业务学习 肾肿瘤文档格式.docx

1、肾脏占位性病变的CT扫描标准至少包括三个时相的数据收集，每一个时相对于帮助诊断都提供了重要的信息。 Unenhanced phase: Necessary as a baseline to quantify enhancement.平扫：对于增强扫描是必须的对比检查。 Nephrographic phase （100 second delay）: The nephrographic phase is the critical phase for evaluating for enhancement, comparing to the unenhanced images.肾实质期（100秒后）：

2、肾实质期对于强化后的评估是很重要的期相。 Pyelographic phase （15 minute delay; also called the excretory phase）: The pyelographic phase is helpful for problem solving and to diagnose potential mimics of cystic renal masses. 肾盂期（15分钟后，又称做分泌期）：肾盂期有助于诊断隐匿的肾脏囊性病变。The pyelographic phase can distinguish between hydronephrosis

3、 （will show dense opacification in the pyelographic phase） and renal sinus cysts （will not opacify）.肾盂期可以鉴别肾盂积水（肾盂期时变得浑浊）和肾窦囊肿（不会变得不透明）。Reflux nephropathy may cause a dilated calyx that can simulate a cystic renal mass on the nephrographic phase. The pyelographic phase would show opacification of th

4、e dilated calyx.反流性的肾病可以导致肾盏的扩大，在肾实质期与肾脏囊性病变很类似。而在肾盂期扩张的肾盏会变的浑浊。The pyelographic phase is also useful to demonstrate a calyceal diverticulum and to show therelationship of a renal mass to the collecting system for surgical planning. 肾盂期也可以很好的显示肾盂憩室，也可以显示肾脏占位性病变与肾集合系统的关系，为外科手术提供帮助。 Optionally, a vasc

5、ular phase can be performed for presurgical planning. 视情况而定，外科手术前需做血管造影检查。Evaluating enhancement （CT and MRI）CT和MRI增强检查的表现 The presence of enhancement is the most important characteristic to distinguish between a benign and malignant non-fat-containing renal mass （a lesion containing intralesional f

6、at is almost always a benign angiomyolipoma, even if it enhances）. 在鉴别非含脂的肾脏占位性病变中（含脂肪的多数为血管平滑肌脂肪瘤，尽管有强化），强化后的表现是非常重要的一个特征。 On CT, enhancement is quantified as the absolute increase in Hounsfield units on postcontrastimages, compared to pre-contrast: （less than）10HU， No enhancement；1019 HU，Equivocal

7、 enhancement.；（greater than or equal to）20 HU， Enhancement. 增强前后的图像CT值对比：小于10hu为无强化；10-19hu为疑似强化；大于等于20hu为强化。 On MRI, enhancement is quantified as the percent increase in signal intensity as measured on post-contrast images:15%: No enhancement. 1519%: Equivocal enhancement. 20%: Enhancement. MRI增强检查

8、，前后对比，小于15%为无强化；15-19%疑似强化；大于等于20%为强化。 Lesions are considered “too small to characterize” if the lesion diameter is smaller than twice the slice thickness. For instance, using 3 mm slices, a lesion less than 6 mm cannot be accurately characterized based on attenuation or enhancement. 如果病灶小于两个层面时，没有特

9、征性的表现。例如，3毫米层厚时，小于6毫米的病灶基于减弱或者增强时，就不能准确的诊断。Renal mass biopsy肾脏占位性病变的活组织切片检查 After full imaging workup is complete, there are several well-accepted indications for percutaneous renal mass biopsy: 所有的影像学检查结束后，有几个被广泛接受的适应症，可以进行肾脏占位性病变的经皮穿刺活检。Indications for renal mass biopsy穿刺活检的适应症 To distinguish rena

10、l cell carcinoma from metastasis in a patient with a known primary. 鉴别肾细胞性肾癌还是转移性肿瘤。 To distinguish between renal infection and cystic neoplasm. 鉴别感染还是囊性的病变。 To definitively diagnose a hyperdense, homogeneously enhancing mass （after MRI has beenperformed）, which may represent a benign angiomyolipoma

11、 with minimal fat versus a renal cellcarcinoma. 最终诊断同肾肿瘤同样强化的高密度病变，代表的有含有很少脂肪的血管平滑肌脂肪瘤与肾细胞肾癌。 To definitively diagnose a suspicious renal mass in patient with multiple comorbidities for whom nephrectomy would be high risk. 在具有高风险的肾脏切除手术并伴有多发并发症的病人，可以最终明确疑似的肾肿瘤性病变。 To ensure correct tissue diagnosis

12、prior to renal mass ablation. 在占位性病变切除前明确病理组织诊断。166Solid renal masses肾脏实性占位Renal cell carcinoma （RCC）肾细胞性肾癌Renal cell carcinoma, stage 3A: Coronal （left image） and axial post-contrast fat-suppressed T1-weighted MRI shows a heterogeneously enhancing mass （yellow arrows） replacing and expanding most o

13、f the left kidney. Contiguous to the mass there is expansion and heterogeneous enhancement of the left renal vein （red arrows）, representing tumor thrombus and extension of the renal carcinoma into the renal vein. 3A期的肾细胞肾癌：冠状位（左）和轴位T1WI压脂后的增强图像示：大部分的左侧肾脏被不均匀强化的肾肿瘤（黄箭头）取代，邻近肿块的是扩张和不均匀强化的左肾静脉（红箭头），表示

14、左肾静脉癌栓形成和受累。 Renal cell carcinoma （RCC） is a relatively uncommon tumor that arises from the renal tubular cells. It represents 23% of all cancers. Risk factors for development of RCC include smoking, acquired cystic kidney disease, von HippelLindau （VHL）, and tuberous sclerosis. 肾细胞肾癌是起源于肾小管细胞的不是很常见

15、的肿瘤。在所有肿瘤中占2-3%。危险因素包括吸烟、继发于肾脏囊性病变、“希佩尔- 林道综合征”和结节性硬化。 Clear cell is the most common RCC subtype （75%）, with approximately 55% 5-year survival.75%的肾癌为透明细胞癌，其5年存活率接近55%。Clear cell RCC tends to enhance more avidly than the less common subtypes.透明细胞肾癌相对于其它亚型的肿瘤强化明显。Clear cell can be sporadic or associated with von HippelLindau.透明细胞可以是散发的或者和“希佩尔- 林道