CAJ | 학술논문

目的：探讨多层螺旋CT（MSCT）三期增强扫描对最大径≥5cm巨大肾细胞癌的鉴别诊断价值。方法回顾性分析本院经手术病理证实的50例最大径≥5cm巨大肾细胞癌患者行M SC T平扫加皮质期、髓质期及排泄期扫描的影像学特征性表现，重点分析CT动态增强扫描技术的应用及强化特点，寻找各病理亚型的影像学异同。结果巨大肾细胞癌出血、坏死囊变明显。透明细胞癌最常见，坏死较多甚而较大，以结节堆积样强化及片样强化为主，强化程度大多高于嫌色细胞癌及乳头状癌、集合管癌等非透明细胞癌；巨大乳头状癌坏死区较小，强化程度较低，相对均匀；嫌色细胞癌密度明显不均匀，强化明显但程度低于透明细胞癌、高于乳头状癌，可见逐渐填充中央疤痕；嫌色细胞癌及乳头状癌很少周围侵犯及转移；集合管癌恶性程度最高，缺乏特异强化形式，强化程度低，极具周围侵犯及淋巴结转移，预后极差。结论巨大肾细胞癌病理亚型的三期增强CT表现各具特征，具有鉴别诊断价值。
목적：탐토다층라선CT（MSCT）삼기증강소묘대최대경≥5cm거대신세포암적감별진단개치。방법회고성분석본원경수술병리증실적50례최대경≥5cm거대신세포암환자행M SC T평소가피질기、수질기급배설기소묘적영상학특정성표현，중점분석CT동태증강소묘기술적응용급강화특점，심조각병리아형적영상학이동。결과거대신세포암출혈、배사낭변명현。투명세포암최상견，배사교다심이교대，이결절퇴적양강화급편양강화위주，강화정도대다고우혐색세포암급유두상암、집합관암등비투명세포암；거대유두상암배사구교소，강화정도교저，상대균균；혐색세포암밀도명현불균균，강화명현단정도저우투명세포암、고우유두상암，가견축점전충중앙파흔；혐색세포암급유두상암흔소주위침범급전이；집합관암악성정도최고，결핍특이강화형식，강화정도저，겁구주위침범급림파결전이，예후겁차。결론거대신세포암병리아형적삼기증강CT표현각구특정，구유감별진단개치。
Objective To investigate the value of multi-slice CT (MSCT) three phase enhanced scan in the differential di-agnosis of huge renal carcinoma (maximum diameter ≥ 5 cm) .Methods We retrospectively analyzed the MSCT scanning imaging characteristics of 50 cases of the huge renal carcinoma (maximum diameter ≥5 cm) confirmed pathologically ,with special emphasis given to the analysis of application and enhanced features of dynamic contrast-enhanced CT scanning tech-nology and looking for the similarities and differences of imaging manifestations between histological subtypes .Results Huge renal carcinoma was obviously shown hemorrhage ,cystic alteration and necrosis .Clear cell carcinoma is the most common type ,which appeared serious necrosis inside the tumor ,with nodular accumulation enhancement and patch en-hancement .The degree of enhancement was mostly higher than that of chromophobe cell carcinoma ,papillary carcinoma , collecting duct carcinoma ,and other types of carcinoma .Giant papillary carcinoma had smaller necrotic areas ,lower de-gree of enhancement and relatively uniform .The density of chromophobe cell carcinoma was significantly uneven ,but ,the degree of enhancement was significantly lower than that of clear cell carcinoma ,higher than that of papillary carcinoma , and the central scar gradually filled .Chromophobe cell carcinoma and papillary carcinoma seldom invaded and metasta-sized .The collecting duct carcinoma was the highest degree of malignancy and lack of specifical enhancement pattern ,with lower degree of enhancement and ,most likely ,the invasion of the surrounding tissues ,metastasis of lymph nodes ,and poor prognosis .Conclusion The manifestations of MSCT three-phases enhanced scaning for the pathological subtype of huge renal cell carcinoma possesses different characteristics ,which are beneficial to the differential diagnosis of this disor-der .