肾脏囊性占位的影像学表现及Bosniak分级系统应用价值的研究  

Use of bosniak classification to evaluate the cystic renal mass

作　　者：吴斌[1] 彭卫军[1] 顾雅佳[1] 杨天锡[1] 蒋朝霞[1] 戴波[2] 张海梁[2] 叶定伟[2] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,上海200032 [2]复旦大学附属肿瘤医院泌尿外科,上海200032

出　　处：《中华肿瘤防治杂志》2008年第5期381-385,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨肾脏囊性占位的影像学表现,及利用Bosniak分级系统对其进行良恶性判断的应用价值。方法:高、低年资两组医生回顾性分析41例(42个病灶)经手术病理确诊的肾脏囊性占位影像学资料,使用Bosniak系统分级评价,用操作者特征曲线(ROC)、Kappa检验分析两组医生的影像判断结果,并与病理结果对照。结果:41例(42个病灶)肾脏囊性占位有40例为单侧病灶,1例为双侧病变。其中良性病灶24个;恶性病灶18个。高、低年资两组医生对本组肾脏囊性占位Bosniak分级的ROC曲线下面积分别是AZ1=0.921和AZ2=0.904,Mann-W-hitneyU检验两者差异无统计学意义,U=0.24,P>0.05。两组医生判断总符合率有中至高度的一致性,K=0.626,Bosniak系统中Ⅰ级(K=0.843)、Ⅳ级(K=0.715)两组医生有较佳一致性,ⅡF级(K=0.545)和Ⅲ级(K=0.545)属中至高度一致,Ⅱ级(K=0.222)符合较差。高、低年资组各分级中癌的阳性率,Ⅰ级分别为6.25%和0,Ⅱ级均为0,ⅡF级分别为0和42.9%,Ⅲ级分别为83.3%和71.4%,Ⅳ级均为100%。单纯囊肿的影像学表现为囊壁薄、光滑和边界清楚,囊液密度均匀,没有厚壁,没有钙化,增强扫描无强化。囊性肾癌的影像学特征性表现为囊壁上存在实性且强化的成分,或囊内及囊壁结节、较多且厚的囊内分隔、较厚且有强化的囊壁以及囊壁处不规则钙化灶。复杂囊肿的影像表现与囊性肾癌有所重叠。结论:Bosniak分级系统在肾脏囊性占位的影像学诊断中有较高的应用价值,提供了影像学描述、诊断及临床处理的标准,简便易学,容易推广。OBJECTIVE： To investigate the appearance of cystic renal mass （CRM） and evaluate the value of Bosniak classification in differentiating benign or malignant CRM. METHODS： Four doctors divide into 2 （senior and junior） groups for assessing the 42 CRM lesions confirmed by surgery and pathology retrospectively and independently, and classifing those lesions according to Bosniak classification and correlating them with the pathologic findings. The methods were tested by using receiver operating characteristic （ROC） curve and Kappa test. RESULTS： Forty CRM lesions were unilateral lesions and one patient had bilateral masses. Among these CRM, benign lesions account for 24 lesions, while there were 16 lesions of cystic renal carcinoma. The area under the ROC curves in senior and junior doctor groups were Az1 = 0. 921 and Az2= 0. 904, retrospectively. There was no statistical difference between the two groups （U=0.24,P〉0.05）. A Kappa value was 0. 626 indicating that there were moderate agreement of this two groups. There were excellent agreement in Bosniak category Ⅰ （K = 0. 843）, and moderate agreement in category Ⅳ （K=0.715）, ⅡF （K=0.545） and Ⅲ （K=0.545）, while bad agreement in category Ⅱ （K = 0. 222）. The radiological appearances of benign simple cyst presented as well-defined margins, homogeneous, water-dense and showed no contrast enhancement, while cystic renal carcinoma often accompanied with irregular thickened wall or solid elements as well as enhancement of cyst walls, septa or solid areas. The complicated cyst resembled those of malignant masses, so the differentiation among those remained difficult. CONCLUSIONS： Bosniak system not only classifies lesions into category but also advocates treatment for each category. It is truly feasible for clinical use in diagnosing cystic renal mass.

关 键 词：肾肿瘤/放射摄影术 肾 囊性/放射摄影术 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R445[医药卫生—影像医学与核医学]