業(yè)務(wù)學(xué)習(xí) 腎腫瘤

1、Kidneys腎臟Diagnostic approach to a renal mass腎臟占位性病變的診斷方法Renal mass protocol multiphase CT腎臟占位性病變的多時(shí)相的CT掃描標(biāo)準(zhǔn) 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.腎臟占位性病變的CT掃描標(biāo)準(zhǔn)至少包括三個(gè)時(shí)相的數(shù)

2、據(jù)收集，每一個(gè)時(shí)相對(duì)于幫助診斷都提供了重要的信息。 Unenhanced phase: Necessary as a baseline to quantify enhancement.平掃：對(duì)于增強(qiáng)掃描是必須的對(duì)比檢查。 Nephrographic phase (100 second delay): The nephrographic phase is the critical phase for evaluating for enhancement, comparing to the unenhanced images.腎實(shí)質(zhì)期（100秒后）：腎實(shí)質(zhì)期對(duì)于強(qiáng)化后的評(píng)估是很重要的期相。 Pye

3、lographic 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. 腎盂期（15分鐘后，又稱做分泌期）：腎盂期有助于診斷隱匿的腎臟囊性病變。The pyelographic phase can distinguish between hydronephrosis (will show dense opacif

4、ication in the pyelographic phase) and renal sinus cysts (will not opacify).腎盂期可以鑒別腎盂積水（腎盂期時(shí)變得渾濁）和腎竇囊腫（不會(huì)變得不透明）。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.反流性的腎病可以

5、導(dǎo)致腎盞的擴(kuò)大，在腎實(shí)質(zhì)期與腎臟囊性病變很類似。而在腎盂期擴(kuò)張的腎盞會(huì)變的渾濁。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. 腎盂期也可以很好的顯示腎盂憩室，也可以顯示腎臟占位性病變與腎集合系統(tǒng)的關(guān)系，為外科手術(shù)提供幫助。 Optionally, a vascular phase can be perfor

6、med for presurgical planning. 視情況而定，外科手術(shù)前需做血管造影檢查。Evaluating enhancement (CT and MRI)CT和MRI增強(qiáng)檢查的表現(xiàn) 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 be

7、nign angiomyolipoma, even if it enhances). 在鑒別非含脂的腎臟占位性病變中（含脂肪的多數(shù)為血管平滑肌脂肪瘤，盡管有強(qiáng)化），強(qiáng)化后的表現(xiàn)是非常重要的一個(gè)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.；（great

8、er than or equal to）20 HU， Enhancement. 增強(qiáng)前后的圖像CT值對(duì)比：小于10hu為無強(qiáng)化；10-19hu為疑似強(qiáng)化；大于等于20hu為強(qiáng)化。 On MRI, enhancement is quantified as the percent increase in signal intensity as measured on post-contrast images: <15%: No enhancement. 1519%: Equivocal enhancement. 20%: Enhancement. MRI增強(qiáng)檢查，前后對(duì)比，小于15%為無強(qiáng)化

9、；15-19%疑似強(qiáng)化；大于等于20%為強(qiáng)化。 Lesions are considered “too small to characterize” if the lesion diameter is smaller than twice the slice thickness. For instance, using 3 mm slices, a lesion less than 6 mm cannot be accurately characterized based on attenuation or enhancement. 如果病灶小于兩個(gè)層面時(shí)，沒有特征性的表現(xiàn)。例如，3毫米層厚時(shí)

10、，小于6毫米的病灶基于減弱或者增強(qiáng)時(shí)，就不能準(zhǔn)確的診斷。Renal mass biopsy腎臟占位性病變的活組織切片檢查 After full imaging workup is complete, there are several well-accepted indications for percutaneous renal mass biopsy: 所有的影像學(xué)檢查結(jié)束后，有幾個(gè)被廣泛接受的適應(yīng)癥，可以進(jìn)行腎臟占位性病變的經(jīng)皮穿刺活檢。Indications for renal mass biopsy穿刺活檢的適應(yīng)癥 To distinguish renal cell carcinom

