瘤内出血及脂肪成分在鉴别良恶性肾脏肿瘤中的价值  

The Value of Combining Intratumoral Hemorrhage and Fat in the Differentiation of Benign and Malignant Solid Renal Masses

作　　者：马德忠[1] 潘靓[1] 丁玖乐[1] 孙军[1] 陈杰[1] 俞胜男[1] MA De-zhong PAN Liang DING Jiu-le SUN Jun CHEN Jie YU Sheng-nan(Department of Radiology, Affiliated Third Hospital of Soochow University, Changzhou, Jiangsu, 213003, China)

机构地区：[1]苏州大学附属第三医院影像科,江苏常州213003

出　　处：《中国血液流变学杂志》2016年第3期365-369,共5页Chinese Journal of Hemorheology

摘　　要：目的评价瘤内出血和脂肪的检出对于鉴别良、恶性肾脏肿瘤的价值。方法回顾性分析经病理证实的167例实性肾脏肿瘤，其中恶性114例，良性53例。所有患者术前行磁敏感加权成像（susceptibility weighted imaging，SWI）、化学位移成像（chemical shift imaging，CSI）检查。分析SWI上瘤内出血的检出率及CSI上瘤内脂肪的检出率，采用χ2检验比较良、恶性肾脏肿瘤之间瘤内出血及脂肪的检出率。瘤内出血和脂肪联合鉴别及预测良、恶性肾脏肿瘤的评价指标是：可见瘤内出血且未见瘤内脂肪为恶性；未见瘤内出血及脂肪为良性；可见瘤内脂肪为良性。结果5．66％的良性肾脏肿瘤和95．61％的恶性肾脏肿瘤检出瘤内出血，84．91％的良性肾脏肿瘤内检出瘤内脂肪，恶性肾脏肿瘤未检出瘤内脂肪；良、恶性肾脏肿瘤之间瘤内出血和脂肪的检出率差异均有统计学意义（P均〈0．05）。瘤内出血和脂肪联合鉴别良、恶性肾脏肿瘤的特异性、敏感性、准确性、阴性预测值和阳性预测值分别为96．23％、95．61％、95．81％、91．07％和98．20％。结论联合瘤内出血和脂肪的检出有助于良、恶性实性肾脏肿瘤的鉴别诊断。Objective To evaluate the value of combining intratumoral hemorrhage and macroscopic fat in the differentiation of the benign from malignant solid renal masses. Methods Susceptibility-weighted imaging （SWI） and chemical shift （CS）-MRI were performed in 167 patients with 167 solid renal masses, including 114 malignant and 53 benign masses all pathologically confirmed. The presence of hemorrhage detected by SWI and macroscopic fat detected by CS-MRI were evaluated in all masses. The rates of hemorrhage and macroscopic fat observed between benign and malignant masses were compared by a χ 2 test. All masses found to contain hemorrhage alone were considered to be malignant. The masses （without macroscopic fat） found not to contain hemorrhage were considered to be benign. The masses found to contain macroscopic fat with or without hemorrhage were considered to be benign. The evaluation indexes for differentiating and forecasting the benign and malignant masses were calculated. Results Significant differences in the rate of hemorrhage （observed in 5.66% of benign masses vs. 95.61% of malignant masses） and macroscopic fat （observed in 84.91% of benign masses vs. 0% of malignant masses） were measured in the benign and malignant groups （P 〈 0.05）. By combining the results for the hemorrhage and macroscopic fat, the specificity, sensitivity, accuracy, negative predictive value, and positive predictive value in the differential diagnosis of the benign and malignant masses were 96.23%, 95.61%,95.81%, 91.07% and 98.20%, respectively. Conclusion Combining the detection of intratumoral hemorrhage and macroscopic fat can be used to differentiate the benign from malignant solid renal masses.

关 键 词：化学位移成像 磁敏感加权成像 肾脏肿瘤 出血 脂肪 

分 类 号：R737.11[医药卫生—肿瘤] R445.2[医药卫生—临床医学]