肾嗜酸细胞腺瘤与不同Fuhrman分级的T1期肾透明细胞癌的CT分析与鉴别  

CT analysis and differentiation of renal oncocytoma and T1 stage clear cell renal cell carcinoma with different Fuhrman grades

作　　者：丁健 王立章 张伟强 孙延豹 DING Jian;WANG Lizhang;ZHANG Weiqiang;SUN Yanbao(Department of Radiology,the First Hospital of Jiaring,Jiaring,Zhejiang Province 314001,China)

机构地区：[1]嘉兴市第一医院放射科,浙江嘉兴314001

出　　处：《实用放射学杂志》2023年第4期608-611,666,共5页Journal of Practical Radiology

基　　金：嘉兴市重点学科资助项目(2019-fc-06)。

摘　　要：目的探讨肾嗜酸细胞腺瘤(RO)与不同Fuhrman分级的T1期肾透明细胞癌(ccRCC)CT影像特征。方法回顾性分析经术后病理证实的12例RO及50例T1期ccRCC患者的临床及影像资料,其中ccRCC根据Fuhrman分级分为低级别组(Fuhrman 1~2级)30例和高级别组(Fuhrman3~4级)20例,将RO与2组ccRCC从形态学特征及双期强化指标进行对比分析。结果在一般形态学上,不同级别ccRCC与RO相比,瘤内或瘤周新生血管明显(P<0.05)。此外,高级别ccRCC相对RO在形态上更为不规则,且囊变、坏死较多。在增强CT定量分析中,RO强化程度弱于低级别ccRCC,表现为双期的绝对强化值、实质期的强化指数、皮质早期的相对强化值有统计学差异,受试者工作特征(ROC)曲线显示皮质早期绝对强化值诊断效能最高,最佳临界为110.5HU时,敏感性60%,特异性100%。而RO与高级别ccRCC在双期相扫描均无统计学差异。结论RO与ccRCC鉴别时,应当考虑肿瘤级别,当增强CT明显强化时,低级别ccRCC可能性大,但强化程度不足时,需结合CT一般形态学特征与高级别ccRCC相鉴别。Objective To investigate the CT imaging characteristics of renal oncocytoma(RO)and T1 stage clear cell renal cell carcinoma(ccRCC)with different Fuhrman grades.Methods The clinical and imaging data of 12 cases of RO and 50 cases of T1 stage ccRCC confirmed by postoperative pathology were analyzed retrospectively,and according to Fuhrman grade,ccRCC was divided into low-grade group(Fuhrman grade 1-2)of 30 cases and high-grade group(Fuhrman grade 3-4)of 20 cases.The morphological features and dual-phase enhancement indicators between RO and two groups of ccRCC were compared.Results In general morphology,the intratumoral or peritumoral neovascularization of two different grades of ccRCC was significantly more obvious than that of RO(P<0.05).In addition,high-grade ccRCC was more irregular than RO,and more cystic degeneration and necrosis.In the quantitative analysis of enhanced CT,the enhancement degree of RO was weaker than that of low-grade ccRCC,showed statistical differences in absolute enhancement value of dual-phase,enhancement index in parenchymal phase and relative enhancement value in early corticomedullary phase.Receiver operating characteristic(ROC)curve showed that the absolute enhancement value in early corticomedullary phase was the most effective.When the optimal critical point was 110.5 HU,the sensitivity was 60%and the specificity was 1oo%.However,there was no significant difference between RO and high-grade ccRCC in dual-phase scanning.Conclusion When distinguishing RO from ccRCC,the tumor grade should be considered.When the tumor is significantly enhanced on CT,it is more likely to be low-grade ccRCC,but when the degree of enhancement is insufficient,it needs to be differentiated from high-grade ccRCC by combining with the general morphological features.

关 键 词：肾嗜酸细胞腺瘤 肾透明细胞癌 Fuhrman分级 计算机体层成像 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]