Ⅰ型和Ⅱ型乳头状肾细胞癌的影像学表现及其差异

发布时间：2018-04-05 09:31

本文选题：肾肿瘤　切入点：乳头状肾细胞癌　出处：《复旦学报(医学版)》2017年03期

【摘要】：目的探讨Ⅰ型和Ⅱ型乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)的影像学表现及其差异。方法回顾性分析经手术病理证实的47例PRCC患者资料,其中Ⅰ型21个病灶,Ⅱ型27个病灶(1例患者左肾含2个病灶)。所有患者术前均行肾脏CT或MRI平扫及动态增强检查。对PRCC的形态学特征、肿瘤外侵征象、增强CT表现进行定性和定量分析。采用独立样本t检验对病灶最大径、三期CT值及皮髓交界期△CT、实质期△CT进行比较,采用Pearsonχ~2检验或Fisher确切概率法对分类变量进行比较。结果一般形态学上,Ⅱ型PRCC平均最大径大于Ⅰ型(t=-2.604,P=0.013),密度/信号更不均匀(χ~2=14.928,P=0.000),更易出现囊变或坏死(χ~2=5.598,P=0.018),且程度更明显(χ~2=4.769,P=0.029);在CT图像上,两型之间出血和钙化征象的差异均无统计学意义。分别有66.7%Ⅱ型PRCC和23.8%Ⅰ型PRCC出现乳头结节,两型之间的差异有显著统计学意义(χ~2=8.694,P=0.003)。在肿瘤外侵表现方面,除边界征象外,Ⅱ型较Ⅰ型PRCC更易发生肾周脂肪侵犯、肾窦侵犯及转移(P0.05)。在增强CT表现方面,两型在皮髓交界期CT值、皮髓交界期△CT的差异均有统计学意义(t=-2.674,P=0.012;t=-3.109,P=0.005),而在平扫期CT值、实质期CT值、实质期△CT上的差异均无统计学意义。结论Ⅰ型和Ⅱ型PRCC在形态学特征、肿瘤外侵征象及强化程度上有一定差异,部分Ⅱ型肿瘤具有侵袭性生物学行为,预后更差。
[Abstract]:Objective to investigate the cell type of renal papillary carcinoma (papillary renal cell carcinoma, PRCC) and different imaging. Methods Retrospective analysis of the clinical data of 47 cases of PRCC confirmed by pathology, including type 21 lesions, type 27 lesions (1 patients with 2 lesions of Zuo Shen). All patients underwent renal CT or MRI plain and dynamic enhanced MRI. Morphological features of PRCC, tumor invasion signs, enhanced CT showed a qualitative and quantitative analysis. Using t test of independent samples the maximum diameter of the lesions, three CT values and the corticomedullary phase of delta CT, Delta CT parenchymal phase compared to compare categorical variables using the Pearson x ~2 test or Fisher exact test. Results the general morphology, type II PRCC average diameter more than 1 (t=-2.604, P=0.013), density / signal more uneven (x ~2=14.928, P=0.000), more prone to cystic degeneration or necrosis (x ~ 2=5.598, P=0.018), and a greater degree (x ~2=4.769, P=0.029); in the CT image, the two type between hemorrhage and calcification. There were no significant differences in type II were 66.7% PRCC and 23.8% type PRCC papillary nodules, there was significant difference between type two (x ~2=8.694, P=0.003). In tumor invasion performance, in addition to boundary signs, type II is the type I PRCC more susceptible to perirenal fat invasion, renal sinus invasion and metastasis (P0.05). In the aspect of enhancing CT performance, type two in the corticomedullary phase CT, corticomedullary phase differences were statistically CT the significance of (t=-2.674, P=0.012; t=-3.109, P=0.005), and scanning CT value on a flat, parenchymal CT, Delta CT on the difference in parenchymal phase was not statistically significant. Conclusion the type I and type II PRCC in morphology, tumor invasion signs and enhancement degree have certain difference, part of tumor aggressive biological The prognosis is worse by learning behavior.

【作者单位】：复旦大学附属中山医院放射科;上海市影像医学研究所;复旦大学上海医学院影像医学系;
【基金】：上海市自然科学基金(14ZR1438400)~~
【分类号】：R445.2;R730.44;R737.11

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