CT能谱成像在鉴别肾血管平滑肌脂肪瘤和肾癌的应用价值  

The Application Value of Spectral CT Imaging in Distinguishing Renal Cell Carcinoma and Renal Angiomyolipom

作　　者：赵娜[1] 程琦[1] 

机构地区：[1]安徽医科大学附属省立医院影像科,合肥230001

出　　处：《临床放射学杂志》2015年第6期945-950,共6页Journal of Clinical Radiology

摘　　要：目的探讨能谱CT成像(GSI)技术在肾血管平滑肌脂肪瘤(RAML)和肾癌(RCC)鉴别诊断中的初步应用价值。方法回顾性分析73例肾肿瘤患者(包括肾癌51例,肾血管平滑肌脂肪瘤22例)肿块的能谱特征及强化方式,所有患者术前均行能谱CT的能谱扫描模式(GSI)扫描,应用能谱分析软件,分析70 ke V单能量下的CT值、能谱曲线、碘浓度及水浓度等CT能谱成像的定量参数,并计算标注化后的分析70 ke V单能量CT值比、能谱曲线斜率、碘浓度比及水浓度比,比较标准化能谱参数及强化方式间的差异。采用两样本t检验分析上述参数。结果 51例肾癌组中"快进快出"强化42例(82.35%),延迟强化9例(17.65%),22例肾血管平滑肌脂肪瘤中"快进快出"强化3例(13.64%),延迟强化19例(86.36%),肿瘤的强化方式对二者的鉴别有统计学差异(P<0.05)。RCC与RAML皮质期70 ke V单能量下的CT值比分别为(0.87±0.26)HU、(0.44±0.12)HU,髓质期70 ke V单能量下的CT值比分别为(0.41±0.10)HU、(0.62±0.15)HU,差异均具有统计学意义(P<0.05);RCC与RAML碘浓度比在皮质期时对应值为(0.68±0.38)、(0.40±0.12),碘浓度比在髓质期时对应的值为(0.46±0.24)、(0.50±0.11),差异均有统计学意义(P<0.05)。RCC与RAML水浓度比在皮质期和髓质期差异均无统计学意义(P均>0.05)。RCC与RAML皮质期能谱曲线斜率分别为(3.57±1.55)、(2.18±0.83);髓质期能谱曲线斜率分别为(2.29±1.16)、(3.41±0.95),差异均有统计学意义(P<0.05)。ROC曲线分析显示70 ke V单能量CT值比值对鉴别鳞癌和腺癌具有较高的敏感性(88%)和特异性(96%),且曲线下面积最大(0.949)。结论 GSI技术多参数联合应用对肾癌和肾血管平滑肌脂肪瘤的鉴别诊断有一定价值。Objective To investigate the value of spectral CT imaging in differential diagnosis of renal cell carcinoma and renal angiomyolipom. Methods 73 patients with renal tumor were retrospectively analyzed,including 51 cases of RCC and 22 cases of RAML were scanned in gemstone spectral imaging（ GSI） mode by using dual energy CT. The spectral analysis were used to calculate the differences of CT spectral imaging parameters,such as 70 ke V single energy ratio,spectral curves,iodine concentration ratio,water concentration ratio,and then standardize them,and the pattern of the enhancement include two groups. The differences of these standardized spectral characteristic parameters and the pattern of the enhancement were evaluated statistically by two-samples t test. Results Enhancement pattern was a valuable predictor in differentiating RCC from RAML（ P〈0. 05）,an early wash-out pattern was observed in 42（ 82. 35%） of 51 cases of RCC,whereas delayed enhancement pattern was observed in 19 lesions（ 86. 36%） of 22 cases of RAML. The 70 ke V single energy ratio were a valuable predictor for differentiating RCC from RAML（ P〈0. 05） both in the cortical phase and in the corticomedullary. In the cortical phase,the 70 ke V single energy ratio were（ 0. 87 ± 0. 26） 、（ 0. 44 ± 0. 12） in the RCC and in the RAML seperately,and were（ 0. 41 ± 0. 10） 、（ 0. 62 ± 0. 15） when they were in the corticomedullary phase. The iodine concentration ratio in the cortical phase and in the corticomedullary phase were（ 0. 68 ± 0. 38） 、（ 0. 40 ± 0. 12）;（ 0. 46 ±0. 24） 、（ 0. 50 ± 0. 11）,there was significant difference（ P〈0. 05）. There were no difference between RCC and RAML both in the cortical phase and in the corticomedullary phase of the water concentration ratio（ P〉0. 05）. There was significant difference in the mean slope of HU curve between RCC group and RAML group（ P〈0. 05） both in the cortical phase and in the corticomedullary phase,the mean slope of HU curve i

关 键 词：能谱CT 单能量图像 肾癌 肾血管平滑肌脂肪瘤 

分 类 号：R737.11[医药卫生—肿瘤]