能谱CT鉴别肾透明细胞癌和乏脂型肾血管平滑肌脂肪瘤的应用  

Value of spectral CT in distinguishing renal cell carcinoma and renal angiomyolipoma with minimal fat

作　　者：马光明 呼延静[1] 曹媛 马洋 韩冬 杨创勃 窦越群[1] MA Guang-ming;HU Yan-jing;CAO Yuan;MA Yang;HAN Dong;YANG Chuang-bo;DOU Yue-qun(Department of Radiology,the Affiliated Hospital of Shaanxi University of Chinese Medicine,Shaanxi 712000,China)

机构地区：[1]陕西中医药大学附属医院放射科,陕西咸阳712000 [2]陕西中医药大学,陕西咸阳712000

出　　处：《影像诊断与介入放射学》2018年第4期278-282,共5页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨能谱CT成像对鉴别肾透明细胞癌和乏脂型肾血管平滑肌脂肪瘤的应用价值。方法回顾性分析经病理证实的肾透明细胞癌22例和肾血管平滑肌脂肪瘤14例能谱CT资料。通过AW 4.6工作站GSI(gemstone spectral imaging)Viewer软件测量病灶直径、平扫有效原子序数、平扫脂基值、皮质期碘浓度、皮质期CT值,髓质期碘浓度、髓质期CT值、皮质期主动脉的碘浓度、髓质期主动脉碘浓度,然后计算皮质期标准化碘浓度(normalized iodine concentration,NIC)、髓质期NIC、皮髓两期NIC差值。采用两样本t检验分析上述参数,并用ROC曲线分析各定量参数的诊断效能。结果肾透明细胞癌的有效原子序数、脂基值、皮质期的NIC浓度、髓质期的NIC浓度、皮髓两期NIC浓度的差值、皮质期CT值、髓质期CT值分别为7.57±0.12、-142.77±32.41 g/L、0.64±0.13、0.49±0.14、0.15±0.16、113.97±13.92 HU、94.34±10.53HU;乏脂型肾血管平滑肌脂肪瘤的分别为7.73±0.10、-101.94±11.14 g/L、0.5±0.82、0.58±0.10、-0.09±0.11、100.36±17.56HU、103.60±14.51 HU,差异均有统计学意义(P<0.05)。ROC曲线分析示脂基值和皮髓两期NIC差值对鉴别肾透明细胞癌和乏脂型肾血管平滑肌脂肪瘤具有较高的敏感度(85.7%、77.3%)和特异度(86.4%、100%),且曲线下面积最大,均为0.891。结论能谱CT多种参数对鉴别肾透明细胞癌和乏脂型肾血管平滑肌脂肪瘤有一定价值,其中脂基值和皮髓两期NIC差值的诊断效能最高。Objective To assess the value of dual-energy spectral CT in differentiating renal cell carcinoma （RCC） from renal angiomyolipoma with minimal fat （AML-MF）. Methods Spectral CT of 36 patients with histologically proven RCCs （22） and AML-MFs （14） was retrospectively analyzed. Images were analyzed on an AW 4.6 workstation with GSI Viewer software to measure the diameters, effective-Z, and fat concentrations of renal lesions on the unenhanced scan. CT values and iodine concentrations （ICs） of lesions as well as ICs of aorta in the cortical and medullary phases were determined. The normalized ICs in the cortical and medulla phases were calculated. All quantitative parameters from lesions were compared using independent sample t test, and ROC analysis was used to evaluate their diagnosis efficiency in differentiating RCC from AML-MF. Results There was significant difference （all P〈0.05） between RCC and AML-MF in the effective-Z （7.57±0.12, 7.73 ± 0.10）,fat concentration （ -142 .77±32.41g/L, -101.94 ± 11.14g/L）, normalized IC in the cortical phase （0.64±0.13, 0.5±0.82）,normalized IC in the medullary phase （0.49±0.14, 0.58±0.10）, normalized IC difference between the cortical and medullary phases （0.15±0.16,- 0.09 ± 0.11 ） ,CT value in the cortical phas e （113.97±13,92 HU, 100.36±17.56 HU） and CT value in the meduHary phase （94.34±10.53 HU, 103.60±14.51 HU）. ROC curve analysis showed that fat concentration and normalized IC difference between the cortical and medullary phases had optimal diagnosis efficiency for distinguishing RCC from AML-MF with 85.7% and 77.3% sensitivities, 86.4% and 100% specificities, respectively. The areas under the ROC curves were all 0.891. Conclusion Spectral CT has clinical value for differentiating RCC from AML-MF with the fat concentration and normalized IC difference providing the highest diagnostic perfoimance.

关 键 词：体层摄影术 X线计算机 肾透明细胞癌 乏脂型肾血管平滑肌脂肪瘤 

分 类 号：R737.11[医药卫生—肿瘤]