乏脂肪型肾血管平滑肌脂肪瘤与肾透明细胞癌的CT定量分析  

The CT quantitative analysis between renal angiomyolipoma with minimal fat and clear cell renal cell carcinoma

作　　者：马燕青[1] 曹芳[1] 管政 

机构地区：[1]浙江省人民医院杭州医学院附属人民医院放射科,浙江杭州310000

出　　处：《实用放射学杂志》2017年第11期1717-1720,共4页Journal of Practical Radiology

摘　　要：目的 通过对CT征象Logistic回归及CT值的定量分析鉴别乏脂肪型肾血管平滑肌脂肪瘤（mf-RAML）及肾透明细胞癌（ccRCC）。方法 收集25例mf-RAML及62例ccRCC患者，通过CT平扫及增强扫描，分析病灶的CT征象，测量CT值，计算CT相对值，通过上述数据进行鉴别分析。结果 假包膜和强化方式（OR=0.061、7.445，P=0.005、0.034）是最终纳入Logistic回归方程的自变量。两者的平扫肌肉%、皮质期CT相对值、髓质期强化值及CT相对值（P=0.000~0.040）有统计学差异。两者与平扫肌肉%、髓质期强化值及CT相对值呈低度正相关性（r=0.221~0.343，P=0.001~0.040），与皮质期CT相对值呈中低度负相关（r=-0.512、-0.225，P=0.000、0.036）。平扫肌肉%、髓质期CT相对值的受试者工作特征（ROC）曲线曲线下面积（AUC）较高，为0.665~0.753。结论 假包膜和强化方式是鉴别mf-RAML和ccRCC的独立因素。mf-RAML病灶平扫CT值与竖脊肌肌肉相似，皮质期强化幅度较ccRCC低，髓质期ccRCC的CT值降低幅度较mf-RAML大。平扫肌肉%、髓质期CT相对值鉴别两者的诊断价值相对较高，其中平扫肌肉%最高。Objective To differentiate the renal angiomyolipoma with minimal fat （mf-RAML） from clear cell renal cell carcinoma （ccRCC） by Logistic regression analysis and CT quantitative analysis. Methods 25 patients with mf-RAML and 62 patients with ccRCC were collected and performed with enhanced CT scan.The CT signs,CT attenuation value and CT relative attenuation value were calculated and recorded.Results Pseudocapsule and enhancement pattern （OR=0.061, 7.445,P=0.005,0.034） were the independent variables of Logistic regression equation. There were statistical difference between the unenhanced muscle%, CT relative attenuation value in renal cortical phase, CT attenuation value and CT relative attenuation value in renal medulla phase and CT relative attenuation value of the mf-RAML and those of the ccRCC （ P = 0.000-- 0.040 ） .In addition, the two diseases had low positive correlation with the unenhanced muscle% and CT attenuation value and CT relative attenuation value in renal medulla phase （r = 0.2 21- 0.3 4 3, P = 0. 001- 0.040 ）, and had low to middle negative correlation with CT relative attenuation value in renal cortical phase （r=- 0.512,-0.225, P 0.000,0.036）. The areas under the ROC curve of unenhanced musele% and CT relative attenuation value in renal medulla phase were relatively high （0.665--0.753 ）.Conclusion Pseudoeapsule and enhancement pattern were independent factors in differentiating mf-RAML from ccRCC. The CT attenuation value of the mf-RAML was similar to the erector spinae muscle. The enhanced degree of mf-RAML in renal cortical phase was lower than that of the ccRCC, while the reduced degree of the ccRCC was higher than that of the mf-RAML in renal medulla phase.The unenhanced muscle% and the CT relative attenuation value in renal medulla phase are of great significance in diagnosing mf-RAML and ccRCC, especially the unenhanced muscle%.

关 键 词：肾肿瘤 肾血管平滑肌脂肪瘤 肾透明细胞癌 计算机体层成像 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]