双能CT单期扫描碘值测量对直径≤3cm的肾脏透明细胞癌和血管平滑肌脂肪瘤的鉴别诊断价值  

Small ccRCC and AML Differentiation By Iodine Measurement at Single Phase with Dual-Energy CT

作　　者：刘学玲[1] 周建军[1] 曾蒙苏[1] 张利军[1] 陆秀良[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032

出　　处：《临床放射学杂志》2012年第10期1431-1435,共5页Journal of Clinical Radiology

摘　　要：目的探讨双能CT单期扫描(皮髓交界期或实质期)碘值测量对直径≤3 cm的肾脏透明细胞癌(clearcell renal cell carcinoma,ccRCC)和血管平滑肌脂肪瘤(angiomyolipoma,AML)的鉴别诊断价值。方法对2010年10月至2011年10月间经手术病理证实的23例直径≤3 cm的ccRCC和14例AML患者资料进行回顾性分析,通过双能量后处理软件Liver-VNC对实质期图像进行处理,测量感兴趣区(region of interest,ROI)的碘值,包括病灶、邻近肾皮质和同层面腹主动脉,定义标准化碘值(NIC)为病灶内碘值/腹主动脉碘值,病灶-肾实质碘值比(LNR)为病灶碘值/肾实质碘值。对两组肿瘤患者的性别采用卡方检验,应用独立样本t检验对两组肿瘤患者的年龄、病灶的大小、NIC值和LNR值进行分析,同时应用受试者工作特征(ROC)曲线评价NIC值和LNR值的诊断性能。结果两组肿瘤的大小差异无统计学意义,而年龄和性别均有统计学意义,ccRCC组的平均年龄为56.3岁(32～73岁),AML组的平均年龄为47.7岁(34～58岁)(P=0.046);ccRCC多见于男性(男∶女为3.6∶1),而AML多见于女性(男∶女为1∶13)(P<0.001);ccRCC的NIC值和LNR值均较AML高,两者间差异有显著统计学意义(P<0.001)。皮髓交界期NIC值和LNR值的ROC曲线下面积(AUC)分别为0.995、0.937,诊断准确性分别为97%、86.7%;实质期NIC值和LNR值的ROCAUC分别为0.970、0.957,诊断准确性分别为97%、90.9%。结论双能CT单期扫描(皮髓交界期或实质期)碘值测量可以较准确地鉴别直径≤3 cm的ccRCC和AML,从而降低辐射剂量。Objective To detect the ability of iodine measurement in differentiating the small（diameter≤3cm） clear cell renal cell carcinoma（ccRCC） and angiomyolipoma（AML） at single phase（corticomedullary or nephrographic phase） with dual-energy CT.Methods Retrospectively analyse 23 cases of small（diameter≤3cm） ccRCCs and 14 cases of AML underwent convetional unenhanced and dual-energy biphase（corticomedullary and nephrographic phase） scan preoperatively between Oct 2010 and Oct 2011.Images were dealt with dual-energy post-processing software Liver-VNC,and definite NIC as iodine concentration in the lesion divides the iodine concentration in the aorta,definite LNR as the lesion-to-normal parenchyma ratio for the iodine concentration.The sex propensity between the two group of patients was tested by chi-square.The age of the two group of patients and the lesion’s size,NIC and LNR values were analysed by Independent samples T test and receiver operating characteristic（ROC） curve analysis was performed for the comparison of the cutoff values for the ccRCCs and AML.Results There was no difference between the size of the two group of patients,while the sex propensity and the age of the two group of patients were significantly different.ccRCCs were more likely to be male（P〈0.001） and more older（P=0.046） while AML were more tend to be female and younger.NIC and LNR values were both higher in ccRCCs than in AML（P〈0.001）.The area under ROC curve for the NIC and LNR values were 0.995 and 0.937 at the corticomedullary phase,the diagnostic accuracy was 97% and 86.7%;the area under ROC curve for the NIC and LNR values were 0.970 and 0.957 at nephrographic phase,the diagnostic accuracy was 97% and 90.9%.Conclusion Single phase（corticomedullary or nephrographic phase） scan with dual-energy CT with the iodine mearsurement technique can differentiate the small（diameter≤3 cm） ccRCCs and AML quite exactly,then the radiation dose could be obviously reduced.

关 键 词：肾肿瘤 体层摄影术 X线计算机 血管平滑肌脂肪瘤 碘图 

分 类 号：R737.11[医药卫生—肿瘤]