[多期多层螺旋CT成像在小肾癌鉴别诊断中的作用]
[Role of multiphasic multidetector CT imaging in differential diagnosis of small renal cell carcinoma].
作者信息
Zhang Yanan, Gao Wei, Zhao Bo, Zhang Xuening
机构信息
Department of Radiology, Tianjin Medical University Second Hospital, Tianjin 300211, China.
Department of Radiology, Tianjin Medical University Second Hospital, Tianjin 300211, China; Email:
出版信息
Zhonghua Zhong Liu Za Zhi. 2015 Nov;37(11):850-4.
OBJECTIVE
To explore the possibility of predicting the histopathological types of small renal cell carcinoma (RCC) by analyzing the different ways of enhancement with multiphasic multidetector computed tomography (MDCT) of small renal cell carcinomas (diameter≤4 cm).
METHODS
CT images of 93 cases, diagnosed as RCC by pathology, were analyzed retrospectively, including 70 clear cell renal cell carcinoma (CCRCC), 13 papillary renal cell carcinoma (PRCC) and 10 chromophobe renal cell carcinoma (CRCC). All of the cases were examined by multiphasic multidetector CT scanning.
RESULTS
In plain scans, 46 CCRCCs were homogeneous, 21 CCRCCs were heterogeneous with low-density area and 3 of them had calcification. CCRCCs were enhanced in contrast scan with a presence of "wash in and wash out" enhancement in general. 11 PRCCs were homogeneous and 2 PRCCs had calcification. Slight-homogeneous enhancement and "delayed enhancement" were present in the PRCCs. Six CRCCs were homogeneous and 2 were calcified, 2 CRCCs were heterogeneous with low-density area. The CRCCs presented as slight or moderate enhancement and 5 CRCCs as homogeneous enhancement, while one CRCC was "spoke-wheel-like enhancement", with a trend of "delayed enhancement". Statistically significant differences were revealed among the actual enhanced CT values, the ratio of enhanced CT value to aorta CT value in the corticomedullary phase, nephrographic phase and excretory phase between the CCRCCs and non-CCRCCs (P<0.001). The analysis of receiver operating characteristic curves (ROC) revealed that when the actual enhanced CT value of tumors in CMP larger than 84.2 HU, the ratio of actual enhanced CT value to aorta CT value at the same phase in CMP larger than 0.315 were used as criteria to diagnose CCRCCs and excluded non-CCRCCs, the diagnostic value was best.
CONCLUSIONS
MDCT is of an important significance in the diagnosis and differential diagnosis of small CCRCCs and non-CCRCCs.
目的
通过分析直径≤4 cm的小肾癌多排螺旋CT（MDCT）多期增强的不同方式，探讨预测小肾癌组织病理学类型的可能性。
方法
回顾性分析93例经病理诊断为肾癌的CT图像，其中透明细胞肾细胞癌（CCRCC）70例、乳头状肾细胞癌（PRCC）13例、嫌色细胞肾细胞癌（CRCC）10例。所有病例均行MDCT多期扫描。
结果
平扫时，46例CCRCC呈均匀密度，21例CCRCC呈不均匀低密度区，其中3例有钙化。CCRCC增强扫描一般表现为“快进快出”强化。11例PRCC呈均匀密度，2例有钙化。PRCC表现为轻度均匀强化和“延迟强化”。6例CRCC呈均匀密度，2例有钙化，2例CRCC呈不均匀低密度区。CRCC表现为轻度或中度强化，5例呈均匀强化，1例呈“辐轮样强化”，有“延迟强化”趋势。CCRCC与非CCRCC在皮质髓质期、肾实质期和排泄期的实际强化CT值、强化CT值与主动脉CT值的比值差异有统计学意义（P<0.001）。ROC曲线分析显示，以皮质髓质期肿瘤实际强化CT值大于84.2 HU、同一期实际强化CT值与主动脉CT值的比值大于0.315为标准诊断CCRCC并排除非CCRCC时，诊断价值最佳。
结论
MDCT对小CCRCC与非CCRCC的诊断及鉴别诊断具有重要意义。
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