Abstract
目的 提高对肾脏集合管癌CT表现的认识.方法报告3例经病理证实的肾脏集合管癌的螺旋CT所见,并作文献复习.结果男2例,女1例,肿瘤位于右肾者2例,左肾1例.位于右肾的1例,肿瘤累及肾皮质和髓质,并突出于肾轮廓之外,大小约8.0 cm×8.0 cm,平扫CT值约37～45 HU,其内见高密度的斑点状钙化灶.增强动脉期(皮质期)及静脉期(髓质期)扫描示病变呈不均匀性强化,无包膜,CT值约52～107 HU,CT诊断为右肾癌,但不排除肾结核.另外2例肿瘤同时累及肾皮质、髓质及肾盂,其中位于左肾的1例,肿瘤大小约7.0 cm×7.5 cm,平扫病变区CT值约22 HU,增强动脉期(皮质期)扫描示肾皮、髓分界不清,病变区CT值约70 HU,静脉期(髓质期)示肾静脉内癌栓形成,排泄期(肾盂期)扫描示左肾盂、肾盏未见显影,CT诊断为左肾癌(集合管癌可能性大).另外1例位于右肾,肿瘤大小约8.0 cm×14.0 cm,平扫CT值约32 HU,增强动脉期(皮质期)及静脉期(髓质期)扫描示肿瘤与正常的肾组织无明显分界,CT值约45～72 HU,排泄期(肾盂期)扫描示左肾盂、肾盏未见显影,CT诊断为右肾癌,但不排除肾结核.3例中2例可见肾周脂肪囊及肾筋膜受侵犯,2例有局部淋巴结转移,1例有肋骨转移.结论 CT对肾脏集合管癌的定性诊断有一定的价值,但确诊还应依赖于病理。
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