Comune Rosita, Tiralongo Francesco, Bicci Eleonora, Saturnino Pietro Paolo, Ronza Francesco Michele, Bortolotto Chandra, Granata Vincenza, Masala Salvatore, Scaglione Mariano, Sica Giacomo, Tamburro Fabio, Tamburrini Stefania
Department of Radiology, Ospedale del Mare-ASL NA1 Centro-Napoli, 80147 Naples, Italy.
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy.
Diagnostics (Basel). 2025 Apr 1;15(7):906. doi: 10.3390/diagnostics15070906.
To describe the US, CEUS, CT, and MRI features of papillary renal cell carcinoma (PRCC) and to underline the imaging characteristics that are helpful in the differential diagnosis. Patients with histologically proven papillary renal cell carcinoma who underwent at least two imaging examinations (US, CEUS, CT, and MRI) were included in the study. Tumor size, homogeneity, morphology, perilesional stranding, contrast enhancement locoregional extension were assessed. A comparison and the characteristics of the imaging features for each imaging modality were analyzed. A total of 27 patients with an histologically confirmed diagnosis of PRCC were included in the study. US was highly accurate in distinguishing solid masses from cystic masses, supporting the differential diagnosis of PRCC, as well as in patients with a poor representation of the solid component. CEUS significantly increased diagnostic accuracy in delineating the solid intralesional component. Furthermore, when using CEUS, in the arterial phase, PRCC exhibited hypo-enhancement, and in the late phase it showed an inhomogeneous and delayed wash-out compared with the surrounding renal parenchyma. At MRI, PRCC showed a marked restiction of DWI and was hypointense in the T2-weighted compared to the renal parenchyma. In our study, the characteristic hypodensity and hypoenhancement of PRCC make CT the weakest method of their recognition, while US/CEUS and MRI are necessary to reach a definitive diagnosis. Knowledge of the appearance of PRCC can support an early diagnosis and prompt management, and radiologists should be aware that PRCC, when detected using CT, may resemble spurious non-septate renal cyst.
描述乳头状肾细胞癌（PRCC）的超声（US）、超声造影（CEUS）、计算机断层扫描（CT）和磁共振成像（MRI）特征，并强调有助于鉴别诊断的影像学特征。纳入经组织学证实为乳头状肾细胞癌且至少接受过两项影像学检查（US、CEUS、CT和MRI）的患者。评估肿瘤大小、均匀性、形态、病灶周围条索状影、对比增强及局部扩展情况。分析每种影像学检查方法的成像特征并进行比较。本研究共纳入27例经组织学确诊为PRCC的患者。US在区分实性肿块与囊性肿块方面具有高度准确性，有助于PRCC的鉴别诊断，对于实性成分显示不佳的患者也是如此。CEUS在勾画病灶内实性成分方面显著提高了诊断准确性。此外，使用CEUS时，PRCC在动脉期表现为低增强，在延迟期与周围肾实质相比表现为不均匀且延迟消退。在MRI上，PRCC在扩散加权成像（DWI）上表现为明显受限，在T2加权像上相对于肾实质呈低信号。在我们的研究中，PRCC的特征性低密度和低增强使CT成为识别它们的最弱方法，而US/CEUS和MRI对于明确诊断是必要的。了解PRCC的表现有助于早期诊断和及时治疗，放射科医生应意识到，使用CT检测到的PRCC可能类似于假性无分隔肾囊肿。
