONCLUSION
In a series of patients with SRMs undergoing 4-phase CT, tumor histologies demonstrated distinct enhancement patterns. Thus, preoperative 4-phase CT imaging may provide useful information regarding pathologic diagnosis in patients undergoing extirpative surgery.
目的
分析小肾肿瘤（SRM）在 4 期 CT 成像期间的增强模式，以预测组织学。
方法
从一家机构中确定了 100 例连续的患有 SRM 并进行了 4 期术前 CT 成像的患者，这些患者接受了肾细胞癌（RCC）、血管平滑肌脂肪瘤（AML）或嗜酸细胞瘤的根治性手术，并进行了病理诊断。一位对组织学结果不知情的专家放射科医生回顾性地记录了肿瘤大小、RENAL（半径、肿瘤的外生/内生特性、肿瘤最深部与集合系统或窦腔的接近程度、前后描述符以及相对于极线的位置）肾单位测量评分、肿瘤衰减和所有 4 个采集（平扫、皮质髓质、肾生成和延迟密度）的肾皮质。
结果
病理诊断包括 48 例透明细胞 RCC（ccRCC）、22 例乳头状 RCC、10 例嫌色细胞 RCC、13 例嗜酸细胞瘤和 7 例 AML。组织学之间的中位肿瘤大小（P=0.8）、肾单位测量评分（P=0.98）或解剖位置（P>.2）没有显著差异。组织学之间的峰值增强（P<.001）和各期特异性增强（P<.007）存在显著差异。乳头状 RCC 表现出独特的增强模式，峰值 CT 值为 56，在 NG 和延迟期增强最大。ccRCC（117 HU）和嗜酸细胞瘤（125 HU）的峰值 HU 最高；ccRCC 常在皮质髓质期达到峰值，而嗜酸细胞瘤则在肾生成期达到峰值。
结论
在一系列接受 4 期 CT 的 SRM 患者中，肿瘤的组织学表现出不同的增强模式。因此，术前 4 期 CT 成像可能为接受根治性手术的患者的病理诊断提供有用的信息。
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