11、a from metastasis in a patient with a known primary. 鑒別腎細(xì)胞性腎癌還是轉(zhuǎn)移性腫瘤。 To distinguish between renal infection and cystic neoplasm. 鑒別感染還是囊性的病變。 To definitively diagnose a hyperdense, homogeneously enhancing mass (after MRI has beenperformed), which may represent a benign angiomyolipoma with minimal f

12、at versus a renal cellcarcinoma. 最終診斷同腎腫瘤同樣強(qiáng)化的高密度病變，代表的有含有很少脂肪的血管平滑肌脂肪瘤與腎細(xì)胞腎癌。 To definitively diagnose a suspicious renal mass in patient with multiple comorbidities for whom nephrectomy would be high risk. 在具有高風(fēng)險(xiǎn)的腎臟切除手術(shù)并伴有多發(fā)并發(fā)癥的病人，可以最終明確疑似的腎腫瘤性病變。 To ensure correct tissue diagnosis prior to renal

13、mass ablation. 在占位性病變切除前明確病理組織診斷。166Solid renal masses腎臟實(shí)性占位Renal cell carcinoma (RCC)腎細(xì)胞性腎癌Renal cell carcinoma, stage 3A: Coronal (left image) and axial post-contrast fat-suppressed T1-weighted MRI shows a heterogeneously enhancing mass (yellow arrows) replacing and expanding most of the left kidn

14、ey. Contiguous to the mass there is expansion and heterogeneous enhancement of the left renal vein (red arrows), representing tumor thrombus and extension of the renal carcinoma into the renal vein. 3A期的腎細(xì)胞腎癌：冠狀位（左）和軸位T1WI壓脂后的增強(qiáng)圖像示：大部分的左側(cè)腎臟被不均勻強(qiáng)化的腎腫瘤（黃箭頭）取代，鄰近腫塊的是擴(kuò)張和不均勻強(qiáng)化的左腎靜脈（紅箭頭），表示左腎靜脈癌栓形成和受累。 Re

15、nal cell carcinoma (RCC) is a relatively uncommon tumor that arises from the renal tubular cells. It represents 23% of all cancers. Risk factors for development of RCC include smoking, acquired cystic kidney disease, von HippelLindau (VHL), and tuberous sclerosis. 腎細(xì)胞腎癌是起源于腎小管細(xì)胞的不是很常見的腫瘤。在所有腫瘤中占2-3%

16、。危險(xiǎn)因素包括吸煙、繼發(fā)于腎臟囊性病變、“希佩爾- 林道綜合征”和結(jié)節(jié)性硬化。 Clear cell is the most common RCC subtype (75%), with approximately 55% 5-year survival.75%的腎癌為透明細(xì)胞癌，其5年存活率接近55%。Clear cell RCC tends to enhance more avidly than the less common subtypes.透明細(xì)胞腎癌相對(duì)于其它亞型的腫瘤強(qiáng)化明顯。Clear cell can be sporadic or associated with von Hi

17、ppelLindau.透明細(xì)胞可以是散發(fā)的或者和“希佩爾- 林道綜合征”相關(guān)。 Papillary RCC is a hypovascular subtype, with a 5-year survival of 8090%.乳頭狀透明細(xì)胞癌是少血供的類型，其5年生存率為80-90%。Papillary RCC tends to enhance only mildly due to its hypovascularity.乳頭狀透明細(xì)胞癌因?yàn)槠渖傺?，表現(xiàn)為輕微強(qiáng)化。A renal “adenoma” is frequently seen on autopsy specimens and is

18、 a papillary carcinoma 5 mm.腎臟腺瘤通常在尸檢標(biāo)本中發(fā)現(xiàn)，死小于5mm的乳頭狀腎癌。 Chromophobe is the subtype with the best prognosis, featuring a 90% 5-year survival.嫌色細(xì)胞癌是一種預(yù)后最好的亞型，5年存活率為90%。 Collecting duct carcinoma is rare and has a poor prognosis.集合管癌是少見并預(yù)后不良。 Medullary carcinoma is also rare, but is known to affect mo

