電腦斷層與超音波掃描對腎細胞癌之診斷

Computed Tomography and Ultrasound in the Evaluation of Renal Cell Carcinoma

吳清俊(Ching-Jiunn Wu) ； 李三剛(San-Kan Lee) ； 何善平(Peter S.P. Ho) ； 余昌遺(Chang-Yi Yu) ； 張聖原(Sun-Yran Chang) ； 馬正平(Cheng-Ping Ma)

《中華放射線醫學雜誌》 10卷4期 (1985/12) Pp. 274-281

摘要

複閱三軍總醫院自民國72年1月至73年12月，經手術及病理證實為腎細胞癌的15例病人，分析其超音波與CT影象。發現腎細胞癌回音強度與腫瘤大小有關；直徑小於5公分的腫瘤呈低回音或等回音；直徑大於5公分的腫瘤則為等回音，高回音或混合回音。腎細胞癌的電腦斷層衰減值在靜脈注射對比劑後，常有不等程度的增強，但都低於注射對比劑後正常腎實質衰減值。CT對於腎細胞癌之分期(staging)亦提供了一個安全、迅速及準確的檢查方法。超音波掃描影像因與操作技術有直接關係，且對腎臟周圍組織及隣近肌肉之評估較困難；但是經濟、無傷害性與方便是超音波檢查的優點，因此可做為腎臟腫塊篩檢的工具。在腎細胞癌治療前的評估及手術後追跺檢查超音波掃描與CT相輔相成。

並列摘要

Renal cell carcinoma is the most common primary malignant tumor of renal parenchyma. When IVP shows irregular contour or space occupying lesion on the kidney, ultrasound and CT become an essential imaging modality for further evaluation.
We collect 15 cases of renal cell carcinoma in our hospital from Jan. 1983 to Dec. 1984, and evaluate their ultrasound and CT appearances. It is important to recognize that the sonographic picture of renal cell carcinoma varies with its size: when less than 5 cm, it is either hypo- or isoechoic, but when more than 5 cm, it may be iso-, hyperechoic or mixed pattern. All of the tumors are various in the increased CT density after I.V. contrast enhancement but they are less than the normal enhanced renal parenchyma. For accuracy of staginf with this modality, tumore emboli in the renal vein and IVC as well as lumph node or distal metastasis are evaluated. The ultrasound and CT play a role on preoperative staging and postoperative follow up.
Ultrasound is effective in differentiate solid or cystic lesion in kidney. It can be used as a screen tool if clinically suspected of renal lesion. Also, aid with doppler study tumor invasion to the vasular structure can be early detected. However, for staging, CT might give more benefits than ultrasound.