韩焱，关文华，史展，周金金，臧志娜

（河南科技大学第一附属医院①放射科，②分子影像中心，河南洛阳471003）



MSCT 3期增强扫描诊断肾透明细胞癌术前T分期的准确性与限度

韩焱1，关文华2，史展1，周金金1，臧志娜1

（河南科技大学第一附属医院①放射科，②分子影像中心，河南洛阳471003）

目的：探讨MSCT 3期增强扫描诊断肾透明细胞癌（clear cell renal cell carcinoma，ccRCC）术前T分期的准确性及其影响因素。方法：回顾性分析经手术病理证实的110例ccRCC患者术前MSCT 3期增强扫描资料，依据2010版TNM分期标准判断术前T分期并评价其诊断效能，分析与T分期相关的肾包膜、肾静脉和（或）下腔静脉、肾周和（或）肾窦脂肪、肾周筋膜受侵情况。结果：①CT术前T分期与病理分期有较好的一致性（K=0.811）；②T3a期准确性（86.4%）、特异性（91.1%）和阴性预测值（83.6%）最低，而高估率（8.9%）最高；T4期敏感性（66.7%）和阳性预测值（66.7%）最低，而低估率（33.3%）最高；③共15例评估错误（低估66.7%）均与T3a期认定相关；肾窦脂肪、肾脏脂肪与肾包膜受侵的CT诊断漏诊率分别为57.1%、25.0%和15.8%。结论：MSCT 3期增强扫描对ccRCC的T分期诊断符合率较高，但T3a期的诊断价值相对较低。

肾透明细胞癌；体层摄影术，X线计算机；TNM分期

［Abstract］Objective：To evaluate the diagnostic accuracy and limitations of multi-slice computed tomography（MSCT）for preoperative T-staging of clear cell renal cell carcinoma（ccRCC）.Methods：In this retrospective study，a total of 110 consecutive patients with ccRCC confirmed by histopathological results were assessed for the preoperative T-staging value using triphasic MDCT scan.And whether renal capsule，renal vein，inferior vena cava，renal sinus fat，perirenal fat，and perirenal fascia invaded by tumor was analyzed.Results：①There was good consistency for T staging of ccRCC between the preoperative CT scan and pathological staging（Kappa=0.811）.②The accuracy（86.4%），the specificity（91.1%）and the negative predictive value（83.6%）of T3astage were lowest；meanwhile the overestimate（8.9%）of T3astage was highest.The sensitivity（66.7%）and the positive predictive value（66.7%）of T4stage were lowest；meanwhile the undervalued rate（33.3%）of T4stage was highest.③A total of 15 patients were diagnosed with wrong T staging，which were all related to the T3astaging and the undervalued rate was 66.7%.The missed rate of CT in the diagnosis of renal sinus fat，renal fat and renal capsule was 15.8%，25% and 57.1% respectively.Conclusion：Three-phase contrast-enhanced multi-slice CT scanning is an accurate method for preoperative T staging of RCC.But the diagnosis of T3astage is still subject to certain restrictions.

［Key words］Clear cell renal cell carcinoma；Tomography，X-ray computed；TNM staging

肾细胞癌是肾脏最常见的恶性肿瘤，以肾透明细胞癌（clear cell renal cell carcinoma，ccRCC）多见，手术切除为首选治疗方案［1］。肿瘤TNM分期，特别是T分期对手术治疗及预后非常重要［2-3］。现回顾性分析2012年7月至2014年6月我院经手术病理证实的110例ccRCC患者的MSCT 3期增强扫描资料，着重评价其在术前T分期方面的作用和限度。

1　资料与方法

1.1一般资料本组110例中，男63例，女47例；年龄33～81岁，平均（57.3±11.8）岁。临床表现：无痛性肉眼血尿35例，单纯腰痛27例，腰痛伴血尿29例，包块6例，体检或其他疾病就诊时发现13例。……