腎透明細胞癌與腎乳頭狀癌磁共振成像表現的對照研究

王謙 任金武 尹媛媛

[摘要] 目的 探討腎透明細胞癌與腎乳頭狀癌的核磁共振成像（MRI）表現。 方法 回顧性分析2013年5月～2017年5月保定市第一中心醫院、武警總醫院收治的85例腎癌患者的臨床資料，其中50例腎透明細胞癌患者納入腎透明細胞癌組，35例腎乳頭狀癌患者納入腎乳頭狀癌組。對兩組患者的MRI平掃及動態增強掃描表現進行比較，比較兩組MRI檢查所顯示的病灶表現及腫瘤-皮質增強指數。 結果 腎透明細胞癌組T1WI平掃呈低信號、混雜信號；腎乳頭狀癌組T1WI平掃呈混雜信號，兩組T1WI平掃表現為低信號的比例差異有統計學意義（P < 0.05）。腎透明細胞癌組T2WI平掃呈高信號和混雜信號，腎乳頭狀癌組T2WI平掃呈低信號和混雜信號，兩組T2WI平掃表現為高信號、混雜信號的比例差異有統計學意義（P < 0.05）。腎透明細胞癌組MRI表現為壞死、新生血管、腎包膜外侵犯的比例明顯高于腎乳頭狀癌組，出血、囊變的比例明顯低于腎乳頭狀癌組，差異均有統計學意義（P < 0.05或P < 0.01）。腎透明細胞癌組MRI表現為皮質期至延遲期漸進性減弱（P < 0.01）；腎乳頭狀癌組MRI表現為皮質期至實質期漸進性輕度增強，實質期至延遲期信號有所降低（P < 0.01）。腎透明細胞癌組皮質期、實質期、延遲期的增強指數均明顯高于腎乳頭狀癌組，差異均有高度統計學意義（P < 0.01）。 結論 腎透明細胞癌與腎乳頭狀癌的MRI表現具有一定的特征性，根據各腎癌亞型的增強程度，能夠顯著鑒別腎透明細胞癌和腎乳頭狀癌。

[關鍵詞] 腎透明細胞癌；腎乳頭狀癌；磁共振成像；鑒別診斷

[中圖分類號] R737.1 [文獻標識碼] A [文章編號] 1673-7210（2019）04（a）-0146-05

A comparative study of MRI of renal clear cell carcinoma and papillary carcinoma

WANG Qian1 REN Jinwu1 YIN Yuanyuan2 ZHAO Zuhong1 WANG Shumei1 MA Congmin1▲

1.CT/MRI Room， Baoding First Central Hospital， Hebei Province， Baoding 071000， China； 2.MRI Room， China Armed Police General Hospital， Beijing 100039， China

[Abstract] Objective To investigate the MRI of renal clear cell carcinoma and papillary carcinoma. Methods The clinical data of 85 patients with renal cell carcinoma admitted to Baoding First Central Hospital and China Armed Police General Hospital from May 2013 to May 2017 were retrospectively analyzed. Among the patients， 50 patients with renal clear cell carcinoma were included in the renal clear cell carcinoma group， and 35 patients with renal papillary carcinoma were included in the renal papillary carcinoma group. MRI scanning and dynamic enhancement imaging were compared between the two groups， and the lesion appearing and the tumor-cortical enhancement index were compared between the two groups. Results In renal clear cell carcinoma group， T1WI scanning showed low signal and mixed signal. The T1WI scanning of the renal papillary carcinoma group presented mixed signal， and the difference in the rate of low signal was statistically significant between the two groups （P < 0.05）. The T2WI scanning of the renal clear cell carcinoma group presented high signal and mixed signal， while the T2WI scanning of the renal papillary carcinoma group presented low signal and mixed signal， the difference in the proportion of high signal and mixed signal on T2WI between the two groups was statistically significant （P < 0.05）. MRI showed necrosis， neovascularization， and extrarenal invasion proportion in the renal clear cell carcinoma group， which was significantly higher than that in the papillary carcinoma group， while the rate of hemorrhage and cystic degeneration was significantly lower than that of the renal papillary carcinoma group， and the differences were statistically significant （P < 0.05 or P < 0.01）. MRI in the renal clear cell carcinoma group showed progressive weakening from cortical phase to delayed phase （P < 0.01）. MRI in the renal papillary carcinoma group showed progressive mild enhancement from cortical phase to parenchymal phase， and decreased signal from parenchymal phase to delayed phase （P < 0.01）. The enhancement indices of cortical， parenchymal and delayed phases were significantly higher than those of papillary carcinoma group， the differences were highly statistically significant （P < 0.01）. Conclusion MRI of renal clear cell carcinoma and papillary carcinoma have certain characteristics， and the enhancement degree of each kidney cancer subtype can significantly differentiate renal clear cell carcinoma and papillary carcinoma.