张惠锋　郝　亮　杜　芳　徐鹏鹏　杨汝春1.杭州市中医院放射科，浙江杭州　310007；.杭州市中医院肾内科，浙江杭州　310007

多层螺旋CT对肾透明细胞癌的诊断及鉴别诊断价值

张惠锋1郝亮1杜芳1徐鹏鹏1杨汝春2
1.杭州市中医院放射科，浙江杭州310007；2.杭州市中医院肾内科，浙江杭州310007

目的探讨肾透明细胞癌多层螺旋CT的影像特征及与其他亚型的鉴别方法。 方法回顾性分析2008年1月～2015年6月61例肾癌患者的CT图像，分成透明细胞癌组和非透明细胞癌组。比较两组增强幅度与肿瘤的大小、有无钙化、囊变、坏死和肿瘤的扩散状况（肾包膜、静脉及淋巴结转移）情况。结果平扫肾透明细胞癌组CT值和非透明细胞癌组CT值差异无统计学意义（P＞0.05）。而皮质期和髓质期的透明细胞癌的CT值显著高于非透明细胞癌（P＜0.05）。结论 肿瘤的增强程度是鉴别肾透明细胞癌和非透明细胞癌最有价值的参数，而肿瘤的大小、有无钙化、囊变、坏死和肿瘤的扩散状况对鉴别有一定的作用。

体层摄影术；X线计算机；肾透明细胞癌；肿瘤扩散；诊断

［Abstract］Objective To eva1uate the image feature of mu1ti-s1ice computed tomography（MSCT）in ana1yzing the different diameter rena1 c1ear ce11 carcinoma and the identification methods of various subtypes.Methods The enhancement degree of 61 cases patho1ogy-proven rena1 c1ear ce11 carcinoma during biphasic contrast enhanced spira1 CT scans from January 2008 to June 2015 were retrospective ana1yzed.The rena1 c1ear ce11 carcinoma patients were divided into two groups with c1ear ce11 carcinoma group（CCRCC group）and non-c1ear ce11 carcinoma group（non-CCRCC group）.The corre1ation between enhanced extent and tumor size，ca1cification，cystic change，necrosis，tumor spread status inc1uding rena1 capsu1e，vein and 1ymph node metastasis were exp1ored.Results There were no significant differences between the p1ain scan va1ue or CT va1ue between two groups（P＞0.05）.Whi1e significant differences between the CT va1ue of CCRCC group and non-CCRCC group were found in cortex and medu11a stage（P＜0.05）.Conclusion The enhanced spira1 CT scan can accurate1y identify the characteristic of rena1 c1ear ce11 carcinoma and non-c1ear ce11 carcinoma.The enhanced degree provides a good channe1 in eva1uating tumor size，ca1cification，cystic change，necrosis，tumor spread status inc1uding rena1 capsu1e，vein and 1ymph node metastasis.

［Key words］Tomography；X-ray computed；Rena1 c1ear ce11 carcinoma；Tumor metastasis；Diagnosis

肾细胞癌（rena1 ce11 carcinoma，RCC），简称肾癌，是肾脏常见的恶性肿瘤，在成人肾脏恶性肿瘤中占75%～85%［1］。其中肾透明细胞癌（c1ear ce11 rena1 carcinoma，CCRCC）为主要病理类型，占RCC的70%～80%，其他如乳头状癌、嫌色细胞癌、Be11ini集合管癌、多房囊性肾细胞癌等［2，3］。临床中因RCC的病理类型不同，其治疗方案及预后存在较大的差异［4］。随着影像学的不断发展，CT影像设备的性能不断提升，CT检查成为诊断肾癌的首选项目。但是CT检查能否对肾透明细胞癌和其他几种类型肾癌给予良好的鉴别，目前报道不一。……