磁敏感加权成像鉴别乏脂肪肾血管平滑肌脂肪瘤与肾癌的价值研究  

Susceptibility Weighted Imaging in Differentiating Fat-poor Renal Angiomyolipoma and Renal Cell Carcinoma

作　　者：沙圆圆 孙军[1] 孙笑芬 邢伟[1] 潘靓[1] SHA Yuanyuan;SUN Jun;SUN Xiaofen(Department of Imaging,The Third Affiliated Hospital of Soochow University,Changzhou,Jiangsu Province 213003,P.R.China)

机构地区：[1]苏州大学附属第三医院(常州市第一人民医院)影像科

出　　处：《临床放射学杂志》2019年第11期2119-2123,共5页Journal of Clinical Radiology

基　　金：国家自然基金面上项目(编号:81771798);常州市卫生计生委重大科技项目(编号:ZD201806);常州市科技局应用基础研究计划资助(编号:CJ20179021)

摘　　要：目的探讨磁敏感加权成像(SWI)鉴别乏脂肪肾血管平滑肌脂肪瘤(RAML)与肾细胞癌(RCC)的价值。方法回顾性分析经病理证实的15枚乏脂肪RAML与63枚RCC的SWI图像,计算SWI检出瘤内出血的肿瘤数量、瘤内出血检出率及不同出血类型(点状、片状、大面积)的发生率。应用Fisher确切概率检验比较乏脂肪RAML与RCC的瘤内出血检出率。以SWI检出瘤内出血者诊断为RCC为标准,采用受试者工作特征曲线(ROC)评估SWI鉴别RCC与乏脂肪RAML的诊断效能。结果SWI上,1枚乏脂肪RAML检出瘤内出血,出血类型为大面积出血;59枚RCC检出瘤内出血,出血类型以片状出血和大面积出血为主。乏脂肪RAML的瘤内出血检出率(6.67%)显著低于RCC(93.65%)(P<0.001)。SWI鉴别RCC与乏脂肪RAML的准确率、敏感度、特异度、阳性预测值、阴性预测值及ROC曲线下面积(AUC)分别为93.59%、98.33%、77.78%、93.65%、93.33%、0.94。结论SWI检测瘤内出血对乏脂肪RAML与RCC的鉴别诊断具有重要价值。Objective To investigate the value of susceptibility weighted imaging(SWI)in differentiating fat-poor renal angiomyolipoma(RAML)and renal cell carcinoma(RCC).Methods A retrospective analysis was performed on SWI images of patients with fat-poor RAML(n=15)or RCC(n=63)confirmed by pathology.The number of tumors which presented with intratumoral hemorrhage on SWI was counted,and the detection rate of intratumoral hemorrhage in fat-poor RAMLs and RCCs was calculated,as well as the incidence of each pattern of intratumoral hemorrhage(punctate,flaky or large-area).Fisher exact test was used to compare the rate of intratumoral hemorrhage between fat-poor RAMLs and RCCs on SWI.Based on the standard that the tumor with intratumoral hemorrhage on SWI was diagnosed as RCC,receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of SWI in differentiating RCC and fat-poor RAML.Results Only one fat-poor RAML presented with intratumoral hemorrhage on SWI,and the pattern of intratumoral hemorrhage was large-area.59 RCCs presented with intratumoral hemorrhage on SWI,and the patterns of intratumoral hemorrhage were mainly flaky or large-area.The detection rate of intratumoral hemorrhage in fat-poor RAMLs(6.67%)on SWI was significantly lower than that in RCCs(93.65%,P<0.001).To differentiate fat-poor RAML and RCC,the accuracy,sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC)of SWI were 93.59%,98.33%,77.78%,93.65%,93.33%,0.94,respectively.Conclusion Using SWI has great value in differentiating fat-poor RAML and RCC by detection of intratumoral hemorrhage.

关 键 词：乏脂肪肾血管平滑肌脂肪瘤 肾癌 磁敏感加权成像 瘤内出血 

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