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目的分析肾细胞癌(renalcell carcinoma,RCC)常见病理亚型的多层螺旋CT(MSCT)表现,旨在提高对RCC各亚型的CT诊断及鉴别诊断水平。资料与方法回顾性分析经手术及病理证实的165例RCC患者的临床及影像资料。所有病例均行MSCT平扫和增强扫描。评价指标包括3种RCC亚型的性别差异、CT平扫和多期增强表现以及周围侵犯和远隔转移等。采用盲法评价,并对其间差异进行统计学分析。结果 3种亚型肿瘤的形态、密度、钙化、强化程度、形式和动态变化等表现的差异均有统计学意义(P<0.05)。其中,透明细胞癌形态常不规则,密度不均,皮质期(CP)呈不均匀明显强化且实质期(NP)强化程度明显减低。此外,局部侵犯和远隔转移的发生率也高于非透明细胞癌。乳头状癌和嫌色细胞癌发生钙化的比率均显著高于透明细胞癌,增强扫描常表现为CP轻度强化和NP强化增高,且增强各期净增CT值均显著低于透明细胞癌。乳头状癌与嫌色细胞癌相比,仅前者表现密度不均、强化不均匀的比例显著高于后者。其他评价指标包括性别和肿瘤大小等,在3种亚型肿瘤间差异无统计学意义(P>0.05)。结论 MSCT对诊断和鉴别诊断透明细胞癌与非透明细胞癌有重要意义,而乳头状癌和嫌色细胞癌MSCT表现虽存在一定差异,但两者间的鉴别诊断仍较难。
Objective To analyze the multi-slice spiral CT (MSCT) features of renal cell carcinoma (RCC), and to improve the diagnostic and differential diagnosis of RCC subtypes. Materials and Methods The clinical and imaging data of 165 RCC patients confirmed by surgery and pathology were retrospectively analyzed. All cases underwent MSCT plain scan and enhanced scan. Evaluation criteria included gender differences in the three RCC subtypes, CT scan and multi-phase enhancement as well as surrounding invasion and distant metastasis. Blind evaluation was used, and statistical analysis of the differences was made. Results The morphological, density, calcification, degree of enhancement, form and dynamic changes of the three subtypes of tumors showed statistical significance (P <0.05). Among them, the morphology of clear cell carcinoma often irregular, uneven density, uneven cortical (CP) was significantly enhanced and the parenchyma (NP) was significantly reduced. In addition, the incidence of local invasion and distant metastasis is also higher than non-clear cell carcinoma. The rates of calcification of papillary carcinoma and chromophobe carcinoma were significantly higher than that of clear cell carcinoma. Enhanced scanning often showed mild enhancement of CP and enhancement of NP, and enhanced net CT value was significantly lower than that of clear cell carcinoma. Papillary carcinoma compared with chromophobe carcinoma, only the former showed uneven density, uneven enhancement ratio was significantly higher than the latter. There were no significant differences among the three subtypes of tumor (P> 0.05). Conclusions MSCT is of great importance in the diagnosis and differential diagnosis of clear cell carcinoma and non-clear cell carcinoma. Although there are some differences in the appearance of MSCT between papillary carcinoma and chromophobe carcinoma, the differential diagnosis between them is still difficult.