小肾癌的多层螺旋CT的影像表现与病理对照研究
摘要
目的:通过本次研究,分析小肾癌的多层螺旋CT的影像表现及探讨小肾癌的CT鉴别诊断。经过术后跟踪,结合病理,分析小肾癌的CT表现与病理类型及肿瘤内部结构之间的关系。
材料与方法:
1.回顾分析2006年5月～2007年12月期间,在佳木斯大学附属第一医院就诊并经B超疑似肾脏小占位性病例128例,均进行肾脏CT检查,作出诊断。选择经CT诊断并由术后病理证实为小肾癌患者30例,观察CT扫描的密度,增强的程度;观察肿瘤的细胞类型,细胞排列方式,内部结构等。CT与病理表现进行对照;强化程度与组织学类型进行对照研究。余98例全部CT诊断和临床拟诊,根据病变种类分为肾血管平滑肌脂肪瘤、肾囊肿和其他小占位性病变。
2.检查方法:
采用德国西门子SOMATOM Sensation 64层螺旋CT扫描机,扫描参数:管电压120KV,有效管电流900mAs,层厚为64×0.6mm,球管旋转360°时间0.33s。动脉期成像采用兴趣区域CT值激发模式(blous traking),先在肾区平面腹主动脉平面选取兴趣区,注射造影剂10s后开始监测兴趣区密度变化,当兴趣区CT值增加100HU时启动动脉扫描。造影剂采用安射力320mgl/ml,注射总量100ml,注射速率5ml/s,随后以同样的速率注射50ml生理盐水。受检者屏气时间为10～12s。扫描结束后,利用预览功能选择重建时相,重建层厚0.75mm,重建间隔0.5mm,重建方式Kernel值B25f smooth++。重建图像在“新沟通”(syngo)工作站上应用多平面重建。
3.强化标准:CT值差异0～10HU为无强化,轻度强化11～20HU,显著强化>20HU,进行评价。
由两位高年资的医师盲法阅片,对检查结果进行分析、诊断。结果:本实验小肾癌患者通过影像表现正确诊断30例,全部经手术病理证实。在正确诊断30例小肾癌患者的病理报告中,透明细胞癌最多见,共23例,占全部的76.7%。颗粒细胞癌4例,混合细胞癌3例,均为单侧。静脉注射造影剂后,25例强化程度明显,为富血供,其中22例细胞排列为实性,含丰富血窦;23例病变增强不均匀。小肾癌平扫可为低密度、等密度、高密度,以低等密度多见。增强特点呈典型“快进快退”特点,在皮质期强化明显,实质期下降。多层螺旋CT对肾形改变、假包膜、囊变、出血的诊断具有重要价值,并可通过CT表现与肾血管平滑肌脂肪瘤、高密度肾囊肿等小占位性病变相鉴别。
结论:
1.多层螺旋CT多期薄层扫描,对小肾癌的定性和定位诊断及鉴别诊断具有重要价值。
2.多层螺旋CT对小肾癌检出和诊断的正确性高,是小肾癌影像诊断必须的方法之一。
3.小肾癌的CT表现与病理类型及肿瘤结构有关。
Objective: Through this research, TO analyze multi-slice spiral CT imaging performance of the renal cell carcinoma and explore the imaging of CT differential diagnosis between small cell carcinoma and the other disease. After tracking, with pathology, to analyze the correlation of CT and pathological manifestation of small renal cell carcinoma.
