双能量CT电子云密度/等效原子系数(Rho/Z)在小肾癌中的应用  

The utility of Rho/Z value derived of dual-energy computed tomography for differentiation of small clear-from non-clear cell renal cell carcinoma

作　　者：李健文 周长圣[1] 张龙江 卢光明[1] LI Jian-wen;ZHOU Chang-sheng;ZHANG Long-jiang(Department of Medical Imaging,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京总医院医学影像科南京大学附属金陵医院医学影像科,南京210002

出　　处：《放射学实践》2019年第2期163-166,共4页Radiologic Practice

基　　金：国家重点实验室军队建设项目资助项目(2014ZDZK004)

摘　　要：目的:探讨双能量CT电子云密度/等效原子系数(Rho/Z)鉴别小肾癌(1～4cm)中肾透明细胞癌(ccRCC)和非透明细胞癌(nccRCC)的价值。方法:回顾性收集2012年1月-2016年10月行术前双能量CT增强扫描的87例肾细胞癌患者,其中ccRCC 70例,nccRCC 17例。选取增强扫描皮髓质期图像,并应用双能量CT Rho/Z对所有图像进行评估,记录Z、Rho和双能量指数(DEI)值。比较Z、Rho和DEI值在ccRCC和nccRCC组间的差异,采用受试者工作特征(ROC)曲线分析各参数的鉴别诊断效能。结果:Z和DEI在ccRCC和nccRCC组间均具有统计学差异(P均<0.001)。在ccRCC和nccRCC的鉴别诊断中,Z的最佳诊断阈值为9.69,总体正确率为88.5%,敏感度为94.1%,特异度为87.1%,ROC曲线下面积(AUC)为0.955;DEI的最佳诊断阈值为0.044,总体正确率为83.9%,敏感度为100%,特异度为80%,AUC为0.953。结论:在增强扫描皮髓质期中,双能量CT的Rho/Z应用中的参数有助于小肾癌(1～4cm)中ccRCC和nccRCC的鉴别。Obstract:To investigate the value of dual-energy CT(DECT)for differentiation of small(1~4cm)clear cell renal cell carcinoma(ccRCC)from non-clear cell renal cell carcinoma(non-ccRCC).Methods:The DECT and clinical data of 87 cases of renal cell carcinoma(1~4cm)including 70 cases of ccRCC and 17 cases of nccRCC proved by operation and pathology between January 2012 and October 2016 were analyzed retrospectively.On the corticomedullary phase images,three parameters of tumors including Z,Rho,and dual-energy index(DEI)were recorded.The diagnostic performance of DECT for differentiation of RCC subtypes was determined by receiving operating characteristic curve analysis.Results:Z and DEI showed significant difference between ccRCC and non-ccRCC group(P<0.001).Z value yielded the sensitivity of 94.1%,specificity of 87.1%,accuracy of 88.5%,and area under the curve(AUC)of 0.955 with the threshold of 9.69.DEI value yielded the sensitivity of 100%,specificity of 80%,accuracy of 83.9%,and AUC of 0.953 with the threshold of 0.044.Conclusions:The parameters of Rho/Z derived of DECT on the nephrography phase images are valuable for the differentiation of small ccRCC from non-ccRCC.

关 键 词：双能量CT 肾细胞癌 肾肿瘤 肾透明细胞癌 非透明细胞肾细胞癌 电子云密度 等效原子系数 双能量指数 

分 类 号：R814.42[医药卫生—影像医学与核医学] R737.11[医药卫生—放射医学]