摘要
目的：分析透明细胞癌（RCCC）的少见CT表现和误诊原因，探讨其与临床和病理的关系，以提高诊断准确性。材料和方法：经手术病理证实的不典型透明细胞癌17例20个病灶，孤立发生14例，多发2例，VHL并发1例。术前分别经螺旋CT或多排螺旋CT平扫、皮髄交界期增强和实质期增强扫描，注射流率3~4ml/s。仔细复习CT扫描结果并和手术病理作回顾性对照分析。结果：17个病例共发现20个肾脏病灶，3个肾外病灶。肾脏病灶位于右肾13个，左肾7个。肿瘤呈圆形或类圆形，病灶中心位于肾皮质14个，位于皮质和髓质6个。肿瘤直径1.7~8.3cm，平均4.7cm。肿瘤实质成分平扫CT值11.4~34.0HU，平均20.9HU。皮髓交界早期CT值27.3~112.5HU，平均48.2HU。实质期CT值36.4~77.4HU，平均53.7HU。实质期增强有利于显示病灶内的坏死和境界，其中动态增强无明显强化8个病灶，显著囊变7个病灶。18个病灶境界清楚，2个病灶境界不清。3个肾外病灶分别为肾上腺嗜铬细胞瘤2个，胰腺尾部胰岛细胞瘤1个，所有肾外病灶皮髓交界早期扫描显著强化，实质期扫描呈持续强化。结论：RCCC少见CT表现包括：肿瘤少血供或乏血供、过度囊变、肉瘤样变、双肾多发等，部分肿瘤容易误诊。认识上述少见CT表现有利于提高诊断准确性和病理分型准确性。
Abstract
Objective: To explore the relationship between the uncommon CT findings of renal clear cell carcinoma with pathology and to evaluate it’s clinical value. Materials and Methods: Seventeen cases with renal clear cell carcinoma confirmed by surgical pathology underwent spiral CT plain scanning and dynamic enhancement scanning before operation, the CT data were reviewed and analysed retrospectively in comparison with surgical and pathological results. Results: Twenty renal lesions and 3 lesions outside of kidney were revealed in these 17 patients. Lesions located in the right kidney(n=13) and in the left kidney(n=7). The center of lesions located in the cortex of kidney(n=14) and between the medulla and the cortex of kidney(n=6). The lesions appeared as round or ellipse in shape with the mean diameter of 4.7cm(range 1.7 to 8.3cm). The CT value of the plain scan, corticomedullary phase and nephrographic phase were 11.4~34.0HU(with a mean value of 20.9HU), 27.3~112.5HU(with a mean value of 48.2HU) and 36.4~77.4HU(with a mean value of 53.7HU) respectively. The margin and the necrosis of tumor were well showed in nephrographic phase. Two adrenal pheochromocytomas and 1 islet cell tumor in the pancreatic tail were revealed outside of kidney. Conclusion: The uncommon CT findings include: insufficient blood supply, cystic, sarcomatous change and bilateral multiple renal lesions. The CT findings are correlated with histologic type, cell differentiation, vascularization and biological behaviour. Recognization the uncommon CT findings is helpful to improve the accuracy of diagnosis and pathological typing.
关键词
肾肿瘤 /
体层摄影术 /
X线计算机
Key words
Kidney neoplasms /
Tomography /
X-ray computed
周建军;王建华;曾蒙苏;严福华;丁建国;周康荣.
透明细胞型肾癌少见CT表现与临床和病理的关系[J]. 中国临床医学影像杂志. 2009, 20(11): 814-818
ZHOU Jian-jun;WANG Jian-hua;ZENG Meng-su;YAN Fu-hua;DING Jian-guo;ZHOU Kang-rong.
Renal clear cell carcinoma: exploring the relationship between uncommon CT findings with pathology[J]. Journal of China Clinic Medical Imaging. 2009, 20(11): 814-818
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