本文選題：腎透明細(xì)胞癌 + 腎乳頭狀細(xì)胞癌�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的：探討腎癌不同病理亞型的MRI表現(xiàn),可以對病理分型提供幫助,為臨床制定手術(shù)方案及判斷預(yù)后提供依據(jù)。 材料及方法：本次研究我們對2009年1月至2013年6月山東省立醫(yī)院泌尿微創(chuàng)中心收治的47例腎癌病例進(jìn)行回顧性分析,患者年齡31～83歲,平均年齡24.7±10.7歲；左側(cè)病變23例,右側(cè)病變24例,均經(jīng)B超、強(qiáng)化CT及MRI檢查,術(shù)后病理確診為腎透明細(xì)胞癌或腎乳頭狀細(xì)胞癌或腎嫌色細(xì)胞癌。以正常腎皮質(zhì)信號強(qiáng)度為標(biāo)準(zhǔn),采用目測法比較各病例的影像學(xué)特點(diǎn),總結(jié)腎癌各病理亞型的MRI的影像學(xué)特點(diǎn)。最后用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行以P=0.05為標(biāo)準(zhǔn)進(jìn)行卡方分析。 結(jié)果：本組腎透明細(xì)胞癌34例,乳頭狀腎細(xì)胞癌6例,腎嫌色細(xì)胞癌7例。腎透明細(xì)胞癌是富血供腫瘤,其T1WI動態(tài)增強(qiáng)序列強(qiáng)化幅度明顯高于其他兩個亞型,即皮質(zhì)期、實(shí)質(zhì)期及排泄期的T1WI信號較其他兩個亞型長,有統(tǒng)計(jì)學(xué)意義(P0.05),且具有明顯的“快進(jìn)快出”及不均勻強(qiáng)化的強(qiáng)化特點(diǎn)。腎乳頭狀細(xì)胞癌平掃時的T1WI呈等或略長信號,T2WI呈等或略長信號均較腎透明細(xì)胞癌略長,有統(tǒng)計(jì)學(xué)意義(P0.05)。而腎乳頭狀細(xì)胞癌與腎嫌色細(xì)胞癌的T1WI動態(tài)增強(qiáng)序列強(qiáng)化幅度無明顯差異(P0.05)。腎透明細(xì)胞癌及腎乳頭狀細(xì)胞癌的化學(xué)位移圖像中部分病例反相位圖像中腫瘤內(nèi)部部分區(qū)域較同相位圖像有所降低,而腎嫌色細(xì)胞癌無此特點(diǎn),有統(tǒng)計(jì)學(xué)意義(P0.05)。而腎嫌色細(xì)胞癌的T2WI圖像較腎乳頭狀細(xì)胞癌略長,可以鑒別,有統(tǒng)計(jì)學(xué)意義(P0.05)。三種腫瘤相比較,其中腎透明細(xì)胞癌中鈣化、出血等表現(xiàn)較腎乳頭狀細(xì)胞癌及腎嫌色細(xì)胞癌多見。三種腫瘤均在DWI圖像上呈略高信號,在ADC圖像上呈略高信號,無明顯差異(P0.05)。 結(jié)論：MRI對鑒別腎透明細(xì)胞癌、乳頭狀腎細(xì)胞癌、腎嫌色細(xì)胞癌均有一定的參考價值,其中MRI的增強(qiáng)序列是鑒別腎透明細(xì)胞癌和乳頭狀腎細(xì)胞癌及腎嫌色細(xì)胞癌的重要參數(shù)。而目前MRI能通過化學(xué)位移成像能較好地鑒別腎乳頭狀細(xì)胞癌與腎嫌色細(xì)胞癌。同樣可通過化學(xué)位移成像來鑒別腎透明細(xì)胞癌與腎嫌色細(xì)胞癌。而腎透明細(xì)胞癌與腎乳頭狀細(xì)胞癌無法通過化學(xué)位移成像來鑒別。這對臨床術(shù)前評估、指導(dǎo)治療及預(yù)后分析有一定意義。
[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 鹵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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.11

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