文档介绍：肾瘟的CT诊断和鉴别诊断301医院放射诊断科概述肾细胞癌(Rena|cel|Carcinoma,RCC)发病率:占恶性肿瘤的2%,占原发性肾恶性肿瘤的75~85%50岁以上多见绝大多数发生于肾的一侧,双侧发病仅占5%病理分型根据组织学图像、胞浆形态分为清亮细胞型、颗粒细胞型、混合型、肉瘤型根据肿瘤生长方式分为:乳头型、小管型、小梁型肾瘟的CT诊断肾癌CT平扫时多表现为等或低密度,极少为高密度,肿块较小时也可为形状规则的圆形或椭圆形,较大时多呈类圆形、不规则形,可有分叶,常使肾的外形扩大或局部隆起。部分肾癌有包膜边界较为清楚,大多数呈浸润性生长,边界不清癌灶内可囊变,出血、坏死、钙化,尤其坏死改变最为常见。据Bernard统计肾癌内含有坏死占49%,%,%,%。癌灶密度的异常正是其不同程度囊变,出血、坏死、钙化结果增强扫描动脉期肾癌多表现为不均质高强化,少数表现为均质强化或弱强化,约75%的肾癌因多血供而表现为动脉期典型的“一过性”不均质强化,静脉内快速团注对比剂和连续动态扫描,尤其是同层动态扫描能明显提高其显示率肾实质期肾癌强化程度一般小于肾实质,这一方面由于肿瘤的坏死、囊变等表现,另一方面是由于肾癌破坏了正常肾实质浓集、排泄含碘对比剂的功能,而本身无浓集和排泄含碘对比剂的功能肾实质后期及排泄期肾实质密度逐渐下降,癟灶可出现短暂的等密度,进而渐为低密度CT双期扫描时多血管癌灶动脉期增强明显,CT值至少提高20HU以上,表现为血管显影期,即皮髓质交界相癌灶密度增加,等于或略高于肾实质,以后便很快下降,而少血供癌灶的检出,肾实质期优于动脉期肾癌分期APPENDI以L47fRenalCellCarcinomRobsonDescriptionTNMTumor<scmconfinedtokiTumor>5cmconfinedtokidneyT2Tumorextendsintoadrenalglandorperinephricfatbutawithingerota'sfasciaTumorextendsintorenalveinorinferiorvenacavabelowhidiaphragmTumorextendsintorenalveinorinferiorvenacavaaboveTumorinvolveslocallymphnodeN|--ans(otherthanipsilateraladrenalpland)[2]andTNMclassificationsystems[16]A:180:1271-1277StagingSystemsforRenalCellCarcinomaandTheirCTCriteriaRobsonNMTumorpositionClassCTFindingsCTPitfallsConfinedwithinrenalSoft-tissuemassenhancescapsulelessthannormalrenalparenchyma;centralcellcarcinomaSmall(<7cmdiameterLarge(≥7cmdiameter)SpreadtoperinephricfatIIT3Perinephricstranding,Notreliableorspecific;ollate1%oofr1andT2Vesstumors;false-negativeifSoft-,notsensitiveinperinephrIcspace45%-50%ofcasesVenousthrombusIIIAFillingdelectwithinaFalse-negative:rightrenadistendedvein;directveinandIvCobscuredbyofthrombuswithprimarymass;NValse-negative:enhancingcontrastenhancementthrombusobscuredindicatestumorthrom-false-posl1bus:collateralveinsenlargementduetoincreasedflow:falseunopacifiedbloodmIVC