能谱CT鉴别乏脂肪肾血管平滑肌脂肪瘤与肾嫌色细胞癌的应用价值  

The value of spectral CT imaging for differentiating renal fat-poor angiomyolipoma from chromophobe cell renal carcinoma

作　　者：王倩文 程琦 曹东兴 罗英姿 何峰 周燕 WANG Qiamren;CHENG Qi;CAO Dongxing;LUO Yingzi;HE Feng;ZHOU Yan(Department of Imaging, the Affiliated Provincial Hospital to Anhui Medical University , Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院影像科,安徽合肥230001

出　　处：《实用放射学杂志》2019年第4期584-588,共5页Journal of Practical Radiology

基　　金：安徽省科技攻关项目(1401045021)。

摘　　要：目的探讨宝石能谱CT(GSI)的多参数定量分析在鉴别乏脂肪肾血管平滑肌脂肪瘤(fpAML)与肾嫌色细胞癌(CCRC)中的应用价值。方法回顾性分析42例肾肿瘤患者,其中fpAML25例,CCRC17例.术前均行能谱CT扫描。通过形态学分析2组肿瘤的差异;应用GSIViewer软件,测量肿瘤在皮、髓质期的碘浓度(IC)、标准化碘浓度(NIC)、能谱曲线斜率,定量分析2组的差异。结果黑星征、劈裂征及坏死特征在fpAML与CCRC的鉴别差异有统计学意义;fpAML与CCRC皮质期的IC分别为30.20±5.25、19.97±4.01,髓质期的IC分别为27.84±&07、22.94±4.46,差异均有统计学意义(P<0.05);fpAML与CCRC皮质期的NIC分别为0.45±0.10、0.32±0.06.髓质期的NIC分别为0.58±0.17、0.46±0.11,差异均有统计学意义(P<0.05)。fpAML与CCRC皮质期的能谱曲线斜率分别为3.45±1.23、2.42±0.48,髓质期的能谱曲线斜率分别为3.24±1.25、2.69±0.47,差异均有统计学意义(P<0.05)。ROC曲线分析显示皮质期NIC鉴别两者具有较高的敏感性(75%)和特异性(86%),且AUC最大(0.886)。结论病灶内囊变、坏死、强化均匀性、强化程度、黑星征、劈裂征及能谱CT多参数(IC、NIC、能谱曲线斜率)对fpAML与CCRC的鉴别诊断起重要作用。Objective To explore the value of multi-parameter quantitative analysis of spectral CT imaging (GSI) in differentiating renal fat-poor angiomyolipoma (fpAML) and chromophobe cell renal carcinoma (CCRC).Methods 42 patients with renal tumor,including 25 cases with fpAML and 17 cases with CCRC, were retrospectively analyzed. All of them were scanned in GSI mode.The morphology differences between the fpAML group and the CCRC group were analyzed. GSI Viewer software was used to calculate the iodine concentration (IC), the normalized iodine concentration (NIC),the slope rate of the spectrum energy curve in the cortical phase (CP) and medullary phase (MP), respectively.The differences of those parameters were compared between the two groups using the two-simple t test.Results Some characteristic signs,such as "black spots" sign,crack sign and necrosis had the value for differential diagnosis. In the CP,the IC of the fpAML and CCRC group were 30.20±5.25 vs 19.97 + 4.01,the NICs were 0.45i0.10 vs 0.32±0.06,and the slope rates of spectrum energy curves were 3.45+ 1.23 vs 2.42±0.48, respectively.In the NP,the IC of the fpAML and CCRC group were 27.84± 8.07 vs 22.94i4.46 , the NICs were 0.58zt0.17 vs 0.46±0.11,and the slope rates of the spectrum energy curves were 3.24± 1.25 vs 2.69 + 0.47 ,respectively.There were significant differences between 2 groups (P <0.05).The NIC in the CP provided high sensitivity (75%) and specificity (86%) in differentiating fpAML from CCRC,and the area under the ROC curve was 0.886.Conclusion The focal cystic and necrotic, enhanced uniformity and degree,u black spots** sign, crack sign and multi-parameters of GSI, in eluding IC, NIC, and the slope rate of the spectrum energy curve could play important role in differential diagnosis between fpAML and CCRC.

关 键 词：计算机体层成像 肿瘤 乏脂肪血管平滑肌脂肪瘤 嫌色细胞癌 

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