19、stly young adult males with sickle cell trait. Medullary carcinoma is an extremely aggressive neoplasm, with a mean survival of 15 months, not helped by chemotherapy.髓樣癌也是少見的，主要發(fā)生于具有鐮刀型細(xì)胞性質(zhì)的年輕人。髓樣癌是非常有侵襲性的腫瘤，不進(jìn)行化療的存活期為15月。 Staging of renal cell carcinoma is based on the Robson system, which characte

20、rizes fascial extension and vascular/lymph node involvement. Stages IIII are usually resectable, although the surgical approach may need to be altered for venous invasion (stages IIIA and IIIC).腎癌的分級(jí)是基于羅布森系統(tǒng)，包括筋膜的受累、血管及淋巴結(jié)的轉(zhuǎn)移。1-3級(jí)的通?？梢郧谐?，因?yàn)殪o脈的受累，手術(shù)入逕常常需要更改。Stage I: Tumor confined to within the renal

21、 capsule.1期：腫瘤局限于腎包膜內(nèi)。Stage II: Tumor extends out of the renal capsule but remains confined within Gerotas fascia.2期：腫瘤突破腎包膜，但仍然局限于腎前筋膜。Stage III: Vascular and/or lymph node involvement.3期：血管和/或淋巴結(jié)轉(zhuǎn)移。IIIA: Renal vein involvement or IVC involvement.IIIA期：深靜脈受累或者下腔靜脈受累。IIIB: Lymph node involvement.III

22、B：淋巴結(jié)轉(zhuǎn)移。IIIC: Venous and lymph node involvement.IIIC：靜脈和淋巴結(jié)轉(zhuǎn)移。Stage IVA: Tumor growth through Gerotas fascia; IVA期：腫瘤突破腎前筋膜生長。Stage IVB: Distant metastasis.IVB：遠(yuǎn)處轉(zhuǎn)移。167Angiomyolipoma (AML)血管平滑肌脂肪瘤Axial non-contrast CT shows an exophytic mass (arrow) in the right kidney containing macroscopic fat. Th

23、ere are a few linear strands of soft tissue within the lesion.軸位平掃可見右腎含脂肪的外生性腫塊，病灶內(nèi)含有一些少許軟組織密度影。 Axial T1-weighted MRI shows that the lesion is predominantly isointense to intra-abdominal fat.軸位T1加權(quán)MRI示：病灶為主要表現(xiàn)為同腹腔脂肪相等的信號(hào)。Axial early arterial post-contrast T1-weighted fat suppressed image shows slig

24、ht enhancement of thesoft tissue components.動(dòng)脈增強(qiáng)早期T1脂肪抑制圖像示：軟組織成分的輕微強(qiáng)化。Late arterial post-contrast T1-weighted fat suppressed image shows more prominent enhancement of the soft tissue components of the lesion.動(dòng)脈晚期示：病變內(nèi)軟組織成分明顯強(qiáng)化。 Angiomyolipoma (AML) is the most common benign renal neoplasm, composed

25、 of fat, smooth muscle, and disorganized blood vessels. The majority are sporadic, but 40% are associated with tuberous sclerosis (where AMLs are bilateral, with multiple renal cysts). 血管平滑肌脂肪瘤是最常見的腎臟良性腫瘤，由脂肪、平滑肌和不規(guī)則的血管組成。大多數(shù)是散在的，但是40%和結(jié)節(jié)性硬化有關(guān)（病灶為雙側(cè)，伴有多發(fā)腎囊腫）。 AML has a risk of hemorrhage when large

26、(4 cm), thought to be due to aneurysmal change of the vascular elements. Small, asymptomatic AMLs are not typically followed or resected.血管平滑肌脂肪瘤大于4cm時(shí)有出血的風(fēng)險(xiǎn)，認(rèn)為是由于血管原因的血管瘤。小的，無癥狀的血管平滑肌脂肪瘤通常不需要隨訪和手術(shù)切除。 A early pathognomonic imaging finding is the presence of macroscopic fat in anon-calcified renal le