Materials and Methods:
1. To analyze retrospectively suspected cases of kidney small footprint 128 cases which inspected in the in the First Affiliated Hospital of the University of Jiamusi in May 2006 to December 2007 period, they all had been carried out with renal CT and made diagnosis. Choose 30 cases of patients with small renal cell carcinoma observed CT scan density by the CT diagnosis and postoperative pathology confirmation. To observe tumor cell type, cell arrangement, internal structure and so on. Comprised between CT and pathologic manifestations, To study CT enhanced degree in histological types. More than 98 cases of all the CT diagnosis and clinical consultation to be, and are grouped under the lesion of renal angiomyolipoma, renal cysts and other small space-occupying lesions
2. Inspection Methods: Using multi-phase scanning with Siemens SOMATOM 64-slice CT system. Scanning parameters: Tube voltage120KV,Effective tube current 900mAs, Collimation 64×0.6mm,The time of tube rotating 0.33s.Using interesting region CT number blous tracking , District first plane in renal abdominal aorta plane select interest areas contrast injection after 10s interest in monitoring changes in density, CT value when interest areas increased by 100HU. An edge - Contrast Agent is used with 300mgl/ml, Total injection with 100ml, Injection rate by 5ml/s, to inject with the same rate of 50ml saline Subsequently. breath-hold time of the subjects is 10 to 12s. After scanning, to reconstruct phase with previewed option, reconstructed thickness by 0.75 mm, reconstructed interval by 0.5 mm, Reconstructed method by Kernel value B25f smooth + +. reconstructed Imaging which is in the "communication" (syngo) workstation applications multiplanar reconstruction.
3.Strengthen standards: CT value difference between 0 to 10 HU was not strengthened, and mildly enhanced 11 to 20 HU was significantly enhanced more 20 HU, and evaluation.
The imaging were diagnosised and analyzed by two physicians unknowed. Results: The small experimental imaging patients with renal cell carcinoma through the correct diagnosis of 30 cases, all confirmed by surgery and pathology. In the correct diagnosis of 30 cases of small cell carcinoma pathology report, see the most transparent cell carcinoma, a total of 23 cases, seventy six point six of the total. Granulosa cell cancer four cases, three cases of mixed cell carcinoma. Are unilateral. After intravenous injection of contrast medium, and 25 cases of significantly strengthening for the rich blood supply, of which 22 are for real cells, rich sinusoids; 23 cases of lesions increased uneven. Small renal cell carcinoma can be plain low-density, density, high density, low density more.Enhanced features of a typical "fast into fast forward" feature in the cortex intensive Obviously, the declining in real terms. Multi-slice Spiral CT in kidney-shaped change, fake capsule, the capsule change, the diagnosis of hemorrhage important value and performance through CT and renal vascular smooth muscle lipoma, high-density small cysts, and other sexually transmitted diseases in disguise footprint identification.
Conclusions:
1.,Multi-phase imaging of multi-slice spiral CT for small renal cell carcinoma is importantant value to a qualitaty diagnosis and differential diagnosis.
2.,Multi-slice Spiral CT in the detection of small renal cell carcinoma and high diagnostic accuracy, which is the imaging diagnosis of renal cell carcinoma must be one of the ways.
3.Small renal cell carcinoma of CT findings is relation with pathologic type and tumor structure.
