多排螺旋CT动态增强扫描对乳头状肾细胞癌与嫌色细胞肾癌的鉴别诊断价值  

Diagnostic value of mult-detector CT for papillary renal cell carcinoma and chromophobe renal ceil carcinoma

作　　者：刘学玲[1] 邹新农[1] 陈宏伟[1] 方向明[1] 胡晓云[1] 孙荣超[2] 

机构地区：[1]南京医科大学附属无锡人民医院放射科,214023 [2]南京医科大学附属无锡人民医院病理科,214023

出　　处：《中华肿瘤杂志》2015年第1期52-56,共5页Chinese Journal of Oncology

摘　　要：目的探讨多排螺旋CT动态增强扫描对乳头状肾细胞癌（PRCC）与嫌色细胞肾癌（ChRCC）的鉴别诊断价值。方法收集41例经病理证实的肾癌患者的临床资料，其中PRCC21例（I型14例，Ⅱ型7例），ChRCC20例。分析PRCC和ChRCC的形态学及动态增强CT特征，利用受试者工作特征曲线（ROC）分析鉴别PRCC和ChRCC的价值。结果ChRCC更常见血管样强化和填充性强化，而PRCC晚期强化发生率更高，PRCCI型较Ⅱ型的钙化发生率低。PRCC和ChRCC在皮髓质期的病灶强化值（ACT）分别为（29．08±20．12）Hu和（48．29±26．70）Hu，差异有统计学意义（P=0．013）。PRCCI型在皮髓质期的ACT值为（26．36±18．16）Hu，与ChRCC比较，差异有统计学意义（P=0．012）。PRCC在皮髓质期的病灶-肾皮质比值（LKR）为0．44±0．19，ChRCC为0．58±0．15，差异有统计学意义（P=0．014）；PRCCI型在皮髓质期的LKR值为0．394-0．15，与ChRCC比较，差异有统计学意义（P=0．001）。PRCC和ChRCC在皮髓质期和实质期病灶强化值的变化值（D．value）分别为（-3．69±8．9）Hu和（8．39±21．98）Hu，差异有统计学意义（P=0．031）；PRCCI型的D—value为（-4．55±9．82）Hu，与ChRCC比较，差异有统计学意义（P=0．028）；皮髓质期的ACT、LKR和D—value在PRCC11型与ChRCC间差异均无统计学意义（均P〉0．05）。以皮髓质期ACT值、LKR值和D—value鉴别PRCC和ChRCC的ROC曲线下面积分别为0．718、0．751和0．668，差异无统计学意义（均P〉0．05）。当皮髓质期ACT值为49，350Hu时，鉴别PRCC和ChRCC的敏感度为50．0％，特异度为90．5％，准确率为70．7％；当皮髓质期LKR值为0．532时，鉴别PRCC和ChRCC的敏感度为65．0％，特异度为81．0％，准确率为73．2％；当D—value为0．400Hu时，鉴别PRCC和ChRCC的敏感度为60．0％，特异度为76．2％，准确率为68．3％。结论皮髓质期ACT值、LKR值和D—Objective To explore the significance of multi-detector CT （MDCT） in differential diagnosis of papillary renal cell carcinoma and chromophobe renal cell carcinoma. Methods Clinical data of forty-one cases of renal cancers confirmed pathologically were collected, including 21 cases of papillary renal cell carcinoma （PRCC） （14 type Ⅰ, 7 type Ⅱ） and 20 cases of ehromophobe renal cell carcinoma （ChRCC）. Their morphological and MDCT characteristics were retrospectively analyzed. Receiver operator characteristic curve （ROC） was used to analyze the value of MDCT in differential diagnosis of PRCC and ChRCC. Two senior radiologists analyzed the morphological and the dynamic enhancement characteristics of the images. The attenuation of the lesions and the adjacent renal parenchyma were measured. The morphological indexes were compared with chi-square test and the quantitative indexes were compared with independent sample T-test. Receiver operator characteristic curve （ROC） was used to analyze the sensitivity, specificity and accuracy of diagnosis of PRCC and ChRCC. Results Angioid enhancement and filled enhancement were more common in ChRCC than in PRCC, while delayed enhancement was more often seen in PRCC than in ChRCC. Calcification was more common in type Ⅰ than type Ⅱ PRCC. The enhancement value （ ACT value ） in corticomedullary phase was （ 29. 08±20. 12 ） Hu for PRCC, significantly lower than the （48.29±26.70） Hu for ChRCC （ t = - 2. 611, P = 0. 013）. The ACT value of type I PRCC in corticomedullary phase was （26.36±18.16） Hu, showing a significant difference from that of ChRCC （t = -2. 666, P = 0. 012）. The lesion to kidney ratio （LKR） in corticomedullary phase was 0.44±0.19 for PRCC and 0.58±0. 15 for ChRCC, with a significant difference between them （t = -2. 587, P =0. 014）. The LKR of type I PRCC in corticomedullary phase was 0.39±0. 15, showing a significant difference from that of ChRCC （ t = - 3. 628, P = 0. 001 ）. The difference value �

关 键 词：肾肿瘤 诊断 鉴别 体层摄影术 螺旋计算机 

分 类 号：R737.11[医药卫生—肿瘤]