摘要
目的探讨64排螺旋CT在肾透明细胞癌诊断中的价值,为临床提供影像学帮助。方法收集2013年1月—2014年10月蚌埠医学院第二附属医院收治的33例经手术及病理证实肾透明细胞癌患者的CT资料进行分析,评价64排螺旋CT在肾透明细胞癌诊断中的价值。结果 33例肾透明细胞癌患者均为单发,肿瘤多发于肾上、下极,多呈类圆形或分叶状,瘤体以囊实性居多,高低混杂不均匀密度为主,可出现囊变、坏死、假包膜、钙化、转移及肿瘤侵犯等情况。增强扫描肿瘤多呈不均匀明显强化,研究中同时发现由于瘤体生长程度不同,肿瘤在肾皮质期可出现强化幅度不同的高、低强化区,高强化区呈典型"快进快出"强化模式。33例病例均能准确行临床TNM分期。12例患者行肾动脉CTA检查,通过三维重建及后处理,能够准确显示肾血管解剖及变异分支,并判定瘤体供血动脉,检查中发现6例患肾动脉血管存在变异。根据33例患者CT扫描资料,统计学采用单因数方差分析检验,发现平扫瘤体实质与同侧相邻正常肾皮质、肾髓质CT值差异无统计学意义(P>0.05)。增强后皮质期、实质期、排泄期瘤体实质与同侧相邻正常肾皮质、肾髓质CT值差异有统计学意义(P<0.05)。结论 64排CT能准确对肾透明细胞癌作出诊断,帮助临床判断肿瘤侵犯范围和术前临床分期,为临床治疗和预后判断提供支持和帮助。
Objective To investigate the clinical value of 64-slice spiral CT in the diagnosis of clear cell renal cell carcinoma（ CCRCC）,and provide imaging basis for the clinical diagnosis and treatment of CCRCC. Methods The CT finding（ including plain and contrast-enhanced CT scan） and CT angiography outcome of 33 cases of CCRCC confirmed by surgery and pathological diagnosis in our hospital from Jan. 2013 to Oct. 2014 were collected and analyzed to assess the role of 64-slice spiral CT in the diagnosis of CCRCC. Results All the 33 patients were confirmed to have single clear cell carcinoma of kidney and most tumors struck the upper and lower poles of kidney with quasi-circular or lobulated shapes. The majority of tumors was solid-cystic with heterogeneous density and might develop situations including cystic degeneration,necrosis,pseudocapsule,calcification,metastasis and neoplasm invasiveness,etc. Enhanced scan found that most tumors presented uneven and significant enhancement. The study also found that due to the different degrees of tumor growth,tumors might develop high and low enhancement areas with different extents of enhancement at the renal cortex phase,and the high enhancement areas presented an enhancement pattern of＂fast in,fast out＂. Accurate clinical TNM staging was achieved in all the 33 cases; 12 patients received examination of renal artery CTA and subsequent 3D reconstruction and post-processing,then the renal vascular anatomy and constructional variation of branches could be displayed accurately. In addition,tumor feeding arteries could be determined accurately and 6 cases were detected to have variation of renal artery.In accordance with the CT scan information of 33 patients,single factor variance analysis was adopted for statistical examination. The differences between plain scan on the tumor parenchyma,ipsilateral adjacent normal renal cortex and the medulla CT value presented no statistical significance（ P〉0. 05）. The differences between the tumor parenchyma at the cortical phase,parenchymal phase and excretory phase after enhancement and the adjacent ipsilateral normal renal cortex and the medulla CT value presented statistical significance（ P〈0. 05）. Conclusion 64-slice spiral CT plays an important role in the qualitative diagnosis,locating of tumors,judgment of the extent of invasion and clinical stages. The three-dimensional post processing techniques should be helpful for determining accurately the anatomy and variation of renal artery,which will provide help for the clinical surgery of CCRCC.
出处
《中华全科医学》
2015年第5期797-799,F0003,共4页
Chinese Journal of General Practice
基金
国家自然科学基金(NSFC11375181)
关键词
肾透明细胞癌
CT平扫
CT增强
影像表现
Clear cell renal cell carcinoma
A plain CT scan
Contrast-enhanced CT scan
Imaging findings