27、sion. The non fat-containing portion enhances avidly andhomogeneously. Calcification is almost never present.典型的征象是在無鈣化的腎臟病灶內(nèi)發(fā)現(xiàn)脂肪。不含脂肪的成分明顯強(qiáng)化，鈣化基本看不見。 On MRI, the fat component will follow retroperitoneal fat on all sequences and will saturate out on fat-saturated sequences. Intracytoplasmic lipid i

28、s not a feature of AML, so there should be no significant signal drop-out on dual-phase MRI. 磁共振圖像，脂肪部分同腹膜后的脂肪一樣在stir序列表現(xiàn)為信號(hào)降低。胞質(zhì)內(nèi)的脂肪并不是血管平滑肌脂肪瘤的特點(diǎn)，因此在雙期磁共振上沒有重要的信號(hào)減低。 Approximately 4% of AMLs will not contain visible macroscopic fat and will appear as a hyperdense enhancing mass. MRI is the next st

29、ep, with the T2-weighted images the most useful to distinguish from renal cell carcinoma in some cases.大約4%的血管平滑肌脂肪瘤不含有脂肪，只表現(xiàn)為增強(qiáng)后高信號(hào)腫塊。在有些病例可以通過MRI的T2圖像來和腎癌鑒別。A T2 hyperintense mass suggests RCC (clear cell subtype) and the patient can proceed to surgery.T2高信號(hào)腫塊提示為腎癌（透明細(xì)胞），建議病人手術(shù)。A T2 hypointense ma

30、ss is nonspecific and can represent either RCC (papillary type) or AML withminimal fat. Although an AML typically would enhance more avidly than a papillary RCC, biopsy iswarranted for definitive diagnosis.T2為低信號(hào)腫塊沒有特異性，可以是腎癌（乳頭狀腎癌）或者血管平滑肌脂肪瘤。盡管血管平滑肌脂肪瘤比乳頭狀瘤強(qiáng)化更明顯，病例始終是金標(biāo)準(zhǔn)。 AML appears hyperechoic on

31、 ultrasound, although up to 1/3 of renal cell carcinomas may also be hyperechoic and ultrasound is thus unreliable to distinguish AML from RCC. 血管平滑肌脂肪瘤在超聲上是強(qiáng)回聲，1/3的腎癌也是強(qiáng)回聲，因此超聲用來鑒別腎癌并不可靠。168Oncocytoma嗜酸細(xì)胞瘤Oncocytoma. Noncontrast CT (left image) shows an isodense renal mass (yellow arrows) containin

32、g a central punctate focus of hyperattenuation (red arrow). The contrast-enhanced pyelographic phase CT (right image)demonstrates that the mass enhances. There is a faint suggestion of a central focus of nonenhancement (red arrow), corresponding to a central scar.嗜酸細(xì)胞瘤，平掃CT（左圖）表現(xiàn)為等密度腫塊（黃色箭頭），包含一個(gè)中央的

33、點(diǎn)狀高密度（紅色箭頭），增強(qiáng)掃描腎盂期（右圖）腫塊強(qiáng)化，中心小點(diǎn)狀的無強(qiáng)化可以輕微的提示此病，表現(xiàn)為中心瘢痕。 Oncocytoma is the most commonly resected benign renal mass and has overlapping imaging findings with renal cell carcinoma.嗜酸細(xì)胞瘤是腎臟良性腫瘤的很常見的，和腎細(xì)胞癌圖像表現(xiàn)有相似。 Imaging features can suggest oncocytoma, but imaging features are not specific and cannot

34、be reliably differentiated from RCC. The imaging features suggestive of oncocytoma are homogeneous enhancement and a central scar.典型的圖像特征可以提示嗜酸細(xì)胞瘤，但并沒有特異性，將其和腎細(xì)胞癌區(qū)分開來不是很可靠。其圖象特征為均勻一致的強(qiáng)化，和中心瘢痕。 Complicating the pathologic diagnosis, oncocytic cells can sometimes be found in the rare chromophobe RCC s

