多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断  

Differential diagnosis of common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in multi-slice spiral CT

作　　者：陈佳 张曦 龚明福 文利 CHEN Jia;ZHANG Xi;GONG Mingfu;WEN Li(Department of Radiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院放射科,重庆400037

出　　处：《第三军医大学学报》2020年第18期1842-1847,共6页Journal of Third Military Medical University

摘　　要：目的探讨基于螺旋CT多期扫描成像中矫正CT值及矫正相对强化率对常见4种肾细胞癌亚型鉴别的可行性。方法回顾性分析本院2017年8月至2019年6月经病理证实的肾细胞癌患者76例临床资料,其中肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)28例、乳头状细胞癌(papillary renal cell carcinoma,PRCC)Ⅰ型24例、乳头状细胞癌Ⅱ型(PRCCⅡ型)6例、嫌色细胞癌(chromophobe renal cell carcinoma,ChRCC)18例,测量、计算各亚型间CT增强扫描各期矫正CT值、相对强化率,进行统计学分析并绘制受试者工作特征(receiver operator characteristic,ROC)曲线。结果各亚型平扫CT值差异均无统计学意义(P>0.05)。增强扫描ccRCC皮髓质期矫正CT值为(110.68±45.62)Hu、相对强化率为(3.19±1.41),显著高于其他亚型(P<0.01)。实质期、排泄期ccRCC矫正CT值分别为(95.36±25.02)Hu、(74.01±16.10)Hu,相对强化率分别为(2.82±1.03)、(2.19±0.71),均高于PRCCⅠ、PRCCⅡ型(P<0.05)。PRCCⅠ型与PRCCⅡ型间各期CT矫正值及相对强化率差异均无统计学意义(P>0.05)。ChRCC各期矫正CT值及相对强化率介于ccRCC与PRCC之间,皮髓质期其矫正CT值与相对强化率高于PRCCⅡ型(P<0.05),实质期矫正CT值高于PRCCⅠ型、PRCCⅡ型(P<0.05)。皮髓质期相对强化率为2.56、2.28、1.25时,ccRCC与ChRCC、PRCCⅠ型、PRCCⅡ型鉴别的敏感性分别为78.6%、95.8%、100.0%,特异性分别为94.4%、78.6%、92.9%。实质期相对强化率为1.64时,鉴别ChRCC与PRCCⅠ型、PRCCⅡ型的敏感性、特异性分别为75.0%、83.3%。结论不同肾癌亚型强化方式各有特点,螺旋CT多期扫描矫正后CT值及矫正后相对强化率有助于提升鉴别各肾癌亚型能力,但PRCCⅠ型与PRCCⅡ型的鉴别有一定困难。Objective To explore the feasibility of differentiating 4 common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in spiral CT multi-phase scanning.Methods We retrospectively analyzed the clinical data of 76 patients with pathologically confirmed renal cell carcinoma,including 28 with clear cell renal cell carcinoma(ccRCC),24 with papillary renal cell carcinoma typeⅠ(PRCCⅠ),6 with papillary renal cell carcinoma typeⅡ(PRCCⅡ)and 18 with chromophobe renal cell carcinoma(ChRCC).The CT values in different phases in spiral CT multi-phase scanning were measured to calculate the corrected CT values and relative enhancement rates,whose sensitivity and specificity for differentiating the subtypes of renal cell carcinoma were analyzed using receiver operating characteristic(ROC)curve analysis.Results No significant difference was found in unenhanced CT values among different subtypes of renal cell carcinoma.For ccRCC,the corrected CT value was 110.68±45.62 Hu and the corrected relative enhancement rate was 3.19±1.41 in the corticomedullary phase,significantly higher than those of the other subtypes(P<0.01).In the nephrographic and excretory phases,the corrected CT values of ccRCC were 95.36±25.02 Hu and 74.01±16.10 Hu and the corrected relative enhancement rates were 2.82±1.03 and 2.19±0.71,respectively,all significantly higher than those of PRCCⅠand PRCCⅡ(P<0.05)but comparable with those of ChRCC.The corrected CT value or relative enhancement rate in each phase did not differ significantly between PRCCⅠand PRCCⅡ.The corrected CT value and relative enhancement rate of ChRCC in each phase were lower than those of ccRCC but higher than those of PRCC;these values in the corticomedullary phase were significantly higher than those of PRCCⅡ(P<0.05),and the corrected CT value of ChRCC was significantly higher than that of PRCCI and PRCCII(P<0.05).At the cutoff values of 2.56,2.28,and 1.25,the relative enhancement rates in the corticomedullary phase had sensitivities

关 键 词：肾细胞癌 组织学亚型 多层螺旋CT 增强扫描 

分 类 号：R730.42[医药卫生—肿瘤] R737.11[医药卫生—临床医学]