肾癌的CT诊断和鉴别诊断 ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,肾瘟的CT诊断和鉴别诊断,301医院放射诊断科,肾瘟的CT诊断和鉴别诊断,1,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7585%,50岁以上多见,绝大多数发生于肾的一侧,双侧发病仅占5%,概述,2,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,病理分型,3,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%,囊变占11.3%,钙化占11.3%,出血占,3.7%。癌灶密度的异常正是其不同程度囊变,出,血、坏死、钙化结果,肾瘟的CT诊断,4,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,增强扫描,5,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,肾实质期,6,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,肾实质后期及排泄期,7,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,CT双期扫描时,8,肾癌分期,APPENDI以L47 f Renal Cell Carcinom,Robson,Description,TNM,Tumor5 cm confined to kidney,T2,Tumor extends into adrenal gland or perinephric fat but,aw ithin gerotas fascia,Tumor extends into renal vein or inferior vena cava below,hi,diaphragm,Tumor extends into renal vein or inferior vena cava above,Tumor involves local lymph node,N|-N2,Tumor involves renal vein or inferior vena cava and local,Tor T3c. NI-N2,lymph nodes,Tumor invades adjacent organs (other than ipsilateral,adrenal pland),Distant metastasis,N4. MI,Criteria based on Robson 2 and TNM classification systems 16,A:180:1271-1277,肾癌分期,9,Staging Systems for Renal Cell Carcinoma and Their CT Criteria,Robson NM,Tumor position,Class,CT Findings,CT Pitfalls,Confined within renal,Soft-tissue mass enhances,capsule,less than normal renal,parenchyma; central,cell carcinoma,Small(7 cm diameter,Large(7 cm diameter),Spread to perinephric fat II T3,Perinephric stranding, Not reliable or specific; found,perinephric collate,1%o of r1 and T2,Vess,tumors; false-negative if,Soft-tissue mass in,5. pread is microscopic,pecific, not sensitive in,perinephrIc space,45%-50% of cases,Venous thrombus,IIIA,Filling delect within a,False-negative: right rena,distended vein; direct,vein and IvC obscured by,of thrombus,with primary mass; NV,alse-negative: enhancing,contrast enhancement,thrombus obscured,indicates tumor throm-,false-posl1,bus: collateral veins,enlargement due to,increased flow: false,unopacified blood m IVC,Staging Systems for Renal Cell,10,肾癌的CT诊断和鉴别诊断 ppt课件,11,肾癌的CT诊断和鉴别诊断 ppt课件,12,肾癌的CT诊断和鉴别诊断 ppt课件,13,肾癌的CT诊断和鉴别诊断 ppt课件,14,肾癌的CT诊断和鉴别诊断 ppt课件,15,肾癌的CT诊断和鉴别诊断 ppt课件,16,肾癌的CT诊断和鉴别诊断 ppt课件,17,肾癌的CT诊断和鉴别诊断 ppt课件,18,肾癌的CT诊断和鉴别诊断 ppt课件,19,肾癌的CT诊断和鉴别诊断 ppt课件,20,肾癌的CT诊断和鉴别诊断 ppt课件,21,肾癌的CT诊断和鉴别诊断 ppt课件,22,肾癌的CT诊断和鉴别诊断 ppt课件,23,肾癌的CT诊断和鉴别诊断 ppt课件,24,肾癌的CT诊断和鉴别诊断 ppt课件,25,肾癌的CT诊断和鉴别诊断 ppt课件,26,肾癌的CT诊断和鉴别诊断 ppt课件,27,肾癌的CT诊断和鉴别诊断 ppt课件,28,肾癌的CT诊断和鉴别诊断 ppt课件,29,肾癌的CT诊断和鉴别诊断 ppt课件,30,