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目的评估乳头状肾细胞癌(pRCC)的MRI表现中的先兆性提示和病理学特征。方法共115例病人128处pRCC病变术前行MRI检查,观察病理学类型(1型或2型),MRI表现(局灶性或浸润性)和其他的MRI征象。根据是否出现转移性疾病将病人分组。结果共有65处病变为局限性1型,54处为局限性2型和9处为浸润性pRCC。所有的浸润性pRCC在组织病理学上均属2型。89%的浸润性pRCC出现肾静脉血栓,而局限性pRCC则无肾静脉血栓。3.7%的局限性1型,7.5%的局限性2型和75.0%的浸润性2型pRCC出现了转移。MRI上浸润性的表现是预测病变转移、独立的病理学类型、病变大小和T分期的重要因子(P≤0.020)。MRI表现为局限性pRCC病人中,病理学2型并非转移性病变的有效预测因子(P=0.648)。其他征象相结合在准确预测病变转移性时均不高于仅有肾静脉血栓一种表现(P>0.5)。结论以MRI上浸润性表现和肾静脉血栓为特征的组织病理学2型pRCC的亚型发生转移的风险显著增高。要点①MRI为术前认知肾细胞肾癌(RCC)提供了新的方法。②某些特定的MRI征象与转移性乳头状RCC具有相关性。③转移性病灶较易出现浸润性表现和肾静脉血栓。
Objective To evaluate the prognostic and pathological features of MRI findings of papillary renal cell carcinoma (pRCC). Methods A total of 128 pRCC lesions of 115 patients underwent preoperative MRI examination. Pathological types (type 1 or type 2), MRI findings (focal or infiltrative) and other MRI signs were observed. Patients are divided according to whether there is a metastatic disease. Results A total of 65 lesions were localized to type 1, 54 localized to type 2 and 9 to invasive pRCC. All invasive pRCCs are histopathologically type 2. Renal venous thrombosis occurred in 89% of invasive pRCCs, whereas renal venous thrombosis did not occur in localized pRCCs. 3.7% of localized type 1, 7.5% of localized type 2 and 75.0% of invasive type 2 pRCC. The manifestation of invasiveness on MRI is an important factor in the prediction of pathological changes, independent pathological types, size of lesion and T stage (P≤0.020). MRI manifests limitations Among pRCC patients, pathology type 2 is not a valid predictor of metastatic disease (P = 0.648). The combination of other signs in the accurate prediction of lesion metastasis were not higher than only a manifestation of renal vein thrombosis (P> 0.5). Conclusions The risk of metastasis to a subtype of histopathological type 2 pRCC characterized by an infiltrative appearance on MRI and renal vein thrombosis is significantly increased. Key Points ① MRI provides a new method for preoperative cognitive renal cell carcinoma (RCC). ② some specific MRI signs and metastatic papillary RCC has relevance. ③ metastatic lesions more prone to invasive performance and renal vein thrombosis.