肾乳头状癌的CT表现-第三军医大学学报.docVIP

肾乳头状癌的CT诊断和鉴别诊断 黄陈恕1；吴景全2；王健1；魏宇 1；华俊1；李志超1 (作者单位：1:第三军医大学附属西南医院放射科；2:重庆医科大学附属第一医院放射科) 提要：目的 探讨肾乳头状癌的CT表现及诊断价值。方法 结合文献回顾性分析经病理证实的9例肾乳头状癌的CT表现。结果 CT平扫9例病灶呈圆形或类圆形，密度不均匀。5例病灶内可见中心片状钙化影。增强扫描皮髓期8例呈不均匀轻中度强化，强化明显低于邻近肾皮质；1例呈不均匀的明显强化。排泄期5例病灶呈明显延迟强化表现。2例病灶可见包膜样强化。结论 CT双期增强扫描可以为肾乳头状癌的与其它肾脏恶性肿瘤的鉴别诊断提供重要参考。 关键词：体层摄影术；X线计算机；肾肿瘤 CT diagnosis and differential diagnosis of papillary renal cell carcinoma Abstract：Objective To explore the manifestation and diagnostic value of CT in papillary renal cell carcinoma by analyzing the CT findings of 9 cases.Materials CT findings were reviewed retrospectively in 9 patients with PPRC proven by pathology.Plain and dual-phase contrast-enhanced abdomen CT scans were performed in all the patients. Results On pre-contrast enhanced CT images, 9 lesions were demonstrated as around or oval inhomogeneous soft tissue density tumors.All 8 tumors except for one showed slightly inhomogeneous enhancement in the CMP,which were significantly lower than that of renal cortex.The other one lesion was appeared as marked enhancement inhomogeneously. In 5 of 9 lesions,the mean CT numbers of the papillary renal cell carcinomas in the EP were still significantly more increased than those in the CMP. The peripheral rim of 2 toumrs markedly enhanced in EP. Conculsion It was believed that dual-phase helical CT scans are helpful for facilitating the differential diagnosis from PPRC and other renal carcinoma. Keywords：X－ray computed tomography；renal neoplasm 肾乳头状癌（papillary renal cell carcinoma，PPRC）是一种不同于其他肾细胞癌的独立亚型，具有不同的分子遗传学、病理学、临床特征[1]，以及特有的治疗方案及预后。本文搜集了我院经手术病理证实的9例肾乳头状癌患者的CT及临床病理资料，进行回顾性分析研究，旨在探讨PPRC的影像特征。 1 材料和方法 1.1 临床资料 共收集我院2005年3月～2008年6月经手术病理证实的肾乳头状癌9例。其中，5例为男性，4例为女性，年龄24～68岁(平均49.3岁)。主要临床表现:上腹部不适5例，血尿2例， 3例无症状。 1.2 一般方法 所有病例均行CT平扫及双期增强扫描。4例采用Siemens Somatom Plus 5单层螺旋CT机扫描，5例采用Siemens Sensation16层螺旋CT机扫描。扫描层厚5～10mm，间隔5～10mm。增强检查用高压注射器经肘前静脉团注对比剂优维显(Ultravist)80～120ml。25～30秒后行皮髓期扫描，120秒后行排泄期扫描。剂量1.5～2.0ml/kg，注射流率3ml/s。 2 结果 2.1 病灶的一般特征 9例病例均经手术病理证实