能谱CT定量分析鉴别诊断肾透明细胞癌与肾脏乏脂肪血管平滑肌脂肪瘤的临床应用  

Differentiating value of spectral CT to the quantitative diagnosis of clear cell renal carcinoma from fat poor renal angiomyolipoma

作　　者：杨晓彤[1] 刘屹[1] 赵宇[1] 

机构地区：[1]中国医科大学附属第一医院放射科,辽宁沈阳110001

出　　处：《临床军医杂志》2016年第9期938-942,共5页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划项目(2013225049)

摘　　要：目的探讨能谱CT定量分析鉴别诊断肾透明细胞癌（ccRCC）和肾脏乏脂肪血管平滑肌脂肪瘤（RAML）的临床价值,以指导临床治疗方案的选择。方法回顾性分析术前行肾脏平扫＋能谱CT双期增强扫描并经手术病理证实的38例ccRCC与9例乏脂肪RAML患者的临床资料。应用能谱分析软件,测量并计算皮、髓质期病灶实性部分的碘浓度（IC）、标准化碘浓度（NIC）、能谱曲线斜率及40-140keV下的CT值,应用独立样本t检验,对两组病变各参数值进行比较,绘制ROC曲线,分析IC、NIC、能谱曲线斜率的诊断效能。结果 ccRCC皮质期IC（62.20±19.50）μg/ml、NIC（0.48±0.13）μg/ml分别高于乏脂肪RAML皮质期IC（35.82±18.40）μg/ml、NIC（0.26±0.12）μg/ml（P〈0.05）。ccRCC皮质期曲线斜率（8.66±2.53）、髓质期曲线斜率（4.86±1.17）分别大于乏脂肪RAML皮质期曲线斜率（4.87±2.50）、髓质期曲线斜率（3.32±1.30）（P〈0.05）。ccRCC皮质期40-100keV、髓质期40-60keV下的CT值分别高于乏脂肪RAML皮质期40-100keV、髓质期40-60keV下的CT值（P〈0.05）。以皮质期与髓质期IC分别〉52.14μg/ml与27.76μg/ml、NIC分别〉0.39与0.69、曲线斜率分别〉6.35与3.76为阈值诊断,ccRCC的敏感度分别为70.6%与85.3%、73.5%与91.2%、85.3%与85.3%,特异度分别为87.5%与75.0%、100.0%与75.0%、75.0%与75.0%。结论能谱CT成像及多参数定量分析对ccRCC与乏脂肪RAML的鉴别诊断有一定临床应用价值,有望为术前治疗方案的选择提供依据。Objective To explore the value of CT spectral imaging in the differential diagnosis of clear cell renal carcinoma（ ccRCC）and fat poor renal angiomyolipoma（ RAML） during the cortex phase（ CP） and nephpographic phase（ NP）,as to guide the choice of clinical treatment. Methods A retrospective study was performed on 38 patients with ccRCC and 9 patients with RAML underwent spectral CT during the CP and NP. The monochromatic images were measured and the CT spectral curves and iodine concentration（ IC）were obtained,the normalized iodine concentration（ NIC） and the slope of spectral curve in the CP and NP were calculated. The twosample-test was used to compare the attenuation values at different energy levels（ 40-140 ke V）,ICs,NICs and the gradient of curve between ccRCC and RAML groups. Results IC and NIC in patients with ccRCC were significantly higher than those in patients with RAML： mean IC were（ 62. 20 ± 19. 50） mg / ml versus（ 35. 82 ± 18. 40） mg / ml,respectively,mean NIC were（ 0. 48 ± 0. 13） mg / ml versus（ 0. 26 ± 0. 12） mg / ml,respectively,during the CP. The IC and NIC for RAML were lower than those of ccRCC during the CP and NP. The differences were statistically significant（ P〈0. 05）. In the CP and NP,the slope of spectral curve of ccRCC was significant higher than that of RAML（ 8. 66 ± 2. 53） versus（ 4. 87 ± 2. 50） in CP,（ 4. 86 ± 1. 17） versus（ 3. 32 ± 1. 30） in the NP（ P〈0. 05）. CT values（ HU） of ccRCC group at 40 - 100 ke V in the CP and at 40 - 60 HU in the NP were significantly higher than those of RAML group,respectively（ P〈0. 05）. Taking IC〉 52. 14 μg / ml,NIC 〉0. 389 slope of spectral curve〉 6. 35,respectively,during the CP and27. 76 μg / ml,0. 694,3. 76,respectively,during the NP. The sensitivity were 70. 6% and 85. 3%,73. 5% and 91. 2%,85. 3% and85. 3%,the speciticity were 87. 5% and 75. 0%,100. 0% and 75. 0%,75. 0% and 75. 0%,respectively,in the CP and the NP. Conclusion CT spectral imaging with m

关 键 词：能谱成像 体层摄影术 X线计算机 肾透明细胞癌 肾脏血管平滑肌脂肪瘤 诊断 鉴别 

分 类 号：R737.1[医药卫生—肿瘤] R814.42[医药卫生—临床医学]