35、ubtype. The pathologist can usually distinguish oncocytoma from the more common clear cell and papillary renal cell carcinoma subtypes.病理學(xué)診斷，嗜酸細(xì)胞常常在嫌色細(xì)胞癌里發(fā)現(xiàn)，病理學(xué)家常常將嗜酸細(xì)胞瘤同普通的腎細(xì)胞癌和乳頭狀腎細(xì)胞癌區(qū)分開來。Renal lymphoma腎淋巴瘤 Primary renal lymphoma is rare, as the kidneys do not contain native lymphoid tissue.原發(fā)的腎淋巴

36、瘤很少見，因?yàn)槟I臟沒有淋巴組織。However, the kidneys may become involved from hematogenously disseminated disease or spread from the retroperitoneum.盡管如此，腎臟仍然可以通過血行轉(zhuǎn)移和腹膜后病灶的鄰近轉(zhuǎn)移受累。 Renal involvement of lymphoma has several patterns of disease:腎淋巴瘤的受累有多種類型：Multiple lymphomatous masses (most common pattern; seen in 5

37、0% of cases of renallymphoma).腎臟多發(fā)腫塊（最常見的類型，見于50%的腎淋巴瘤）。Solitary renal mass.單發(fā)的腫塊。Diffuse lymphomatous infiltration, causing nephromegaly.淋巴瘤的侵犯導(dǎo)致腎臟的腫大。Direct extension of retroperitoneal disease.腹膜后病變的直接侵犯。Non-neoplastic solid renal masses非腫瘤性的腎臟占位 When evaluating a potential renal mass, its import

38、ant to always consider that anapparent solid renal mass may represent a non-neoplastic lesion.當(dāng)評(píng)估腎臟可疑占位時(shí)，考慮其為非腫瘤性的病變是很重要的。 Infection, especially focal pyelonephritis, can masquerade as a solid renal mass. Renalabscess may be difficult to differentiate on imaging from a cystic renal cell carcinoma.感染

39、，特別是局灶性的腎盂腎炎，很像一個(gè)腎實(shí)質(zhì)性的腫塊。在圖像上腎膿腫很難和囊性的腎細(xì)胞癌鑒別。 Renal arteriovenous malformation (AVM ) will avidly enhance and can mimic ahypervascular renal mass. One clue to the presence of an AVM would be asymmetricenhancement of the renal vein on the affected side, due to early shunting of venous blood.腎臟的動(dòng)靜脈畸形是

40、明顯強(qiáng)化的很像富血供的腎臟腫瘤。動(dòng)靜脈畸形的一個(gè)征象為患側(cè)的腎靜脈不均勻強(qiáng)化，由于靜脈的分流。169Renal pseudotumors腎臟假腫瘤征 Renal pseudotumors are normal variations of renal morphology that may mimic arenal mass.腎臟假腫瘤是腎臟的一種正常變異，類似于腎臟腫瘤。 Hypertrophied column of Bertin: The columns (septa) of Bertin are normal structuresthat anchor the renal cortex

41、to the hilum and create the separations between the renal pyramids. When hypertrophied, the columns of Bertin may mimic a renal mass.腎柱肥大：腎柱是正常的結(jié)構(gòu)，為腎皮質(zhì)深入相鄰腎錐體之間的部分。當(dāng)其增生時(shí)同腎腫瘤很像。 Persistent fetal lobation/lobulation: In normal fetal development, the fetal kidneys are divided into discrete lobes. Occas

42、ionally these lobulations persist in adulthood, producing an indentation of the renal cortex.永存性的腎胚胎分葉：正常胎兒腎臟發(fā)育為相互獨(dú)立的腎小葉。少數(shù)情況下這些腎小葉間溝持續(xù)存在直到成年，表現(xiàn)為腎皮質(zhì)的切跡。 This indentation can cause an adjacent focal bulge that simulates a renal mass. This pseudomass can usually be distinguished from a true mass by th

