摘要
目的
探讨多排螺旋CT多期增强扫描在评价肾脏病变中的诊断价值。
材料和方法
前瞻性纳入89例因临床及超声检查疑有肾脏病变而接受肾脏多排螺旋CT扫描的连续性病例，经手术／病理(31例)、典型影像学表现(45例)或随访观察(13例)获得最后诊断。所有病例均在肾脏平扫之后行三期增强扫描，即皮质期、实质期和肾盂期。由3位有经验的腹部CT诊断医师在统一标准下独立分析阅片：①对各期扫描的图像按以下5级标准进行评定。0级，病变不明显或不能发现病变；1级，病变较模糊，但大致可辨；2级，病变明显可见，但定性困难；3级，病变很清晰，有一定把握定性；4级，病变明显，有较大把握定性。②对诊断为肾癌的，则进一步评价其强化类型和程度。采用成组等级资料的秩和检验来比较各期扫描之间诊断价值有无差别。
结果
1．本研究病例的最后诊断包括：①未见异常者18例(除完全正常外，包括驼峰肾3例，Bertin柱肥大4例及肾窦脂肪增多1例)；②肾囊肿28例；③肾肿瘤21例(肾细胞癌15例，肾盂移行细胞癌2例，
Objective
To investigate the diagnostic value of contrast-enhanced multi-phasic scanning for renal diseases by multi-detector-row spiral CT (MDCT).
Materials and methods
89 consecutive patients suspected to have renal abnormalities on clinical ground and ultrasound examination were prospectively included into the study for multi-phasic scanning by 16-slice MDCT. The final diagnosis was confirmed by surgery and pathology (31 cases) and by typical imaging findings (45 cases) and clinical follow-up (13 cases) in this study. Phases of MDCT scanning included plain scan, renocortical phase, corticomedullary or parenchymal phase and excretory phase. 3 senior experienced radiologists who were unaware of the final diagnosis reviewed CT images of all phases, focusing on: ① rating the image quality and lesion visibility according to following criteria. Rate 0, lesion not visible; Rate 1, lesion is visible, but unclear; Rate 2, lesion is visible, but not good for lesion characterization; Rate 3, lesion is clear, with some certainty for lesion characterization; Rate 4, lesion is very clear, with high certainty for characterization. ② judging the degree and patterns of tumor enhancement in renal tumor patients . Paired Rank Sum test was used for statistical analysis.
Results
1. There were: ①18 cases without apparent abnormalities (including 8 cases
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