Wen Xuewei, Kang Huanhuan, Bai Xu, Ning Xueyi, Li Chaobo, Yi Sicheng, Ding Xiaohui, Sun Hao, Wang He, Zhou Yan, Cao Kai, Guo Hao, Wang Haiyi
Department of Radiology, the First Medical Center of the Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China (X.W., H.K., X.B., X.N., C.L., S.Y., H.W.); Chinese PLA Medical School, 28 Fuxing Road, Haidian District, Beijing 100853, China (X.W., H.K., X.B., X.N., C.L., S.Y.).
Department of Pathology, the First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China (X.D.).
Acad Radiol. 2025 May;32(5):2787-2796. doi: 10.1016/j.acra.2024.12.017. Epub 2024 Dec 24.
To improve the diagnostic recognition of papillary renal neoplasm with reverse polarity (PRNRP) through comprehensive analysis of computed tomography (CT) and magnetic resonance imaging (MRI) findings.
A retrospective multi-center study was conducted on patients with pathologically confirmed PRNRPs from 2019 to 2024, encompassing six institutions. Clinical and pathological data were meticulously documented. Preoperative CT (n=23) and MRI (n=9) features were independently evaluated in consensus by two genitourinary radiologists, focusing on tumor location, morphologic features, attenuation, signal intensity, and enhancement patterns. Postoperative outcomes were assessed through medical record review or telephone follow-up.
The study cohort comprised 26 patients (mean age 62±12 years, 13 men) with 26 well-defined PRNRPs (mean diameter 2.2±1.0 cm) were included. 15 cases (58%) were situated in the right kidney, 18(69%) were exophytic, and 23(88%) were quasi-spherical. A pseudocapsule was identified in eight cases (89%) on MRI. All cases demonstrated iso- or slight hyperattenuation (43.1±13.6 HU) on non-contrast CT, hypointensity on T2-weighted imaging (T2WI), and mild diffusion restriction on diffusion-weighted imaging (DWI). All cases exhibited mild or moderate enhancement in the corticomedullary phase, followed by progressive enhancement in the nephrographic and excretory phases. Concomitant renal cysts were found in 17 cases (65%). All cases showed no evidence of recurrence or metastasis.
PRNRP typically presents as a small hypovascular renal mass, and characterized by a pseudocapsule, iso- or slight hyperattenuation on non-contrast CT, heterogeneous T2WI hypointensity, and mild diffusion restriction on DWI.
通过对计算机断层扫描（CT）和磁共振成像（MRI）结果的综合分析，提高对具有反向极性的乳头状肾肿瘤（PRNRP）的诊断识别能力。
对2019年至2024年期间来自六个机构的经病理证实的PRNRP患者进行了一项回顾性多中心研究。详细记录了临床和病理数据。由两位泌尿生殖系统放射科医生对术前CT（n = 23）和MRI（n = 9）特征进行独立的一致性评估，重点关注肿瘤位置、形态特征、密度、信号强度和强化模式。通过病历审查或电话随访评估术后结果。
该研究队列包括26例患者（平均年龄62±12岁，13例男性），共纳入26个边界清晰的PRNRP（平均直径2.2±1.0 cm）。15例（58%）位于右肾，18例（69%）为外生性，23例（88%）为准球形。MRI上8例（89%）发现假包膜。所有病例在非增强CT上均表现为等密度或轻度高密度（43.1±13.6 HU），在T2加权成像（T2WI）上呈低信号，在扩散加权成像（DWI）上有轻度扩散受限。所有病例在皮质髓质期均表现为轻度或中度强化，随后在肾实质期和排泄期逐渐强化。17例（65%）伴有肾囊肿。所有病例均无复发或转移迹象。
PRNRP通常表现为小的乏血管性肾肿块，其特征为有假包膜，非增强CT上等密度或轻度高密度，T2WI不均匀低信号，DWI上有轻度扩散受限。
