时间密度曲线联合肿瘤廓清率在肾上腺肿瘤CT诊断中的价值  

Significance of time-density curves combined with washout percentage in the diagnosis of adrenal tumors with contrast CT scan

作　　者：管维[1] 郭蕾[2] 胡志全[1] 庄乾元[1] 周四维[1] 叶章群[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院放射科,湖北武汉430030

出　　处：《现代泌尿外科杂志》2010年第5期357-359,共3页Journal of Modern Urology

摘　　要：目的探讨时间密度曲线(T-D曲线)联合肿瘤廓清率在肾上腺肿瘤CT诊断中的价值。方法选取41例共43个肾上腺肿瘤(腺瘤22个,非腺瘤21个),均行CT平扫及延时1、3、57、min动态增强扫描。绘制时间-密度(T-D)曲线并归类,A、C型为廓清快速组,B、D、E为廓清缓慢组。计算各延时时间点的绝对廓清率(Washa)和相对廓清率(Washr)。采用受试者工作特性(ROC)曲线分析并确定鉴别肾上腺腺瘤与非腺瘤的最佳延时时间点及廓清阈值。采用SPSS12.0统计软件包对上述数据进行统计学分析。结果肾上腺腺瘤与非腺瘤的T-D曲线类型分布存在统计学差异(P=0.000),肾上腺腺瘤多表现为A、C型曲线,非腺瘤表现为B、D、E型。延时5 min腺瘤与非腺瘤的廓清率存在统计学差异(P<0.05)。以Washr为32%或Washa为26%为阈值诊断价值最高。肿瘤Washr≥32%或Washa≥26%提示为肾上腺腺瘤,反之为非腺瘤。以T-D曲线和肿瘤廓清率作为联合标准,对肾上腺腺瘤的诊断灵敏度、特异度有较大提高,分别达到96%、95%。结论肾上腺肿瘤的T-D曲线类型及延时5 min以Washr≥32%或Washa≥26%为阈值对肾上腺腺瘤与非腺瘤都具有鉴别诊断价值。以T-D曲线及肿瘤廓清率为联合诊断标准,能提高腺瘤的诊断符合率。Objective To evaluate the time-density（T-D） curves combined with washout percentage in differentiating adrenal adenomas from non-adenomas with contrast CT scan.Methods Forty-one patients with 43 adrenal tumors（22 adenomas and 21 non-adenomas） were enrolled into this study.Nonenhanced CT was followed by dynamic contrast-enhanced CT 1,3,5 and 7 min later.The CT attenuation value was measured in all tumors at different scanning time and the time-density（T-D） curves were acquired.The types of A and C belonged to the faster Wash Group and the types of B,D,and E the slower Wash Group.The absolute washout percentage（Washa） and relative washout percentage（Washr） at different times were measured and the best delayed time and the washout percentage to distinguish adenomas from non-adenomas were identified by ROC curve.The data were analyzed with T-test and X-test by SPSS12.0 statistical software,and P0.05 was considered to be significant.Results There were significant difference in the types of T-D curves between adenomas and non-adenomas.The adenomas generally presented with the type of A and C,while the non-adenomas with the type of B,C,and E.There were significant differences in the 5-min-delayed wash percentage between adenomas and non-adenomas.Washr≥32% or Washa≥26% indicated the tumor was adenomas.The standard based on both the T-D curves and the 5-min-delayed washout percentage could improve the sensitivity and specificity to adenomas to 96% and 95% respectively.Conclusion Both T-D curve and Washr≥32% or Washa≥26% at 5-min-delayed CT are helpful in differentiating adrenal adenomas from non-adenomas.The standard based on them can improve the accuracy in differentiating adrenal adenomas from non-adenomas.

关 键 词：体层摄影术 X线计算机 动态增强 肾上腺肿瘤 

分 类 号：R737[医药卫生—肿瘤]