MSCT多期扫描在肾脏乏脂肪血管平滑肌脂肪瘤与透明细胞癌鉴别诊断中的应用价值  

Value of MSCT in the differential diagnosis of renal fat-poor angiomyolipoma and clear cell renal cell carcinoma

作　　者：孙鑫[1] 王智涛[1] 崔延安[1] 魏云飞[2] 汤井源 朱敬荣[1] SUN Xin;WANG Zhitao;CUI Yanan;WEI Yunfei;TANG Jinyuan;ZHU Jingrong(Department of Radiology,Jiangsu Province Hospital of TCM,Nanjing 210029,China;Department of Urology,Jiangsu Province Hospital of TCM, Nanjing 210029, China)

机构地区：[1]江苏省中医院放射科,江苏南京210029 [2]江苏省中医院泌尿外科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2021年第1期37-40,共4页Chinese Journal of Surgical Oncology

基　　金：国家自然科学基金青年科学基金项目(81902570)。

摘　　要：目的探讨肾脏乏脂肪血管平滑肌脂肪瘤(fpAML)和透明细胞癌(ccRCC)多排螺旋CT(MSCT)平扫及多期增强扫描表现,提高诊断准确率。方法选取2015年1月至2019年12月江苏省中医院经手术病理确诊的fpAML和ccRCC患者各20例,测量肿瘤的短径和长径、CT平扫及多期增强的肿瘤CT值及邻近肾皮质的CT值,对肿瘤的短/长径比、多期相的肿瘤CT值及肿瘤/肾皮质CT值之比(相对强化值)进行比较分析,并绘制两者的短/长径比值、皮质期相对强化值的受试者工作特征(ROC)曲线,选取参考阈值。结果fpAML组与ccRCC组的平均年龄、短/长径比值、平扫CT值、皮质期相对强化值比较,差异均有统计学意义(P<0.05)。ROC曲线示当短/长径比选取0.88为参考阈值时,诊断fpAML和ccRCC的敏感性为85.0%,特异性为75.0%;当皮质期相对强化值选取0.84作参考阈值,诊断fpAML和ccRCC的敏感性为80.0%,特异性为75.0%。结论短/长径比值、平扫CT值、皮质期相对强化值对鉴别fpAML与ccRCC有价值,选取适当阈值有助于提高诊断的敏感性和特异性。Objective The aim of this study is to evaluate the MSCT features of renal fat-poor angiomyolipoma(fpAML)and clear cell renal cell carcinoma(ccRCC)in plain scan and dynamic contrast enhanced scan,which provides the references for the differential diagnosis.Methods MSCT appearance of 20 cases with fpAML and 20 cases with ccRCC confirmed by surgery and pathology in Jiangsu Province Hospital of Chinese Medicine from January 2015 to December 2019 was retrospectively analyzed respectively.The long diameter and short diameter of the lesion were measured.The ratio of short diameter/long diameter was calculated.The density of the lesion and the adjacent normal renal cortex were measured.The ratios of lesion/renal cortex enhancement(relatively improved value)were calculated for three enhanced phases.The receiver operating characteristic(ROC)curves of the ratio of short diameter/long diameter and the relative enhancement value in cortical phase were drawn to select the optimal threshold respectively.Results There were statistically significant differences between the fpAML group and the ccRCC group in average age,short/long diameter ratio,CT value of plain scan and relative enhancement value in cortical phase(P<0.05).The ROC curve showed that the sensitivity and specificity of fpAML and ccRCC were 85.0%and 75.0%respectively when the short/long diameter ratio was 0.88 as the reference threshold.The sensitivity and specificity of fpAML and ccRCC were 80.0%and 75.0%respectively when the cortical enhancement value in cortical phasewas 0.84 as the reference threshold.Conclusions The short/long diameter ratio,CT value of plain scan and relative enhancement value in cortical phase are beneficial to distinguish fpAML from ccRCC.Selecting apprapriate threshold value is helpful to improve the sensitivity and specificity of diagnosis.

关 键 词：肾脏 乏脂肪血管平滑肌脂肪瘤 透明细胞癌 体层摄影术 X线计算机 

分 类 号：R73[医药卫生—肿瘤]