CT多期增强扫描鉴别多房囊性肾癌与肾癌坏死囊变  

Multi-phase contrast enhanced CT in differential diagnosis of multilocular cystic renal cell carcinoma and necrotic cystic renal cell carcinoma

作　　者：夏威利[1,2] 王立峰[1,2] 张建伟[1,2] 魏晓艳[1,2] 李祥[1,2] 黎海亮[1,2] 曲金荣[1,2] 陈学军[1,2] 吴越[1,2] 张宏凯[1,2] 

机构地区：[1]郑州大学附属肿瘤医院 [2]河南省肿瘤医院放射科,河南郑州450008

出　　处：《中国医学影像技术》2013年第11期1886-1890,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨CT多期增强扫描鉴别诊断多房囊性肾癌(MCRCC)与肾癌坏死囊变(NCRCC)的价值。方法分析经手术病理证实的20例MCRCC及41例NCRCC的CT表现及临床资料,绘制ROC曲线,得出鉴别二者的CT值阈值,并应用CT值阈值联合Bosniak分级鉴别MCRCC与NCRCC。结果 35.00%(7/20)的MCRCC Bosniak分级为ⅡF级,60.00%(12/20)为Ⅲ级,5.00%(1/20)为Ⅳ级;4.88%NCRCC(2/41)Bosniak分级为ⅡF级,36.59%(15/41)为Ⅲ级,58.54%(24/41)为Ⅳ级。CT平扫及增强扫瞄中,MCRCC的CT值均低于NCRCC(P均<0.05);以皮髓期CT值34HU为阈值,判断NCRCC的敏感度为79%,特异度为85%;联合Bosniak分级和皮髓期CT值阈值鉴别诊断MCRCC和NCRCC的敏感度、特异度分别为87%、93%。结论 MCRCC与NCRCC鉴别困难;皮髓期CT值阈值和Bosniak分级相结合,可提高鉴别诊断的敏感度及特异度。Objective To explore the value of multi-phase contrast enhanced CT in differential diagnosis of multilocular cystic renal cell carcinoma （MCRCC） and necrotic cystic renal cell carcinoma （NCRCC）. Methods Twenty patients with MCRCC and 41 patients with NCRCC confirmed by pathology were enrolled. Taking CT value as standard to differentiating MCRCC from NCRCC, ROC curve was used to justify the accuracy and get the threshold of CT value, and combined with Bosniak classication to identify MCRCC from NCRCC. Results Among 20 cases of MCRCC, 7 （7/20, 35.00%） were classified as Bosniak classification Ⅱ F, 12 （12/20, 60.00%） as Ⅲ 1 （1/20, 5.00%） as IV. In 41 cases of NCRCC, 2 （2/41, 4.88%） were classified as Bosniak classification ⅡF, 15 （15/41, 36.59%） as Ⅲ , 24 （24/41, 58.54%） as IV. CT values of MCRCC in plain and enhanced scan were both lower than those of NCRCC. Taking 34 HU during corticomedullary phase （CMP） as threshold, the sensitivity and specificity was 790% and 85 %, respectively, which might be increased to 87% and 93% when combining with Bosniak classification. Conclusion MCRCC is difficult to distinguish from NCRCC. Combination of Bosniak classification and the threshold of CT value during CMP could increase the sensitivity and specificity in differential diagnosis.

关 键 词：癌 肾细胞 多房囊性 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R737.11[医药卫生—放射医学]