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肾脏嫌色细胞癌影像分析(附20例报告)

作者:李清霞1 何 健2 汪 维3 秦国初2 朱 斌2

所属单位:1.江苏省南京市仙林鼓楼医院B超 室 (江苏 南京 210046) 2.南京大学医学院附属鼓楼医院放 射科 (江苏 南京 210008) 3.南京大学医学院附属鼓楼医院泌 尿科 (江苏 南京 210008)

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摘要

目的 探讨肾脏嫌色细胞癌 (chromophobe renal cell carcinoma, CRCC)的超声与CT影像特点,提高其影像 诊断及鉴别诊断能力。方法 回顾分析20 例经手术病理证实的CRCC的超声及CT表 现,常规超声检查及CT平扫及增强检查 20例,超声造影检查15例。结果 常规超 声:肿块以低回声(15/20,75%)为主, 病灶内回声以均匀多见(16/20,80%)。 超声造影:肿块均匀强化9例,不均匀强 化6例,皮质期同步强化10例,缓慢强化 5例。达峰值时肿块呈低增强11例,等增 强4例。CT检查:平扫显示病灶等密度16 例,稍高或稍低密度各2例,80%(16/20) 密度均匀,20%(4/20)密度不均匀,肿块 中央点片状钙化7例。CT增强扫描CRCC多 表现为皮质期、实质期呈轻到中度强化, 皮质期强化达峰值11例,实质期达峰值9 例,病灶中央显示瘢痕3例。结论 CRCC的 超声及CT表现具有一定特征,依据肿瘤均 质、轻到中度强化的特点,大多数患者术 前能得到正确诊断。

Objective To study the ultrasonic and CT features of chromophobe renal cell carcinoma (CRCC). Methods Twenty cases of postoperative pathologically confirmed CRCCs were retrospectively analyzed. All the patients underwent conventional ultrasonography (US), plain and contrast enhanced CT (CECT) scanning, and 15 of them received contrast enhanced US (CEUS). Results In US, CRCCs usually showed hypoechoic (15/20, 75%) and homogeneous echo (16/20, 80%). In CEUS, 9 cases showed homogeneous enhancement and 6 appeared heterogeneous enhancement. And 10 cases showed isochronous enhancement and 5 demonstrated delayed enhancement in the cortical phase of CEUS. And 11 cases manifested low enhancement and 4 showed equal enhancement compared with the renal cortex at the peak time. On plain CT scan, CRCCs showed iso- (n=16), hypo- (n=2) and hyperattenuations (n=2) respectively. CRCCs showed homogeneous (16/20, 80%) and heterogeneous density (4/20, 20%) on plain CT scan. Seven cases (7/20, 35%) contained punctate or patchy calcifications in the center of tumor. On CECT scan, all CRCCs showed mildly to moderately homogeneous enhancement. The enhancement of 11 and 9 CRCCs peaked in the cortical and parenchymal phases respectively. In addition, 3 cases demonstrated stellate scar in the central area. Conclusion Correct preoperative diagnosis of CRCC could be made based on ultrasonic and CT findings, especially tumor homogeneity and mildly to moderately homogeneous enhancement on CECT and CEUS.

【关键词】嫌色细胞肾癌;体层摄影术,X线计算机;超声检查

【中图分类号】R445.3;R737.11

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.06.026

前言

CRCC是肾细胞癌中一种少见肾癌亚型,约占5%[1],其预后及生物 学行为跟其他类型肾癌不同,预后良好,如果术前能明确诊断,对临 床制订治疗方案有较大的指导意义,部分患者可以避免不必要的根治 术。目前CRCC的影像学诊断主要依靠B超和CT检查,B超快捷、方便, CT是诊断CRCC的首选影像学检查,尤其是动态增强扫描具有较高的诊 断价值。本文共搜集了南京鼓楼医院20例经手术病理证实的CRCC,分 析其超声及CT特点,以提高对本病的诊断水平。