CAJ | 학술논문

目的探讨CT扫描对肾癌亚型的鉴别诊断价值.方法 2001年2月至2012年3月收集53例经手术病理证实的肾癌患者资料,其中肾透明细胞癌(CCRCC)28例,Xp11.2易位/TFE基因融合相关性肾癌(Xp11.2/TFE RCC)6例,集合管癌(CDC)7例,肾嫌色细胞癌(CRCC) 12例,对比分析各亚型肿瘤患者CT平扫及三期增强扫描表现并与病理对照,采用单因素方差分析和LSD法进行比较.结果 CCRCC和CDC多数密度不均(分别为23/28例和6/7例),常见坏死(21/28例和6/7例);Xp11.2/TFE RCC和CRCC密度多均匀(分别为5/6例和8/12例).CCRCC、Xp11.2/TFERCC和CRCC多有包膜(分别为25/28例、6/6例和10/12例),CDC多无包膜(6/7例);CCRCC淋巴结及远处器官转移最常见(19/28例).CT平扫期,Xp11.2/TFE RCC密度为(53.7±4.1) HU,高于CCRCC、CDC、CRCC及正常肾皮质的(45.8±3.6)、(41.4±2.4)、(47.7±3.6)与(41.5±5.1) HU,(F值=5.458,P＜0.01).增强CT三期扫描CCRCC强化程度最高,强化模式呈“快进快退”,Xp11.2/TFE RCC和CRCC呈中度强化,CDC强化程度最低,三者均呈“渐进性”延迟强化.CCRCC强化程度接近于各期肾皮质强化,Xp11.2/TFE RCC、CDC及CRCC强化程度明显低于肾皮质强化(P＜0.01).Xp11.2/TFERCC强化程度高于CDC及CRCC(P＜0.01).皮质期及皮髓质期,Xp11.2/TFE RCC和CRCC强化高于肾髓质(P＜0.01),但肾盂期低于肾髓质(P＜0.01).皮质期、皮髓质期及肾盂期,CDC强化均低于肾皮质和肾髓质(P＜0.05).结论 CCRCC、Xp11.2/TFE RCC、CDC和CRCC的CT扫描有一定的特征性表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断中有着较高的临床应用价值.
목적 탐토CT소묘대신암아형적감별진단개치.방법 2001년2월지2012년3월수집53례경수술병리증실적신암환자자료,기중신투명세포암(CCRCC)28례,Xp11.2역위/TFE기인융합상관성신암(Xp11.2/TFE RCC)6례,집합관암(CDC)7례,신혐색세포암(CRCC) 12례,대비분석각아형종류환자CT평소급삼기증강소묘표현병여병리대조,채용단인소방차분석화LSD법진행비교.결과 CCRCC화CDC다수밀도불균(분별위23/28례화6/7례),상견배사(21/28례화6/7례);Xp11.2/TFE RCC화CRCC밀도다균균(분별위5/6례화8/12례).CCRCC、Xp11.2/TFERCC화CRCC다유포막(분별위25/28례、6/6례화10/12례),CDC다무포막(6/7례);CCRCC림파결급원처기관전이최상견(19/28례).CT평소기,Xp11.2/TFE RCC밀도위(53.7±4.1) HU,고우CCRCC、CDC、CRCC급정상신피질적(45.8±3.6)、(41.4±2.4)、(47.7±3.6)여(41.5±5.1) HU,(F치=5.458,P＜0.01).증강CT삼기소묘CCRCC강화정도최고,강화모식정“쾌진쾌퇴”,Xp11.2/TFE RCC화CRCC정중도강화,CDC강화정도최저,삼자균정“점진성”연지강화.CCRCC강화정도접근우각기신피질강화,Xp11.2/TFE RCC、CDC급CRCC강화정도명현저우신피질강화(P＜0.01).Xp11.2/TFERCC강화정도고우CDC급CRCC(P＜0.01).피질기급피수질기,Xp11.2/TFE RCC화CRCC강화고우신수질(P＜0.01),단신우기저우신수질(P＜0.01).피질기、피수질기급신우기,CDC강화균저우신피질화신수질(P＜0.05).결론 CCRCC、Xp11.2/TFE RCC、CDC화CRCC적CT소묘유일정적특정성표현,여기병리특점밀절상관,재신암아형적감별진단중유착교고적림상응용개치.
Objective To investigate the differential diagnostic features of subtpes of renal cell carcinoma (RCC) using CT scan.Methods The CT appearances of 53 RCCs,including 28 clear cell RCCs (CCRCC),6 Xp11.2 /TFE RCCs (Xp11.2 /TFE RCC),7 collecting ducts RCCs (CDC),12 chromophobe RCCs (CRCC),were retrospectively analyzed and compared with finding of pathology.Dynamic contrast-enhanced CT (DCE-CT) was conducted in each case after intravenous administration of contrast agent,and the data was analyzed by AVONA and LSD text.Results On unenhanced and enhanced CT,most CCRCCs and CDCs showed heterogeneous density (23/28,6/7),with necrosis (21/28,6/7),and most Xp11.2/TFE RCCs,CRCCs showed homogeneous density(5/6,8/12).Most CCRCCs,Xp11.2/TFE RCCs and CRCCs had clearly boundaries with well demonstrated at enhanced CT delayed phase (25/28,6/6,10/12),CDCs had unclearly boundaries (6/7),and most CCRCCs had lymph node or other metastasis (19/28).A phenomenon of quick staining and quick fainting was observed in CCRCCs.Xp11.2/TFE RCCs,CDCs,CRCCs showed delayed enhancement.On unenhanced CT,the Xp11.2/TFE RCC attenuation was greater than CCRCC,CDC,CRCC and normal renal cortex (53.7±4.1 vs 45.8±3.6 vs 41.4±2.4 vs 47.7±3.6 vs 41.5±5.1,F=5.458,P＜0.01,respectively).The enhancement degree was highest for CCRCCs,lowest for CDCs,and intermediate for Xp1 1.2/TFE RCCs and CRCCs.The enhancement degree of Xp1 1.2/TFE RCC was higher than that of the CDC and CRCC (P＜ 0.01).The enhancement degree of Xp11.2/TFE RCC and CRCC were higher than that of the normal renal medulla at cortical and medullary phases (P＜0.01),but lower than that of the renal medulla on delayed phase (P＜0.01).The enhancement degree of CDC were lower than that of the normal renal cortex and medulla on cortical,medullary and delayed phases (P＜0.05).Conclusions CT could distinctly show imaging features of CCRCC,Xp1 1.2/TFE RCC,CDC and CRCC,which were related to their pathological characteristics,and these features were helpful in predicting a specific subtype of RCC.