43、e presence of septa of Bertin on either side.這些切跡可以使相鄰的腎實(shí)質(zhì)局限性隆起，而類似于腎臟腫瘤。這些假腫瘤征象可以通過相鄰的腎柱間分隔鑒別出來。Syndromes with renal masses (all have increased risk of RCC )腎臟多發(fā)腫塊綜合征 von HippelLindau (VHL)希佩爾-林道綜合征 von HippelLindau (VHL) is an autosomal dominant multiorgan syndrome caused by a mutation in the VHL

44、tumor suppressor gene on chromosome 3, which leads to cysts and neoplasms in multiple organs.希佩爾-林道綜合征是常染色體顯性遺傳額多臟器受累的綜合征，是3好染色體的腫瘤抑制因子突變，表現(xiàn)為多臟器的囊腫和腫瘤。 The primary manifestation of VHL in the genitourinary system is bilateral or multifoca renal cell carcinomas, most commonly the clear-cell subtype.林

45、道綜合征的在泌尿系統(tǒng)最常見的表現(xiàn)是雙側(cè)的多發(fā)腎細(xì)胞癌，最多見于透明細(xì)胞癌。 Other genitourinary manifestations of VHL include multifocal pheochromocytoma and renal cysts.其他的泌尿系統(tǒng)最常見的是多發(fā)嗜鉻細(xì)胞瘤和腎囊腫。 Central nervous system manifestations of VHL include hemangioblastoma of the brainstem, cerebellum, or spinal cord.中樞神經(jīng)系統(tǒng)最常見的表現(xiàn)是腦干、小腦和脊髓的血管母細(xì)胞瘤

46、。 Pancreatic and hepatic manifestations include malignant neuroendocrine pancreatic tumor, pancreatic serous cystadenoma (a benign neoplasm), and pancreatic/hepatic cysts.胰腺和肝臟的表現(xiàn)包括惡性的胰腺神經(jīng)內(nèi)分泌腫瘤，胰腺的漿液囊腺瘤（良性腫瘤），和胰腺、肝臟的囊腫。BirtHoggDubeBHD綜合征 BirtHoggDube is an autosomal dominant syndrome of dermatologic

47、 lesions, cystic lung disease, and multiple renal oncocytomas and renal cell carcinomas.BHD綜合征是常染色體顯性遺傳的皮膚病變的綜合征，肺囊腫、多發(fā)的腎臟嗜酸細(xì)胞瘤和腎細(xì)胞癌。Tuberous sclerosis (TS)結(jié)節(jié)硬化 Tuberous sclerosis is an autosomal dominant neurocutaneous disease caused by a tumor suppressor gene mutation. It manifests clinically with

48、 seizures, developmental delay, and (mostly) benign tumors in multiple organ systems.結(jié)節(jié)硬化是常染色體顯性遺傳疾病，由腫瘤抑制基因突變?cè)斐?。其臨床表現(xiàn)為癲癇、發(fā)育遲緩，和多器官的良性腫瘤。 The most common renal manifestation of tuberous sclerosis is multiple bilateral rena angiomyolipomas (AMLs). Approximately 50% of patients with TS will have at le

49、ast one AML.最常見的腎臟病變是雙側(cè)多發(fā)的血管平滑肌脂肪瘤，50%的結(jié)節(jié)硬化的病人至少有有一個(gè)血管平滑肌脂肪瘤。 Renal cysts can be seen in 25%.25%的有多發(fā)腎囊腫。 The relative risk of renal cell carcinoma is increased in patients with TS, and occurs inapproximately 23% of patients. Diagnosis of renal cell carcinoma is complicated by the abnormal kidneys th

50、at may have multiple cysts and/or AMLs.約2-3%結(jié)節(jié)硬化的病人有患腎癌的風(fēng)險(xiǎn)，在那些并發(fā)多發(fā)腎囊腫和血管平滑肌脂肪瘤的患者。 In the heart, the most common neoplasm is a rhabdomyoma. A cardiac rhabdomyoma may be present during fetal life and can be detected by fetal ultrasound.在心臟，最常見新生物是橫紋肌瘤，通常在胎兒時(shí)可以通過胎兒超聲發(fā)現(xiàn)。 In the lung, a process of smoot