材料与方法:
1.回顾分析2006年5月～2007年12月期间,在佳木斯大学附属第一医院就诊并经B超疑似肾脏小占位性病例128例,均进行肾脏CT检查,作出诊断。选择经CT诊断并由术后病理证实为小肾癌患者30例,观察CT扫描的密度,增强的程度;观察肿瘤的细胞类型,细胞排列方式,内部结构等。CT与病理表现进行对照;强化程度与组织学类型进行对照研究。余98例全部CT诊断和临床拟诊,根据病变种类分为肾血管平滑肌脂肪瘤、肾囊肿和其他小占位性病变。
2.检查方法:
采用德国西门子SOMATOM Sensation 64层螺旋CT扫描机,扫描参数:管电压120KV,有效管电流900mAs,层厚为64×0.6mm,球管旋转360°时间0.33s。动脉期成像采用兴趣区域CT值激发模式(blous traking),先在肾区平面腹主动脉平面选取兴趣区,注射造影剂10s后开始监测兴趣区密度变化,当兴趣区CT值增加100HU时启动动脉扫描。造影剂采用安射力320mgl/ml,注射总量100ml,注射速率5ml/s,随后以同样的速率注射50ml生理盐水。受检者屏气时间为10～12s。扫描结束后,利用预览功能选择重建时相,重建层厚0.75mm,重建间隔0.5mm,重建方式Kernel值B25f smooth++。重建图像在“新沟通”(syngo)工作站上应用多平面重建。
3.强化标准:CT值差异0～10HU为无强化,轻度强化11～20HU,显著强化>20HU,进行评价。
由两位高年资的医师盲法阅片,对检查结果进行分析、诊断。结果:本实验小肾癌患者通过影像表现正确诊断30例,全部经手术病理证实。在正确诊断30例小肾癌患者的病理报告中,透明细胞癌最多见,共23例,占全部的76.7%。颗粒细胞癌4例,混合细胞癌3例,均为单侧。静脉注射造影剂后,25例强化程度明显,为富血供,其中22例细胞排列为实性,含丰富血窦;23例病变增强不均匀。小肾癌平扫可为低密度、等密度、高密度,以低等密度多见。增强特点呈典型“快进快退”特点,在皮质期强化明显,实质期下降。多层螺旋CT对肾形改变、假包膜、囊变、出血的诊断具有重要价值,并可通过CT表现与肾血管平滑肌脂肪瘤、高密度肾囊肿等小占位性病变相鉴别。
结论:
1.多层螺旋CT多期薄层扫描,对小肾癌的定性和定位诊断及鉴别诊断具有重要价值。
2.多层螺旋CT对小肾癌检出和诊断的正确性高,是小肾癌影像诊断必须的方法之一。
3.小肾癌的CT表现与病理类型及肿瘤结构有关。
Objective: Through this research, TO analyze multi-slice spiral CT imaging performance of the renal cell carcinoma and explore the imaging of CT differential diagnosis between small cell carcinoma and the other disease. After tracking, with pathology, to analyze the correlation of CT and pathological manifestation of small renal cell carcinoma.
Materials and Methods:
1. To analyze retrospectively suspected cases of kidney small footprint 128 cases which inspected in the in the First Affiliated Hospital of the University of Jiamusi in May 2006 to December 2007 period, they all had been carried out with renal CT and made diagnosis. Choose 30 cases of patients with small renal cell carcinoma observed CT scan density by the CT diagnosis and postoperative pathology confirmation. To observe tumor cell type, cell arrangement, internal structure and so on. Comprised between CT and pathologic manifestations, To study CT enhanced degree in histological types. More than 98 cases of all the CT diagnosis and clinical consultation to be, and are grouped under the lesion of renal angiomyolipoma, renal cysts and other small space-occupying lesions
2. Inspection Methods: Using multi-phase scanning with Siemens SOMATOM 64-slice CT system. Scanning parameters: Tube voltage120KV,Effective tube current 900mAs, Collimation 64×0.6mm,The time of tube rotating 0.33s.Using interesting region CT number blous tracking , District first plane in renal abdominal aorta plane select interest areas contrast injection after 10s interest in monitoring changes in density, CT value when interest areas increased by 100HU. An edge - Contrast Agent is used with 300mgl/ml, Total injection with 100ml, Injection rate by 5ml/s, to inject with the same rate of 50ml saline Subsequently. breath-hold time of the subjects is 10 to 12s. After scanning, to reconstruct phase with previewed option, reconstructed thickness by 0.75 mm, reconstructed interval by 0.5 mm, Reconstructed method by Kernel value B25f smooth + +. reconstructed Imaging which is in the "communication" (syngo) workstation applications multiplanar reconstruction.
3.Strengthen standards: CT value difference between 0 to 10 HU was not strengthened, and mildly enhanced 11 to 20 HU was significantly enhanced more 20 HU, and evaluation.
