CAJ | 학술논문

目的：探讨多层螺旋CT扫描对乳头状肾细胞癌的诊断价值。资料与方法回顾性分析23例经手术病理证实的乳头状肾细胞癌的CT平扫及三期动态增强CT表现，并以同期96例肾透明细胞癌患者作为对照，比较两者肿瘤囊变、肿瘤平扫及三期强化CT值、强化方式（均匀强化、周边强化及不均匀强化）及肿瘤扩散情况（肾周侵犯、淋巴结转移及肾静脉侵犯）。结果乳头状肾细胞癌与肾透明细胞癌皮质期、髓质期及延迟期强化CT值比较，差异均有统计学意义（t=9.70、8.08、5.92, P<0.01），乳头状肾细胞癌强化程度低于肾透明细胞癌；乳头状肾细胞癌囊变率（21.7%）低于肾透明细胞癌（54.2%），差异有统计学意义（χ2=7.54, P<0.01）；两者强化方式差异有统计学意义（χ2=30.40, P<0.01），乳头状肾细胞癌主要表现为轻度均匀强化（60.9%），而肾透明细胞癌主要为明显不均匀强化（68.8%）；两者在肾周侵犯、淋巴结转移及肾静脉侵犯方面差异均无统计学意义（χ2=0.51、0.11、0.03, P>0.05）。结论乳头状肾细胞癌多层螺旋CT增强扫描呈轻度均匀强化，少有囊变、坏死，有助于与肾透明细胞癌进行鉴别。
목적：탐토다층라선CT소묘대유두상신세포암적진단개치。자료여방법회고성분석23례경수술병리증실적유두상신세포암적CT평소급삼기동태증강CT표현，병이동기96례신투명세포암환자작위대조，비교량자종류낭변、종류평소급삼기강화CT치、강화방식（균균강화、주변강화급불균균강화）급종류확산정황（신주침범、림파결전이급신정맥침범）。결과유두상신세포암여신투명세포암피질기、수질기급연지기강화CT치비교，차이균유통계학의의（t=9.70、8.08、5.92, P<0.01），유두상신세포암강화정도저우신투명세포암；유두상신세포암낭변솔（21.7%）저우신투명세포암（54.2%），차이유통계학의의（χ2=7.54, P<0.01）；량자강화방식차이유통계학의의（χ2=30.40, P<0.01），유두상신세포암주요표현위경도균균강화（60.9%），이신투명세포암주요위명현불균균강화（68.8%）；량자재신주침범、림파결전이급신정맥침범방면차이균무통계학의의（χ2=0.51、0.11、0.03, P>0.05）。결론유두상신세포암다층라선CT증강소묘정경도균균강화，소유낭변、배사，유조우여신투명세포암진행감별。
Purpose To evaluate the value of multi-slice spiral computed tomography (MSCT) scan in the diagnosis of papillary renal cell carcinoma. Materials and Methods A retrospective study was conducted on the findings of plain CT scan and triphasic dynamic contrast enhanced CT scan of 23 patients with papillary renal cell confirmed pathologically, and further contrasted with the findings of 96 patients with clear cell renal cell carcinoma at corresponding phases in such aspects as cystic degeneration, enhancement degree and pattern (homogeneous, peripheral or heterogeneous) and tumor spreading pattern (perinephric invasion, lymphadenopathy or venous invasion). Results The degree of enhancement CT value for both diseases showed statistical significance in corticomedullary phase, parenchymal phase and excretory phase (t=9.70, 8.08, 5.92;P<0.01), but papillary renal cell carcinoma was lower than clear cell renal cell carcinoma. In terms of cystic degeneration, papillary renal cell carcinoma was significantly lower than clear cell renal cell carcinoma (21.7%vs 54.2%,χ2=7.54, P<0.01). Papillary renal cell carcinoma mainly showed homogeneous enhancement (60.9%) whereas clear cell renal cell carcinoma mainly presented heterogeneous enhancement (68.8%) with statistical difference (χ2=30.40, P<0.01). The tumor spreading patterns like perinephric invasion, lymphadenopathy and venous invasion had no significant difference (χ2=0.51, 0.11, 0.03;P>0.05). Conclusion Papillary renal cell carcinoma shows homogeneous enhancement, seldom cystic degeneration or necrosis on MSCT scan, which is helpful for the differential diagnosis from clear cell renal cell carcinoma.