CAJ | 학술논문

目的总结CT和MRI检查诊断肾集合管癌的经验. 方法回顾性分析2005年2月至2012年1月10例经手术病理证实的肾集合管癌患者资料.男6例,女4例.年龄21 ～62岁,平均48岁.主要症状为腰痛7例,腰胀不适3例.实验室检查6例尿常规尿红细胞(++++).行CT检查7例,MRI检查3例.分析CT和MRI影像中的肿块生长方式、生长部位,动态增强扫描强化时相、方式及肿瘤扩散、转移情况. 结果病灶位于左肾6例,右肾4例.肿块大小4.4 cm×5.8 cm～7.2 cm×7.4 cm,平均5.7 cm×6.4 cm.肿块中心位于肾实质中央,形态不规则,呈浸润性生长,皮髓质分界模糊,肾脏形状基本正常.肿块同时累及肾皮质及髓质4例,同时累及肾皮质、髓质和肾盂6例.7例行CT检查者中,实质性肿块6例,CT平扫呈稍低密度或等密度,内有片状或斑片状低密度坏死灶,其中2例肿块内有小斑片钙化;囊实性肿块1例,肿块的囊性部分为形态不规则的液性低密度灶.3例行MRI检查者均为实性肿块,平扫肿块信号不均匀,实质部分T1WI呈稍低信号,T2WI为低信号,坏死灶在T1WI为低信号,T2WI为高信号.动态增强扫描:实质部分呈轻中度强化,皮髓质期密度或信号低于肾皮质,稍高于肾髓质,实质期轻度持续强化,仍低于肾实质,延迟扫描呈持续强化;囊性或坏死灶无强化.肾动脉被包绕2例,肾静脉瘤栓2例,肾门、腹主动脉旁淋巴结肿大9例,胸、腰椎体转移1例,肾上腺转移1例.均行患肾根治性切除术,病理报告为肾集合管癌. 结论肾集合管癌在CT及MRI影像上的特点为肿块中心位于肾实质中央,呈浸润性生长,T2WI为低信号,具有一定的特征性,动态增强扫描为轻度持续强化,并且肿瘤恶性程度高,易侵袭肾窦、肾周脂肪囊,常有肾门、腹主动脉旁淋巴结肿大,或出现远处转移.
목적 총결CT화MRI검사진단신집합관암적경험. 방법 회고성분석2005년2월지2012년1월10례경수술병리증실적신집합관암환자자료.남6례,녀4례.년령21 ～62세,평균48세.주요증상위요통7례,요창불괄3례.실험실검사6례뇨상규뇨홍세포(++++).행CT검사7례,MRI검사3례.분석CT화MRI영상중적종괴생장방식、생장부위,동태증강소묘강화시상、방식급종류확산、전이정황. 결과 병조위우좌신6례,우신4례.종괴대소4.4 cm×5.8 cm～7.2 cm×7.4 cm,평균5.7 cm×6.4 cm.종괴중심위우신실질중앙,형태불규칙,정침윤성생장,피수질분계모호,신장형상기본정상.종괴동시루급신피질급수질4례,동시루급신피질、수질화신우6례.7례행CT검사자중,실질성종괴6례,CT평소정초저밀도혹등밀도,내유편상혹반편상저밀도배사조,기중2례종괴내유소반편개화;낭실성종괴1례,종괴적낭성부분위형태불규칙적액성저밀도조.3례행MRI검사자균위실성종괴,평소종괴신호불균균,실질부분T1WI정초저신호,T2WI위저신호,배사조재T1WI위저신호,T2WI위고신호.동태증강소묘:실질부분정경중도강화,피수질기밀도혹신호저우신피질,초고우신수질,실질기경도지속강화,잉저우신실질,연지소묘정지속강화;낭성혹배사조무강화.신동맥피포요2례,신정맥류전2례,신문、복주동맥방림파결종대9례,흉、요추체전이1례,신상선전이1례.균행환신근치성절제술,병리보고위신집합관암. 결론 신집합관암재CT급MRI영상상적특점위종괴중심위우신실질중앙,정침윤성생장,T2WI위저신호,구유일정적특정성,동태증강소묘위경도지속강화,병차종류악성정도고,역침습신두、신주지방낭,상유신문、복주동맥방림파결종대,혹출현원처전이.
Objective To summarize the experience of using CT and MRI to diagnose the renal collecting duct carcinoma.Methods From February 2005 to January 2012,10 cases with renal collecting duct carcinoma,confirmed by pathology,were reviewed retrospectively.The data contained 6 men and 4 women,whose age ranged from 21 to 62 years (mean age 48 years).The flank pain was complained by 7 cases,waist discomfort was complained by 3 cases.In urine laboratory test,positive urine erythrocytes (++++) were found in 6 cases.In 10 cases,7 cases accepted CT examination and 3 cases accepted MRI examination.The growth pattern,lesion location,dynamic enhanced scan phase of the tumor and the way of spreading and metastasis were analyzed based on those CT and MRI images.Results The lesions were located in the left kidney in 6 cases,located in the right kidney in 4 cases.The size of tumors ranged from 4.4 cm×5.8 cm to 7.2 cm× 7.4 cm (mean size 5.7 cm× 6.4 cm).The mass,located in the center of renal parenchyma with irregular shape,showed infiltrative growth pattern.The shape of kidney was normal,whereas the border line between cortex and medulla was indistinct.The tumor involved the renal cortex and medulla in 4cases and involved the renal cortex,medulla,pelvis simultaneously in 6 cases.Among 7 patients who accepted the CT scanning,the solid mass was revealed in 6 cases.On CT plain scanning,the masses demonstrated slightly low or equal density within flaky or patchy low-density necrosis.Two cases showed small punctate calcification within the mass.One case was solid and cystic mass,which the cystic part of the mass showed irregular shape of the liquid-density.Among 3 patients accepted MRI scanning,all masses showed solid characters.The substantial part showed slightly hypointense on T1WI and low signal intensity on T2WI.The necrotic foci demonstrated low signal intensity on T1WI and high signal on T2WI.Dynamic enhanced scan revealed mild to moderate enhanced in the substantive part.The density of signal was lower than the renal cortex and slightly higher than the renal medulla in corticomedullary phase.It enhanced continuously in parenchymal phase,but still lower than the renal parenchyma.It enhanced continuously in the delayed phase,while the cystic or necrotic lesions were not observed the enhancement.Renal artery was surrounded by the mass in 2 cases.Tumor embolus was found in the renal vein in 2 cases,9 cases were noticed with renal hilum and paraortic hyperlymphonodus.The thoracic and lumbar spinal metastasis was found in 1 case and adrenal metastasis was found in another case.All patients underwent radical nephrectomy,that pathological diagnosis was renal collecting duct carcinoma.Conclusions The CT and MRI imaging characteristics of renal collecting duct carcinoma can be described as the mass located in the center of renal parenchyma with the infiltrative growth pattern.In MRI image,it demonstrates low signal intensity on T2WI.And a mild continuously enhanced can be observed on dynamic enhanced scanning.Moreover,the tumor often involves renal hilum,perirenal fat capsule,paraortic lymph node,and shows the tendency of distant metastasis.