CT和MRI对肾脏囊性病变的诊断与鉴别诊断  

Renal cystic lesions： CT and MRI diagnosis and differential diagnosis

作　　者：彭玉 林光武 李仕红 贾惠惠 PENG Yu;LIN Guangwu;LI Shihong;JIA Huihui(MR Room,Huadong Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院MR室,上海200040

出　　处：《实用放射学杂志》2018年第9期1401-1406,1422,共7页Journal of Practical Radiology

摘　　要：目的 探讨CT和MRI对肾脏囊性病变的诊断价值，以提高诊断的准确性。方法 收集经手术或随访确诊的98例肾脏囊性病变患者的临床和影像学资料，其中肾囊性灶62例（其中Bosniak Ⅰ型24例，Bosniak Ⅱ型16例，Bosniak ⅡF型4例，Bosniak Ⅲ型12例，Bosniak Ⅳ型6例），上皮样血管平滑肌脂肪瘤4例，肾癌坏死出血囊性变32例。所有病灶行CT（平扫或增强）或MRI（平扫或增强）扫描，分析囊性病灶的影像学特点。所有病灶均由2名影像诊断医师进行Bosniak分型，通过前后2次阅片，对他们的诊断结果进行受试者工作特征曲线（ROC曲线）分析。结果 肾脏囊性病灶在囊壁及分隔的厚度、囊液的密度、软组织及动态强化方式上的差异有一定的统计学意义（P＜0.05），在多房囊性肾癌与肾癌坏死囊性变的差异更为显著。2名诊断医师第1次阅片的ROC曲线的曲线下面积（AUC）为0.759±0.05，第2次阅片AUC为0.908±0.034，差异有统计学意义（P＜0.05）。结论 CT和MRI可以准确地诊断肾脏囊性病变，明确不同性质的囊性病变的影像学特点，有重要的临床应用价值。Objective To explore the diagnostic value of CT and MRI for renal cystic lesions, to improve the accuracy of diagnosis. Methods Unenhanced and dynamic enhanced CT and MRI images of 98 patients with renal cystic lesions confirmed by surgery or follow-up were analyzed retrospectively. There were cystic lesions in 62 cases （including 24 cases of Bosniak Ⅰ, 16 cases of Bosniak Ⅱ, 4 cases of Bosniak ⅡF, 12 cases of Bosniak Ⅲ, 6 cases of Bosniak Ⅳ ）, epithelioid angiomyolipoma in 4 cases and necrotic cystic renal cell carcinomas in 32 cases.All of the lesions were analyzed twice by the two radiologists based on the Bosniak classification. Statistical analysis was used by Fisher＇ exact test and receiver operating characteristic （ROC） curve.Results Among the renal cystic lesions, there were differences in the thickness of cystic wall and septum, cystic fluid density, soft tissue and the pattern of dynamic enhancement （P〈0.05）, especially between the multilocular cystic renal cell carcinoma and the necrotic cystic renal cell carcinoma. The area under the ROC curve by the two radiologists was 0.759±0.05 at the first reading, and 0.908±0.034 at the second time with significant difference（P〈0.05）.Conclusion CT and MRI can accurately diagnose renal cystic lesions, and identify the imaging features of different cystic lesions. CT and MRI have important clinical value in diagnosing the renal cystic lesions.

关 键 词：囊性病变 肾 计算机体层成像 磁共振成像 

分 类 号：R692[医药卫生—泌尿科学] R814.42[医药卫生—外科学]