MSCT多期增强扫描在肾脏透明细胞癌中的诊断价值

目的探讨多排螺旋CT(MSCT)多期增强扫描在肾脏透明细胞癌诊断中的规律性,提高对该肿瘤诊断水平。方法回顾性分析2016年1月~2018年6月14例均经手术切除病理证实为肾脏透明细胞癌患者的CT影像资料,所有病例均行MSCT平扫及多期动态增强扫描。结果14例肾脏透明细胞癌形态大多数呈圆形或者类圆形,瘤体最大径范围1.7cm^11.3cm,平均(4.8±1.4)cm,13例CT平扫时肿瘤密度不均匀,呈等低密度,1例呈等密度;12例出现坏死囊变,钙化1例,伴肾盂、肾盏侵犯2例;动态增强扫描可见12例包膜完整,1例均匀性强化,13例不均匀性强化;引入对比剂后皮质期,出现10例病灶强化幅度大于肾皮质,而仅4例低于肾皮质,三期平均CT值分别为110±30Hu,90±15Hu及75±14Hu,其中在实质期出现13例肿瘤强化幅度小于肾实质,仅1例大于肾实质。结论引入对比剂动态增强扫描后,肾脏透明细胞癌在皮质期明显不均匀强化,实质期强化幅度下降显著,呈现出典型的“快进快出”血流动力学强化方式,且肿瘤容易出现坏死、囊变为其特点。

The diagnostic value of MSCT multi-phase enhanced scanning in clear cell carcinoma of kidney

Objective To investigate the regularity of multi-slice spiral CT(MSCT)multi-phase enhanced scanning in the diagnosis of clear cell carcinoma of the kidney and improve the diagnosis level of this tumor.Methods The CT images of 14 patients with renal clear cell carcinoma confirmed by surgical resection and pathology from January 2016 to June 2018 were retrospectively analyzed,and MSCT plain scan and muti-phase dynamic enhanced scan were performed in all cases.Results Most of the 14 cases of clear cell carcinoma of the kidney presented circular shape or similar shape.with the maximum diameter of the tumor ranging from 1.7cm to 11.3cm,with an average of(4.8±1.4)cm.There were 12 cases of necrotic degeneration,1 case of calcification,and 2 cases of renal pelvis and calyces invasion.Dynamic enhancement scan showed 12 cases with intact capsule,1 case with uniform enhancement,13 cases with non-uniform enhancement.In the cortical stage after the introduction of contrast agent,10 cases showed lesion intensification greater than renal cortex,while only 4 cases showed lesion intensification lower than renal cortex.The mean CT values of the three stages were 110±30Hu,90±15Hu and 75±14Hu,respectively.Conclusion After the introduction of contrast-enhanced dynamic scanning,the clear cell carcinoma of the kidney was strengthened unevenly in the cortical phase,and the enhancement amplitude decreased significantly in the parenchymal phase,presenting a typical“fast in and fast out”hemodynamic enhancement mode,and the tumor was prone to necrosis and cystic degeneration.