MRI灰阶比值在肾乏脂性血管平滑肌脂肪瘤与透明细胞癌鉴别诊断中的价值  

Value of MRI Gray Scale Ratio in the Differentiation Between Angiomyolipomas with Minimal Fat and Clear Cell Renal Cell Carcinoma

作　　者：张丽青 韩志江[1] 陈文辉[1] 倪子英[1] ZHANG Liqing;HAN Zhijiang;CHEN Wenhui(Department of Radiology, Hangzhou First People's Hosptial,Hangzhou 310006,P. R.China)

机构地区：[1]浙江省杭州市第一人民医院放射科,310006

出　　处：《临床放射学杂志》2019年第5期864-867,共4页Journal of Clinical Radiology

摘　　要：目的探讨MRI灰阶比值在肾乏脂性血管平滑肌脂肪瘤(AMLmf)与肾透明细胞癌(CCRCC)鉴别诊断中的价值。方法回顾性分析经手术病理证实的最大径≤3.0 cm的18例20枚AMLmf与30例30枚CCRCC的MRI增强资料,通过RADinfo阅片系统灰阶直方图软件,测量增强各期病灶和对侧同层面肾皮质灰阶值,计算病灶与肾皮质灰阶比值(LGS/CGS),采用t检验及χ~2检验对两组比值进行分析,并通过受试者工作特征曲线(ROC)获得鉴别AMLmf与CCRCC最佳比值的阈值。结果 20枚AMLmf与30枚CCRCC的LGS/CGS值在皮质期、髓质期和排泄期中分别为(0.660±0.159)/(0.878±0.208)(t=3.740,P=0.001)、(0.645±0.208)/(0.810±0.198)(t=2.968,P=0.005)、(0.658±0.123)/(0.775±0.195)(t=2.428,P=0.019),AMLmf三期比值为"持续性"强化,CCRCC为"快进快出"强化。皮质期、髓质期和排泄期的LGS/CGS值鉴别AMLmf与CCRCC的曲线下面积和最佳阈值分别为0.804和0.755、0.747和0.844、0.684和0.844,相应的敏感度和特异度分别为76.7%和82.4%、53.3%和100.0%、43.3%和100.0%;联合皮质期或髓质期、皮质期或排泄期、髓质期或排泄期LGS/CGS的最佳阈值来鉴别CCRCC,其敏感度和特异度分别为80.0%和80.0%、76.7%和85.0%、56.7%和95.0%。结论 MRI灰阶比值是鉴别AMLmf与CCRCC的重要参数,且联合增强各期相灰阶比值能有效提高CCRCC诊断的敏感度,减少漏诊的发生。Objective To investigate the value of MRI Gray Scale ratio in the differential diagnosis of angiomyolipomas with minimal fat(AMLmf) and clear cell renal carcinoma(CCRCC). Methods Contrast-enhanced MRI data of 18 cases surgical and pathological comfirmed of 20 AMLmf and 30 cases of proven 30 CCRCC with the diameter ≤3 cm were retrospectively analyzed. According to the gray-scale value of lesions in each phase of the post-contrast sequences and the same level of contralateral renal cortex through RADinfo Reading System, then Lesion Gray Scale/Cortex Gray Scale ratio(LGS/CGS) was reformed. Using t test and χ~2 test the two groups of data were analyzed. The threshold value of the optimal ratio to identify AMLmf and CCRCC was obtained through the ROC curve. Results The LGS/CGS ratio of 20 AMLmf and 30 CCRCC were(0.660±0.159)/(0.878±0.208)(t=3.740,P=0.001)、(0.645±0.208)/(0.810±0.198)(t=2.968,P=0.005)、(0.658±0.123)/(0.775±0.195)(t=2.428,P=0.019)in the cortical phase,medulla phase and excretion phase, respectively. AMLmf showed nearly continuous enhancement,while the ratio of CCRCC showed an early washout pattern. The area under the curves and optimal threshold in the identification of AMLmf and CCRCC respectively were 0.804 and 0.755,0.747 and 0.844,0.684 and 0.844,while the corresponding sensitivity and specificity were 76.7% and 82.4%,53.3% and 100.0%,43.3% and 100.0% through ROC curve analysis. The sensitivity and specificity in diagnosis of CCRCC combination with cortical or medullary phase,cortical or excretion phase,medullary or excretion phase were 80.0% and 80.0%,76.7% and 85.0%,56.7% and 95.0% respectively. Conclusion The Gray Scale ratio of MRI is an important parameter to identify AMLmf and CCRCC. It can improve the sensitivity to diagnose CCRCC through combination with different enhanced phases and reduce the occurrence of missed diagnosis.

关 键 词：灰阶比值 血管平滑肌脂肪瘤 透明细胞癌 磁共振成像 

分 类 号：R737.11[医药卫生—肿瘤] R445.2[医药卫生—临床医学]