肾脏小肾癌的影像学特征

肾脏小肾癌的影像学特征

作者：赵艳王成林袁知东冯飞余宏建罗莉丽刘鹏程

【摘要】目的探讨肾脏小肾癌的影像学特征和鉴别诊断。方法对2003年至今我院经手术和病理证实的直径≦3CM的小肾癌和小良性病变的影像学表现进行分析，总结其影像学特征，并进行其鉴别诊断。结果本组小肾癌8例，全部行CT检查，其中一例小肾癌还做了MRI 和DSA检查。小肾癌CT三期扫描，8例小肾癌10个病灶，动脉期明显强化2个病灶，轻度强化7个病灶，实质期病灶内造影剂退出明显，其中一例两个病灶中的1个病灶各期均未见强化，ＭＲＩ动脉期两个病灶也是一个强化，一个不强化，这与其ＤＳＡ表现一个多血供，一个少血供吻合。1例感染性病变密度各期均低于正常肾实质，1例不典型囊性病变未见强化。本组8例小肾癌10个病灶，病理诊断均为肾透明细胞癌。结论 1.小肾癌螺旋CT三期扫描中多数动脉期呈轻度-明显强化，实质期强化明显减退，呈典型“快进快出”特点，少数少血病灶不强化。2.同一肾脏多发病灶，且影像学表现相同或不同，病理确相同。

【关键词】小肾癌诊断螺旋CT 鉴别诊断

Imageologic characteristic of small renal carcinoma

[Abstract] Objective :To investigate the imageologic characteristic and diferential diagnosis of small renal carcinoma. Methods: Retrospectively analyze the imageologic characteristic of small renal carcinoma and small benign pathological changes (diameter less than or equal to 3cm) proved by surgery and pathology, summarize its imageologic characteristic and make diferential diagnosis. Results：This group has 8 patients and 10 small renal carcinomas proved by surgery and pathology, all of them have three phase dynamic enhanced CT image and one case has MRI and DSA image also.2 carcinomas enhanced markedly and 7 enhanced lightly during the cortical phase, all the carcinomas wash-out apparently during the parenchyma phase. One of patients has 2 carcinomas, 1 carcinomas enhanced and another showed no enhancement during all phases on CT, 1 enhanced and another did mot enhance during the cortical phase on MRI, this characteristic was confirmed by DSA. One infective pathological change showed hypo-attenuation during all phases. One atypical cystal pathological change showed no enhancement. Conclusion：1.Major of small renal carcinoma showed light to marked enhancement during the cortical phase and the enhancement wash-out during the parenchyma phase, presented typical characteristic of

“quick staining and quick fainting”. Minor of small renal carcinoma lack of blood supply showed no enhancement. 2. The imageologic characteristic of multiple carcinomas grew in one renal are same or different, but pathology confirmed them.

[Key words] small renal carcinoma ，Diagnosis，Spiral CT，diferential diagnosis

肾癌病灶直径小于3CM时诊断困难，一般称之为小肾癌，但随着医学影像技术日新月异的发展和人们健康意识的提高，肾脏小占位病变（直径≦3CM）的发现率逐年提高，而肾癌和肾良性占位的治疗方法和预后迥异，所以对肾小占位病变作出早期准确的定性诊断非常重要。现将我院2003年至今经手术和病理证实的直径≦3CM的小肾癌和小良性病变的影像学表现进行分析，总结其影像学特征，并进行其鉴别诊断。

材料与方法

一、一般资料

本组10例，8例小肾癌，1例感染性病变，1例不典型囊性病变。男8例，女2例。年龄28-56岁，平均41.3岁。腰痛4例，腰痛伴血

尿1例，无任何症状于体检时发现6例。

二、仪器和方法

仪器为

9例行螺旋CT三期扫描（动脉期、静脉期、实质期），1例同时行MRI和DSA检查。结果

本组10例，小肾癌8例和2例良性病变，全部行CT检查，其中一例小肾癌还做了MRI和DSA检查。小肾癌CT三期扫描，8例小肾癌10个病灶，动脉期明显强化2个病灶，轻度强化7个病灶，实质期病灶内造影剂退出，其中一例两个病灶中的1个病灶各期均未见强化，ＭＲＩ动脉期两个病灶也是一个强化，一个不强化，这与其ＤＳＡ表现一个多血供，一个少血供吻合（如图1）。1例感染性病变密度各期均低于正常肾实质，1例囊性病变未见强化（如图）。

病理诊断，本组8例小肾癌10个病灶均为肾透明细胞癌。一例为感染性病变，治疗后病灶吸收消失（如图），一例病理为囊性病变。