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目的评价MR对肾癌1期瘤栓的诊断价值。方法22例经手术病理证实的肾癌患者,均于术前行MR检查,观察肾静脉内和下腔静脉内有无瘤栓及瘤栓的范围,并与手术结果进行对照。评价MR对肾静脉和下腔静脉的显示情况及对肾癌I期瘤栓的诊断准确性。结果22例患者,均为单侧肾癌。手术病理共发现8处肾静脉瘤栓,无下腔静脉内瘤栓。MR对肾癌的检出率为100%。MR对21支肾静脉显示清楚,1支肾静脉显示不清。在显示清楚的21支肾静脉中,MR诊断8支肾静脉内有瘤栓,13支肾静脉内无瘤栓,均与手术病理符合。1支显示不清的肾静脉内,手术未见瘤栓。MR对22支下腔静脉均显示清楚,未见瘤栓。22例肾癌中,9例行增强CT检查,对瘤栓的诊断正确7例,漏诊1例,误诊1例。16例行超声检查,对瘤栓的诊断正确13例,误诊2例,漏诊1例。4例行DSA检查,诊断正确4例。结论MR对肾癌Ⅰ期瘤栓的诊断准确性高,当术前MR对肾静脉显示清楚时,MR可作为术前I期瘤栓评价的金标准。
Objective To evaluate the diagnostic value of MR for stage 1 renal cell carcinoma tumor thrombus. Methods Twenty-two patients with renal cell carcinoma confirmed by surgery and pathology were examined by MR before operation to observe the presence or absence of tumor thrombus and tumor thrombus in renal vein and inferior vena cava, and to compare the results with the surgical results. Evaluation of MR on the renal vein and inferior vena cava display and the diagnosis of renal cell carcinoma I thrombus diagnostic accuracy. Results 22 patients were all unilateral renal cell carcinoma. Surgical pathology were found in 8 renal vein tumor thrombus, no inferior vena cava tumor emboli. MR detection rate of renal cell carcinoma was 100%. MR showed clearly on 21 renal veins, 1 renal vein showed unclear. In the 21 clear renal veins, MR diagnostic tumor thrombus in 8 renal vein, 13 renal vein tumor-free suppositories, all in line with the surgical pathology. One showed indistinct renal vein, the operation no tumor suppository. MR on the 22 inferior vena cava showed clear, no tumor embolus. In 22 cases of renal cell carcinoma, 9 cases underwent enhanced CT examination, 7 cases were diagnosed correctly for tumor embolus, 1 case missed diagnosis and 1 case was misdiagnosed. Twenty-six cases underwent ultrasonography, 13 cases were correctly diagnosed as tumor suppository, 2 cases were misdiagnosed, and 1 case was missed. 4 routine DSA examination, the diagnosis of the correct 4 cases. Conclusion MR has a high diagnostic accuracy for stage I renal cell carcinoma tumor. MR can be used as the gold standard for stage I tumor suppository evaluation when preoperative MR is clear for renal vein.