CAJ | 학술논문

目的探讨囊性肾瘤(CN)和多房囊性肾癌(MCRCC)的CT表现特点,以期提高术前诊断及鉴别诊断的准确性.方法采用盲法回顾性分析经手术病理证实的9例CN和19例MCRCC患者的CT表现,对CN和MCRCC的部分CT表现进行统计学分析.结果 9例CN和19例MCRCC患者均表现为肾内单发的、边缘规则的多房囊性肿瘤.9例CN的囊壁及分隔厚度为0.5～5 mm,局部囊壁及分隔稍厚,未见附壁结节.19例MCRCC内均可见数量不等的实性成分,表现为囊壁及分隔不均匀增厚,囊壁及分隔厚度为3～13 mm,伴附壁结节者8例,结节直径为4.5～ 16 mm.9例CN患者中,肿瘤呈浅分叶状6例,肿瘤突入肾窦7例.19例MCRCC患者中,肿瘤呈浅分叶状3例,肿瘤突入肾窦2例.CT增强扫描显示,9例CN患者的肿瘤囊壁及分隔均有强化,其中8例患者的肿瘤囊壁及分隔呈轻、中度延迟强化;19例MCRCC患者的肿瘤囊壁、分隔及附壁结节均有强化,其中17例呈皮质期明显强化.CN和MCRCC的CT表现中,肿瘤有否浅分叶、是否向肾窦内突入、有否附壁结节、囊壁及分隔厚度、皮质期增强净值、实质期增强净值的差异均有统计学意义(均P＜0.05).结论 CT检查可为CN和MCRCC的诊断和鉴别诊断提供重要依据.CN通常表现为囊壁及分隔相对薄且均匀、无附壁结节、有浅分叶、向肾窦内突入、轻中度强化且动态增强呈延迟强化,相反则提示MCRCC的可能性大.
목적 탐토낭성신류(CN)화다방낭성신암(MCRCC)적CT표현특점,이기제고술전진단급감별진단적준학성.방법 채용맹법회고성분석경수술병리증실적9례CN화19례MCRCC환자적CT표현,대CN화MCRCC적부분CT표현진행통계학분석.결과 9례CN화19례MCRCC환자균표현위신내단발적、변연규칙적다방낭성종류.9례CN적낭벽급분격후도위0.5～5 mm,국부낭벽급분격초후,미견부벽결절.19례MCRCC내균가견수량불등적실성성분,표현위낭벽급분격불균균증후,낭벽급분격후도위3～13 mm,반부벽결절자8례,결절직경위4.5～ 16 mm.9례CN환자중,종류정천분협상6례,종류돌입신두7례.19례MCRCC환자중,종류정천분협상3례,종류돌입신두2례.CT증강소묘현시,9례CN환자적종류낭벽급분격균유강화,기중8례환자적종류낭벽급분격정경、중도연지강화;19례MCRCC환자적종류낭벽、분격급부벽결절균유강화,기중17례정피질기명현강화.CN화MCRCC적CT표현중,종류유부천분협、시부향신두내돌입、유부부벽결절、낭벽급분격후도、피질기증강정치、실질기증강정치적차이균유통계학의의(균P＜0.05).결론 CT검사가위CN화MCRCC적진단화감별진단제공중요의거.CN통상표현위낭벽급분격상대박차균균、무부벽결절、유천분협、향신두내돌입、경중도강화차동태증강정연지강화,상반칙제시MCRCC적가능성대.
Objective To study the CT findings of cystic nephroma (CN) and multilocular cystic renal cell carcinoma (MCRCC) and to improve the accuracy of preoperative diagnosis of these two diseases.Methods The CT findings of nine CN cases and 19 MCRCC cases confirmed by pathology were blindly reviewed and compared with their pathological results.Fisher's exact test and independent～samples T test were applied to statistically analyze some of the CT features of the CN and MCRCC lesions.Results The thickness of cystic walls and partitions in the nine CN cases ranged from 0.5 to 5 mm.Cystic walls and partitions were slightly thicker in some parts without visible mural nodules.Varying amounts of solid tissue could be found in all the 19 MCRCC tumors, and the cystic walls and partitions were found partially thickened ranging from 3 mm to 13 mm.Eight cases were with mural nodules (nodule diameter: 4.5～16 mm).Nine cases of CN tumors were lobulated and 7 protruded into the renal sinus.Three out of the 19 MCRCC presented shallow lobulation, and 7 tumors protruded into the renal sinus.The CT contrast-enhancement scanning displayed moderate delayed enhancement in the cystic walls and partitions in 8 cases.The enhanced scanning revealed that all the nine cases showed enhancement of the cystic walls and partitions, while 8 cases of them had mild to moderate delayed enhancement.The cystic walls, partitions and nodules were enhanced in 19 MRCC cases, among them 17 cases displayed obvious enhancement in the cortical phase.Among the differences of CT findings between MC and MRCC, the shallow lobulation, protruding into the renal sinus, mural nodules, cystic wall and partition thickness, and net growth in the cortical and nephrographic phase were statistically significantly different (P＜0.05 for all).Conclusions CT scan can provide significant evidence for CN and MCRCC diagnosis.CN cases usually present relatively thin and even cystic walls and partitions without mural nodules and with shallow lobulation and protruding into the renal sinus.The enhancement is mild to moderate, dynamic and delayed, while the opposite CT findings may indicate a higher possibility of MCRCC.