CAJ | 학술논문

目的：分析肾脏嫌色细胞癌(CCRC)的 CT、MRI 影像征象以及与病理组织学的关系。方法回顾性分析23例经手术病理证实的 CCRC 的 CT、MRI 影像资料,分别观察肿瘤的部位、形状、大小、密度、边界、血供以及对周围脏器的侵犯等,重点分析其动态增强方式,并与病理对照。结果23例患者均为一侧肾脏单发肿块,其中左肾12例,右肾11例,病灶直径27~330 mm,圆形或类圆形,16例边界清晰,7例边界欠清。肿瘤突破肾包膜3例,侵及肾盂、肾周脂肪伴肾静脉、下腔静脉癌栓3例,腹膜后淋巴结转移2例。18例患者行 CT 检查,平扫病灶呈软组织密度(CT 值为30~44 HU),6例患者行 MRI 扫描,T1 WI 呈等/稍低信号, T2 WI 信号不均,呈高低混杂信号,2例假包膜表现为 T2 WI 环形低信号影。根据动态增强方式不同,分为3型。(1)轻中度强化型(14例)：包括轻度均匀强化(7例)与轻度不均匀强化(7例)；(2)明显强化型(7例)：6例为不均匀强化；1例为均匀强化；(3)轮辐状或瘢痕样强化(2例)。CCRC 大体标本以实性成分为主,切面呈黄棕色或褐色,镜下根据 HE 染色情况分为3型：经典型、嗜酸细胞型、混合型。结论肾 CCRC 的动态增强表现有一定特征性,综合分析其影像学表现,有助于诊断及鉴别诊断。
목적：분석신장혐색세포암(CCRC)적 CT、MRI 영상정상이급여병리조직학적관계。방법회고성분석23례경수술병리증실적 CCRC 적 CT、MRI 영상자료,분별관찰종류적부위、형상、대소、밀도、변계、혈공이급대주위장기적침범등,중점분석기동태증강방식,병여병리대조。결과23례환자균위일측신장단발종괴,기중좌신12례,우신11례,병조직경27~330 mm,원형혹류원형,16례변계청석,7례변계흠청。종류돌파신포막3례,침급신우、신주지방반신정맥、하강정맥암전3례,복막후림파결전이2례。18례환자행 CT 검사,평소병조정연조직밀도(CT 치위30~44 HU),6례환자행 MRI 소묘,T1 WI 정등/초저신호, T2 WI 신호불균,정고저혼잡신호,2례가포막표현위 T2 WI 배형저신호영。근거동태증강방식불동,분위3형。(1)경중도강화형(14례)：포괄경도균균강화(7례)여경도불균균강화(7례)；(2)명현강화형(7례)：6례위불균균강화；1례위균균강화；(3)륜복상혹반흔양강화(2례)。CCRC 대체표본이실성성분위주,절면정황종색혹갈색,경하근거 HE 염색정황분위3형：경전형、기산세포형、혼합형。결론신 CCRC 적동태증강표현유일정특정성,종합분석기영상학표현,유조우진단급감별진단。
Objective To investigate the imaging features and the relationship with pathological characteristics of chromophobe cell renal carcinoma (CCRC).Methods The clinicopatholocal manifestations and CT or MRI imaging findings were analyzed retro-spectively in 23 patients with surgically confirmed CCRC.The location,shape,size,density,border,blood supply and invasion of adjacent organs of CRCC,especially the dynamic enhanced mode,were mainly analyzed and compared with pathology.Results The 23 cases of CCRC showed unilateral single mass on CT and MRI scans,and 12 located in right kidney while 1 1 in left kidney.The size ranged from 27-330 mm in diameter,and round or oval-shaped soft tissue mass was observed.The boundaries of 1 6 cases were clear,and 3 cases of mass broke through renal capsule,3 invaded renal pelvis,perirenal fat,renal vein and inferior vena cava,2 ca-ses with retroperitoneal lymph node metastases.18 cases were scanned by CT and the mass presented as soft tissue density on plain CT (CT value 30-44 HU).6 cases were scanned by MRI with abnormalities presenting with iso or hypo-intense on the T1 WI,hy-per or hypo-intense on the T2 WI,and 2 cases of pseudocapsule were showed as circled hypointense on T2 WI.According to the dy-namic enhancement,23 cases of CCRC were divided into three type:(1 )Mild-to-moderate enhanced type(n= 14):including mild homogeneous strengthening (n=7)and mild heterogeneous strengthening (n=7);(2)Significantly enhanced type(n=7):including heterogeneous enhancement(n=6)and uniform enhancement(n=1);(3)Spokes shape or scar enhancement(n=2).The sample of CCRC was mainly solid and showed yellowish-brown or brown section.According to the situation of HE staining,the characteristic microscopic features were divided into three types:the typical,acidophil type and mixed type.Conclusion Combined imaging find-ings of CT dynamic enhanced mode can provide characteristic information for diagnosis of CCRC,and comprehensive analysis of the imaging findings will contribute to the diagnosis and differential diagnosis.