47例肾癌不同病理亚型的MRI回顾性分析

发布时间：2018-06-11 11:09

本文选题：肾透明细胞癌 + 肾乳头状细胞癌　；参考：《山东大学》2014年硕士论文

【摘要】：目的：探讨肾癌不同病理亚型的MRI表现,可以对病理分型提供帮助,为临床制定手术方案及判断预后提供依据。材料及方法：本次研究我们对2009年1月至2013年6月山东省立医院泌尿微创中心收治的47例肾癌病例进行回顾性分析,患者年龄31～83岁,平均年龄24.7±10.7岁；左侧病变23例,右侧病变24例,均经B超、强化CT及MRI检查,术后病理确诊为肾透明细胞癌或肾乳头状细胞癌或肾嫌色细胞癌。以正常肾皮质信号强度为标准,采用目测法比较各病例的影像学特点,总结肾癌各病理亚型的MRI的影像学特点。最后用SPSS13.0统计软件进行以P=0.05为标准进行卡方分析。结果：本组肾透明细胞癌34例,乳头状肾细胞癌6例,肾嫌色细胞癌7例。肾透明细胞癌是富血供肿瘤,其T1WI动态增强序列强化幅度明显高于其他两个亚型,即皮质期、实质期及排泄期的T1WI信号较其他两个亚型长,有统计学意义(P0.05),且具有明显的“快进快出”及不均匀强化的强化特点。肾乳头状细胞癌平扫时的T1WI呈等或略长信号,T2WI呈等或略长信号均较肾透明细胞癌略长,有统计学意义(P0.05)。而肾乳头状细胞癌与肾嫌色细胞癌的T1WI动态增强序列强化幅度无明显差异(P0.05)。肾透明细胞癌及肾乳头状细胞癌的化学位移图像中部分病例反相位图像中肿瘤内部部分区域较同相位图像有所降低,而肾嫌色细胞癌无此特点,有统计学意义(P0.05)。而肾嫌色细胞癌的T2WI图像较肾乳头状细胞癌略长,可以鉴别,有统计学意义(P0.05)。三种肿瘤相比较,其中肾透明细胞癌中钙化、出血等表现较肾乳头状细胞癌及肾嫌色细胞癌多见。三种肿瘤均在DWI图像上呈略高信号,在ADC图像上呈略高信号,无明显差异(P0.05)。结论：MRI对鉴别肾透明细胞癌、乳头状肾细胞癌、肾嫌色细胞癌均有一定的参考价值,其中MRI的增强序列是鉴别肾透明细胞癌和乳头状肾细胞癌及肾嫌色细胞癌的重要参数。而目前MRI能通过化学位移成像能较好地鉴别肾乳头状细胞癌与肾嫌色细胞癌。同样可通过化学位移成像来鉴别肾透明细胞癌与肾嫌色细胞癌。而肾透明细胞癌与肾乳头状细胞癌无法通过化学位移成像来鉴别。这对临床术前评估、指导治疗及预后分析有一定意义。
[Abstract]:Objective: to study the MRI findings of different pathological subtypes of renal cell carcinoma, which can be helpful for pathological classification. Materials and methods: from January 2009 to June 2013, we retrospectively analyzed 47 cases of renal cell carcinoma in the minimally invasive center of urinary system of Shandong Provincial Hospital. The patients were 31 to 83 years old. The mean age was 24.7 卤10.7 years old, 23 cases were left lesions and 24 cases were right side lesions, all of them were diagnosed as renal clear cell carcinoma or renal papillary cell carcinoma or chromophobe cell carcinoma by B-ultrasound, enhanced CT and MRI. According to the signal intensity of normal renal cortex, the imaging features of different pathological subtypes of renal cell carcinoma were compared by visual method. Results: 34 cases of renal clear cell carcinoma, 6 cases of papillary renal cell carcinoma and 7 cases of chromophobe cell carcinoma were analyzed by SPSS 13.0 statistical software. Renal clear cell carcinoma (RCC) is a blood-rich tumor. The enhancement amplitude of T1WI on T1WI is significantly longer than that of the other two subtypes, namely, cortical phase, parenchymal phase and excretory phase. It has statistical significance (P0.05), and has obvious characteristics of "fast in and out" and inhomogeneous enhancement. The signal intensity of T1WI on T1WI was slightly longer than that of renal clear cell carcinoma on T2WI, which was significantly longer than that of renal clear cell carcinoma (P 0.05). However, there was no significant difference in the enhancement amplitude of T1WI between renal papillary cell carcinoma and chromophobe cell carcinoma (P 0.05). In the chemical shift images of renal clear cell carcinoma and renal papillary cell carcinoma, the internal region of the tumor in some cases was lower than that in the same phase image, but the chromophobe cell carcinoma of the kidney had no such characteristic, which had statistical significance (P 0.05). The T2WI images of renal chromophobe cell carcinoma were longer than that of renal papillary cell carcinoma, and could be distinguished from each other (P 0.05). Calcification and hemorrhage were more common in renal clear cell carcinoma than in renal papillary cell carcinoma and chromophobe cell carcinoma. The three kinds of tumors were slightly hyperintense on DWI images and slightly hyperintense on ADC images without significant difference (P0.05). Conclusion: the ratio of Mr imaging is useful in differentiating renal clear cell carcinoma, papillary renal cell carcinoma and chromophobe cell carcinoma. The enhanced sequence of MRI is an important parameter to distinguish clear cell carcinoma from papillary renal cell carcinoma and chromophobe cell carcinoma. At present, MRI can distinguish renal papillary cell carcinoma from renal chromophobe cell carcinoma by chemical shift imaging. Chemical shift imaging can also be used to distinguish renal clear cell carcinoma from chromophobe cell carcinoma. Renal clear cell carcinoma and renal papillary cell carcinoma cannot be distinguished by chemical shift imaging. It has certain significance for clinical preoperative evaluation, guiding treatment and prognosis analysis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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