肾透明细胞癌与肾乳头状癌磁共振成像表现的对照研究

王谦 任金武 尹媛媛

[摘要] 目的 探討肾透明细胞癌与肾乳头状癌的核磁共振成像（MRI）表现。 方法 回顾性分析2013年5月～2017年5月保定市第一中心医院、武警总医院收治的85例肾癌患者的临床资料，其中50例肾透明细胞癌患者纳入肾透明细胞癌组，35例肾乳头状癌患者纳入肾乳头状癌组。对两组患者的MRI平扫及动态增强扫描表现进行比较，比较两组MRI检查所显示的病灶表现及肿瘤-皮质增强指数。 结果 肾透明细胞癌组T1WI平扫呈低信号、混杂信号；肾乳头状癌组T1WI平扫呈混杂信号，两组T1WI平扫表现为低信号的比例差异有统计学意义（P < 0.05）。肾透明细胞癌组T2WI平扫呈高信号和混杂信号，肾乳头状癌组T2WI平扫呈低信号和混杂信号，两组T2WI平扫表现为高信号、混杂信号的比例差异有统计学意义（P < 0.05）。肾透明细胞癌组MRI表现为坏死、新生血管、肾包膜外侵犯的比例明显高于肾乳头状癌组，出血、囊变的比例明显低于肾乳头状癌组，差异均有统计学意义（P < 0.05或P < 0.01）。肾透明细胞癌组MRI表现为皮质期至延迟期渐进性减弱（P < 0.01）；肾乳头状癌组MRI表现为皮质期至实质期渐进性轻度增强，实质期至延迟期信号有所降低（P < 0.01）。肾透明细胞癌组皮质期、实质期、延迟期的增强指数均明显高于肾乳头状癌组，差异均有高度统计学意义（P < 0.01）。 结论 肾透明细胞癌与肾乳头状癌的MRI表现具有一定的特征性，根据各肾癌亚型的增强程度，能够显著鉴别肾透明细胞癌和肾乳头状癌。

[关键词] 肾透明细胞癌；肾乳头状癌；磁共振成像；鉴别诊断

[中图分类号] R737.1 [文献标识码] A [文章编号] 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.