业务学习 肾肿瘤.doc

Kidneys肾脏Diagnostic approach to a renal mass肾脏占位性病变的诊断方法Renal mass protocol multiphase CT肾脏占位性病变的多时相的CT扫描标准 A renal mass protocol CT consists of at least three phases of data acquisition, with each phase providing important information to aid in the diagnosis of a renal mass.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）：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 (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 the 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 vascular 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 fat 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 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: 70 Hounsfield units on noncontrast imaging represents a benign hyperdense cyst, likely secondary to prior hemorrhage.平扫CT值大于70hu的均质肾囊肿，多位良性的高密度囊肿，多是继发于出血。 A hyperdense cyst cannot be diag