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CT在肾脏富血供肿瘤鉴别诊断中的价值

作者:高玉青 刘 斌

所属单位:安徽医科大学第一附属医院放射科(安徽 合肥 230022)

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摘要

目的探讨肾脏富血供肿瘤CT平 扫及动态增强影像学特点,提高对肾脏 富血供肿瘤影像学表现的认识及鉴别诊 断水平。方法 回顾性分析109例(其中透 明细胞癌79例,乏脂型血管平滑肌脂肪 瘤14例,嫌色细胞癌9例,嗜酸性细胞腺 瘤7例)经手术病理证实的肾脏肿瘤。结 果 (1)透明细胞癌出现囊变坏死的概率 (87.34%)明显高于其他三种肿瘤;(2)中 央瘢痕对嗜酸性细胞腺瘤的诊断有一定的 帮助,可视为其特征性CT表现,但不是其 特异性征象;(3)“成角征”对于肿瘤定 性诊断具有统计学意义;(4)嫌色细胞癌 与其他三种肿瘤的CT值间差异有统计学意 义,实质期及延迟期嗜酸性细胞腺瘤与其 他三组的CT值间差异有统计学意义,乏脂 型血管平滑肌脂肪瘤与透明细胞癌的CT值 间差异无统计学意义。结论 CT平扫及增 强扫描对肾脏富血供肿瘤的鉴别诊断有一 定价值,有利于指导临床及预后。

Objective To improve the understanding and differential diagnostic level of imaging features of hypervascular renal tumors by investigating the imaging characteristics of CT scan and three phase dynamic enhanced. Methods A total of 105 cases including 79 cases of renal clear cell carcinoma and 14 cases of lipoprotein-deficient angiomyolipoma, 8 cases of chromophobe cell tumor and 4 cases of eosinophil adenoma were analyzed retrospectively. The cases were all confirmed as renal tumors by pathology surgery. Results (1) The probability of occurrence of cystic necrosis of clear cell carcinoma(87.34%) was significantly higher than that of the other three types of tumors. (2) The central scar is helpful to the diagnosis of eosinophil adenoma, which can be regarded as its CT features, but not the specific sign. (3) "Angular sign" was statistically significant for the qualitative diagnosis of tumors. (4)The diffrence of CT values between chromophobe cell tumor and other three kinds of tumors was significant statistically. The difference of CT values between eosinophil adenoma and the other three groups in parenchymal and excretory period was statistically significant. The difference of CT values between lipoproteindeficient angiomyolipoma and renal clear cell carcinoma was not statistically significant. Conclusion CT scan and enhancement are worth of diagnosing hypervascular renal tumors. It is helpful to guide the clinical and prognosis.

【关键词】肾脏;CT;透明细胞癌;嫌色细胞癌;乏脂性血管平滑肌脂肪瘤;嗜酸性细胞腺瘤

【中图分类号】R445.3;R737.11

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.12.034

前言

肾脏肿瘤是泌尿系统较常见的占位性病变且具有多种肾细胞亚 型,文献报道,在过去二十年里,肾脏肿瘤的发病率呈逐渐升高趋 势[1]。肾透明细胞癌、嫌色细胞癌、乏脂性血管平滑肌脂肪瘤及嗜酸 性细胞腺瘤均为血供较丰富的肿瘤,其影像学表现有相似之处,而临 床症状无特异指向性,术前对肾脏富血供肿瘤进行良恶性鉴别对于临 床选择手术方式及患者预后具有重要意义,多层螺旋CT作为一种快速 无创的检查方法已广泛应用于临床,本研究的目的在于进一步明确CT 对于肾脏富血供肿瘤的鉴别诊断价值。