目的 研究肾癌不同亚型的CT征 象及CT定量分析的临床价值。方法 回顾 性分析2013年7月至2015年7月在我院经过 手术和穿刺活检病理证实为肾癌的87例患 者的影像学资料，根据不同亚型分类，其 中透明细胞癌43例，乳头状肾细胞癌26 例，嫌色细胞癌18例。比较三种亚型肾癌 患者平扫及增强后CT值，比较三种亚型肾 癌病灶大小和强化方式，并分析肾癌亚型 与CT征象的关系。结果 乳头状肾细胞癌 患者皮质期、实质期、排泄期CT值较嫌色 细胞癌患者显著较高(P＜0.05)；透明细 胞癌患者中强化均匀者为23.26%较乳头状 肾细胞癌患者57.69%与嫌色细胞癌患者 66.67%显著较低(P＜0.05)；透明细胞癌 患者发生坏死或囊变的概率为81.40%较乳 头状肾细胞癌57.69%、嫌色细胞癌22.22% 显著较高，嫌色细胞癌者发生坏死或囊变 的概率较乳头状肾细胞癌显著较低，透明 细胞癌患者肿瘤边缘清晰的概率为30.23% 较乳头状肾细胞癌76.92%和嫌色细胞癌 88.89%显著较低(P＜0.05)。结论 肾癌不 同亚型之间的CT表现存在一定的差异，临 床上能通过CT征象及CT定量分析对肾癌亚 型进行初步判断，对肾癌的治疗有一定的 临床指导价值。

Objective To study the clinical value of CT signs and CT quantitative analysis of different subtypes of renal cell carcinoma. Methods Imaging data of 87 patients with renal cell carcinoma confirmed by surgery and biopsy in our hospital from July 2013 to July 2015 were analyzed retrospectively, according to different subtype classification, there were 43 cases in clear cell carcinoma, 26 cases in papillary renal cell carcinoma, 18 cases in chromophobe cell tumor. Plain CT scan and enhanced CT value of three subtypes of renal cell carcinoma patients were compared, lesions sizes, enhancement pattern of three subtypes of renal cell carcinoma were compared, relationship between the subtypes of renal cell carcinoma and the CT signs were analyzed. Results Cortical phase CT value, tangible CT value and excretion phase CT value of patients with papillary renal cell carcinoma were significantly higher than patients with chromophobe cell tumor (P<0.05), patients with homogeneous enhancement in clear cell carcinoma patients was 23.26%, which was significantly lower than papillary renal cell carcinoma patients (57.69%) and chromophobe cell tumor patients (66.67%) (P<0.05), the incidence of necrosis and cystic degeneration in clear cell carcinoma patients were 81.40%, which were significantly higher than the papillary renal cell carcinoma (57.69%) and chromophobe cell tumor (22.22%), the incidence of necrosis and cystic degeneration in chromophobe cell tumor were significantly lower than papillary renal cell carcinoma, the incidence of tumors with clear margin in clear cell carcinoma patients was 30.23%, which was significantly lower than papillary renal cell carcinoma (76.92%) and chromophobe cell tumor(88.89%) (P<0.05). Conclusion There are some differences in CT features of different subtypes of renal cell carcinoma, CT signs and CT quantitative analysis can judge subtypes of renal cell carcinoma initially in clinic, they have a certain clinical guidance value for the treatment of renal cell carcinoma.