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目的探讨直径≤3 cm的肾透明细胞癌MRI的影像表现与病理组织学的关系。方法收集经临床手术病理证实的10例直径≤3 cm的肾透明细胞癌患者的1.5T核磁共振平扫及动态增强扫描的影像资料,观察肿瘤的部位、形状、大小、边界,信号及强化特点,并与病理对照分析。结果全部为单肾单发病灶,呈圆形及卵圆形,标本以实性为主,剖面呈淡黄、多彩状;镜下细胞核呈粗颗粒状,胞浆内含有脂质和糖原,瘤细胞围绕血管结构呈腺泡排列,胶体铁染色(-);其中病变位于左肾4例,右肾6例;直径1~3 cm,平均1.5 cm;T1WI同相位/反相位呈等信号8例/9例,低信号2例/1例;T2WI及T2WI-FS呈中高信号8例,混杂信号1例,T2WI呈等信号/T2WI-FS呈略高信号1例;DWI呈不均匀高信号9例,等信号1例,6例假包膜在T2WI呈低信号;动态增强皮质期边缘强化7例,瘤体内斑片状强化3例,其中强化程度与肾皮质相仿5例,高于肾皮质3例,低于肾皮质2例;实质期为不均匀强化,强化程度低于肾实质6例,与肾实质相仿3例,低于肾实质1例;肾盂期强化程度全部低于肾实质;病变边界清晰7例,模糊3例;其中6例可见包膜强化,9例肿瘤内见不规则坏死及囊变区,无强化。未见肾静脉、下腔静脉瘤栓及区域淋巴结转移。结论直径≤3 cm的肾透明细胞癌MRI信号有一定特征性,结合动态增强扫描,可以为临床术前提供正确诊断。
Objective To investigate the relationship between MRI findings and histopathology in renal clear cell carcinoma (diameter ≤ 3 cm). Methods Fifty-one cases of clear cell renal cell carcinoma with diameter ≤3 cm confirmed by clinical surgeries were scanned with 1.5T MRI and dynamic contrast-enhanced scan to observe the location, shape, size, boundary, signal and enhancement features of the tumor , And pathological control analysis. The results were all single kidney lesions, were round and oval, the specimens mainly solid, section was pale yellow, colorful; microscopic nuclei were coarse granular cytoplasm containing lipid and glycogen, The tumor cells were arranged in acinar structures around blood vessels and colloidal iron staining (-). Among them, the lesions were located in the left kidney in 4 cases and in the right kidney in 6 cases; the diameter was 1-3 cm in diameter with an average of 1.5 cm; T1WI in-phase / 8 cases / 9 cases, 2 cases of low signal / 1 case; T2WI and T2WI-FS showed high signal in 8 cases, mixed signal in 1 case, T2WI was signal / T2WI-FS was slightly high signal in 1 case; DWI was unevenly Signal in 9 cases, and other signals in 1 case, 6 cases of pseudocapsules showed a low signal in T2WI; dynamic enhanced cortical edge enhancement in 7 cases, tumor patch enhancement in 3 cases, of which the degree of enhancement and renal cortical similarities in 5 cases, Cortical in 3 cases, lower than in 2 cases of renal cortex; parenchymal heterogeneity, enhanced less than 6 cases of renal parenchyma, similar to the renal parenchyma in 3 cases, lower than the renal parenchyma in 1 case; ; 7 cases of clear boundary, fuzzy 3 cases; 6 cases showed enhancement of the capsule, 9 cases of tumor see irregular necrosis and cystic area, no enhancement. No renal vein, inferior vena cava tumor thrombus and regional lymph node metastasis. Conclusion MRI signal of renal clear cell carcinoma with diameter ≤3 cm has certain characteristic. Combined with dynamic contrast-enhanced scan, it can provide correct diagnosis for clinical preoperative.