摘要
目的 探讨CT扫描对肾癌亚型的鉴别诊断价值.方法 2001年2月至2012年3月收集53例经手术病理证实的肾癌患者资料,其中肾透明细胞癌（CCRCC）28例,Xp11.2易位/TFE基因融合相关性肾癌（Xp11.2/TFE RCC）6例,集合管癌（CDC）7例,肾嫌色细胞癌（CRCC） 12例,对比分析各亚型肿瘤患者CT平扫及三期增强扫描表现并与病理对照,采用单因素方差分析和LSD法进行比较.结果 CCRCC和CDC多数密度不均（分别为23/28例和6/7例）,常见坏死（21/28例和6/7例）;Xp11.2/TFE RCC和CRCC密度多均匀（分别为5/6例和8/12例）.CCRCC、Xp11.2/TFERCC和CRCC多有包膜（分别为25/28例、6/6例和10/12例）,CDC多无包膜（6/7例）;CCRCC淋巴结及远处器官转移最常见（19/28例）.CT平扫期,Xp11.2/TFE RCC密度为（53.7±4.1） HU,高于CCRCC、CDC、CRCC及正常肾皮质的（45.8±3.6）、（41.4±2.4）、（47.7±3.6）与（41.5±5.1） HU,（F值=5.458,P＜0.01）.增强CT三期扫描CCRCC强化程度最高,强化模式呈“快进快退”,Xp11.2/TFE RCC和CRCC呈中度强化,CDC强化程度最低,三者均呈“渐进性”延迟强化.CCRCC强化程度接近于各期肾皮质强化,Xp11.2/TFE RCC、CDC及CRCC强化程度明显低于肾皮质强化（P＜0.01）.Xp11.2/TFERCC强化程度高于CDC及CRCC（P＜0.01）.皮质期及皮髓质期,Xp11.2/TFE RCC和CRCC强化高于肾髓质（P＜0.01）,但肾盂期低于肾髓质（P＜0.01）.皮质期、皮髓质期及肾盂期,CDC强化均低于肾皮质和肾髓质（P＜0.05）.结论 CCRCC、Xp11.2/TFE RCC、CDC和CRCC的CT扫描有一定的特征性表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断中有着较高的临床应用价值.
Objective To investigate the differential diagnostic features of subtpes of renal cell car- cinoma （RCC） using CT scan. Methods The CT appearances of 53 RCCs, including 28 clear cell RCCs （CCRCC）, 6 Xpll.2 /TFE RCCs （Xpll.2 /TFE RCC）, 7 collecting ducts RCCs （CDC）, 12 chromo- phobe RCCs （CRCC） , were retrospectively analyzed and compared with finding of pathology. Dynamic con- trast-enhanced CT （DCE-CT） was conducted in each case after intravenous administration of contrast agent, and the data was analyzed by AVONA and LSD text. Results On unenhanced and enhanced CT, most CCRCCs and CDCs showed heterogeneous density （23/28, 6/7）, with necrosis （21/28, 6/7）, and most Xpl 1.2/TFE RCCs, CRCCs showed homogeneous density（5/6,8/12）. Most CCRCCs, Xpl 1.2/TFE RCCs and CRCCs had clearly boundaries with well demonstrated at enhanced CT delayed phase （25/28, 6/6, 10/ 12） , CDCs had unclearly boundaries （6/7）, and most CCRCCs had lymph node or other metastasis （ 19/28）. A phenomenon of quick staining and quick fainting was observed in CCRCCs. Xpll.2/TFE RCCs, CDCs, CRCCs showed delayed enhancement. On unenhanced CT, the Xpll.2/TFE RCC attenuation was greater than CCRCC, CDC, CRCC and normal renal cortex （53.7＋_4.1 vs 45.8＋_3.6 vs 41.4＋_2.4 vs 47.7＋_ 3.6 vs 41.5＋_5.1, F= 5.458, P〈0.01, respectively）. The enhancement degree was highest for CCRCCs, lowest for CDCs, and intermediate for Xpl 1.2/TFE RCCs and CRCCs. The enhancement degree of Xpl 1.2/ TFE RCC was higher than that of the CDC and CRCC （P〈 0.01 ）. The enhancement degree of Xpl 1.2/TFE RCC and CRCC were higher than that of the normal renal medulla at cortical and medullary phases （P〈 0.01 ） , but lower than that of the renal medulla on delayed phase （P〈0.01）. The enhancement degree of CDC were lower than that of the normal renal cortex and medulla on cortical, medullary and delayed phases （P〈0.05）. Conclusions CT could distinctly show imaging features of CCRCC, Xpl 1.2/TFE RCC, CDC
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2014年第3期168-173,共6页
Chinese Journal of Urology
基金
扬州市社会发展科技攻关课题（SGG201230084）
关键词
肾细胞癌
鉴别诊断
亚型
CT
Renal cell carcinoma
Differential diagnosis
Subtpe
Computed tomography