51、h muscle proliferation identical to lymphangioleiomyomatosis can occur, causing cystic replacement of lung parenchyma.在肺組織，會(huì)發(fā)生與淋巴管平滑肌增生癥相同的平滑肌增生，導(dǎo)致囊腫取代肺組織。It has been suggested that the abnormal smooth muscle in the lung in patients with TS represents genetically identical metastatic smooth muscle f

52、rom a renal angiomyolipoma.發(fā)生在結(jié)節(jié)性硬化病人肺的異常平滑肌增生，被認(rèn)為和腎臟血管平滑肌脂肪瘤的基因相同。170Approach to a cystic renal mass囊性腎腫瘤性病變的診斷方法 A cystic renal mass may be neoplastic or infectious; the two most common entities to cause a cystic renal mass are renal cell carcinoma and renal abscess.囊性腎腫瘤性病變可以是腫瘤或者感染引起的；最常見的是腎細(xì)胞癌和

53、腎膿腫。Neoplastic differential of a cystic renal mass囊性腎腫瘤性病變和腫瘤新生物的鑒別 Cystic renal cell carcinoma. Although renal cell carcinoma most commonly presents as a solid renal mass, it can also manifest as a cystic renal mass.囊性腎細(xì)胞癌：盡管腎細(xì)胞癌最常見表現(xiàn)為實(shí)質(zhì)性腫塊，也可以表現(xiàn)為囊性的腎腫塊。 Multilocular cystic nephroma is a benign cys

54、tic neoplasm with enhancing septa that occurs in a bimodal age distribution in baby boys and middle-aged women. 多房囊性腎細(xì)胞瘤是一個(gè)分隔強(qiáng)化的良性腎臟囊性病變，主要發(fā)生在小男孩和中年女性。A characteristic but nonspecific feature is the propensity to herniate into the renal pelvis, causing hydronephrosis.其非特異性的一個(gè)征象是向內(nèi)壓迫腎盂，而造成腎盂積水。In adu

55、lts, multilocular cystic nephroma can be indistinguishable from cystic renal cell carcinoma.在成人，多房囊性腎細(xì)胞瘤和囊性腎細(xì)胞癌鑒別困難。In children, multilocular cystic nephroma can be indistinguishable from cystic Wilms tumor.在兒童，多房囊性腎細(xì)胞瘤和囊性Wilms瘤鑒別困難。 Mixed epithelial and stromal tumor (MEST ) is a benign neoplasm co

56、mposed of epithelial and mesenchymal elements, typically found in middle-aged women. MEST may appear as either a solid or cystic mass.混合上皮間質(zhì)性腫瘤是一個(gè)良性的腫瘤，包含有上皮和間葉細(xì)胞，最常見于中年女性。可以表現(xiàn)為囊性或者實(shí)性腫塊。Non-neoplastic differential of a cystic renal mass囊性腎腫瘤性病變和非腫瘤性新生物的鑒別 Renal abscess is a contained purulent collec

57、tion within the kidney.腎膿腫是腎臟膿液的一個(gè)聚集。 Hemorrhagic renal cyst, which will not have any enhancing component.出血性囊腫，沒有強(qiáng)化部分。Role of MRI in evaluation of a complex cystic renal massMRI在診斷復(fù)雜囊性腎腫瘤性病變中的價(jià)值 MRI has a limited role in the evaluation of a cystic renal mass. The key advantage of MRI is more accurate enhancement characterization, as MRI does not suffer from the CT phenomenon of pseudoenhancement due to beam hardening from adjacent, densely enhancing renal parenchyma.MRI在診斷囊性腎腫瘤方面有點(diǎn)局限性，他最重要的優(yōu)點(diǎn)是增強(qiáng)的準(zhǔn)確性，不會(huì)受到像CT圖像上鄰近的高密度