The imaging were diagnosised and analyzed by two physicians unknowed. Results: The small experimental imaging patients with renal cell carcinoma through the correct diagnosis of 30 cases, all confirmed by surgery and pathology. In the correct diagnosis of 30 cases of small cell carcinoma pathology report, see the most transparent cell carcinoma, a total of 23 cases, seventy six point six of the total. Granulosa cell cancer four cases, three cases of mixed cell carcinoma. Are unilateral. After intravenous injection of contrast medium, and 25 cases of significantly strengthening for the rich blood supply, of which 22 are for real cells, rich sinusoids; 23 cases of lesions increased uneven. Small renal cell carcinoma can be plain low-density, density, high density, low density more.Enhanced features of a typical "fast into fast forward" feature in the cortex intensive Obviously, the declining in real terms. Multi-slice Spiral CT in kidney-shaped change, fake capsule, the capsule change, the diagnosis of hemorrhage important value and performance through CT and renal vascular smooth muscle lipoma, high-density small cysts, and other sexually transmitted diseases in disguise footprint identification.
Conclusions:
1.,Multi-phase imaging of multi-slice spiral CT for small renal cell carcinoma is importantant value to a qualitaty diagnosis and differential diagnosis.
2.,Multi-slice Spiral CT in the detection of small renal cell carcinoma and high diagnostic accuracy, which is the imaging diagnosis of renal cell carcinoma must be one of the ways.
3.Small renal cell carcinoma of CT findings is relation with pathologic type and tumor structure.
引文
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[6]施裕新,周康荣,胡振民。小肾癌的CT研究。使用放射学杂志。1998,17(10):587
[7]高鹏,凡杰,夏术阶,等.小肾癌的影像学诊断(附43例报告).中华泌尿外科杂志,2006,27:101-103
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[9]曾培尧.螺旋CT多期扫描诊断小肾癌24例分析.实用医学杂志,2006,13:1447-1448.
[10]Urban BA,Ratner LE,Fishman EK.Three-dimensional volume rendered CT angiography of the renal arteries and veins: normal anatomy,variants,and clinical applications.Radiographics,2001,21:373-386
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[2]倪希和,曹代荣,游瑞雄.肾肿瘤CT征象探讨[J]实用放射杂志,1996.12(12):735
[3]潘柏年.王田,杨勇,等.小肾癌(附34例报告).中华泌尿外科杂志, 1998,19:32-34
[4] Reddan DN , Raj GV , Polascik TJ.Management of small renal tumors: an overview,Am JMed,2001 , 110:558-562
[5]Lee CT.Katz J,Shi W, et al.Surgical manage of renal tumors 4 cm or less in a contemporary cohort,J Urol , 2000, 163:730-736
[6]施裕新,周康荣,胡振民。小肾癌的CT研究。使用放射学杂志。1998,17(10):587
[7]高鹏,凡杰,夏术阶,等.小肾癌的影像学诊断(附43例报告).中华泌尿外科杂志,2006,27:101-103
[8]曹国洪,许乙凯,阳红艳.螺旋CT多期增强扫描在小肾癌诊断中的应用.医学影像学杂志,2005,15:904-907.
[9]曾培尧.螺旋CT多期扫描诊断小肾癌24例分析.实用医学杂志,2006,13:1447-1448.
[10]Urban BA,Ratner LE,Fishman EK.Three-dimensional volume rendered CT angiography of the renal arteries and veins: normal anatomy,variants,and clinical applications.Radiographics,2001,21:373-386
[11]Bosniak MA.The small(<3cm)renal parenchymal tumor detection,diagnosis and correlation.Radiology,1991,179:307-317.
[12]Form an HP,Middleton WD,Melson GL,et al.Hyperechoic renal cell carcinomas:increase in detection at US.Radiology,1993,188:431-434.
[13]裴昌松,朱有华,郭峰,等.肾癌76例临床分析.中华泌尿外科杂志,2003,24:725-727.
[14]梁开文,崔国儒,王新民,等.小肾癌MRI诊断与鉴别诊断的研究.广东医学学报,2005,23:128-130.
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