小肾非富脂血管平滑肌脂肪瘤与小肾透明细胞癌的CT鉴别诊断  

Differential diagnosis of small renal non-lipid-rich vascular smooth muscle lipoma and small renal clear cell carcinoma by CT

作　　者：王昱昊 牟焕晨[2] 王韵琪 WangYuhao;Mu Huanchen;Wang Yunqi(School of Clinical Medicine,Jiamusi University 154002,China;Department of Imaging,The First Affiliated Hospital of Jiamusi University 154002,China)

机构地区：[1]佳木斯大学临床医学院,154002 [2]佳木斯大学附属第一医院影像科,154002

出　　处：《实用医技杂志》2023年第4期265-269,F0003,共6页Journal of Practical Medical Techniques

摘　　要：目的 探讨多层螺旋CT(MDCT)增强扫描在长径≤4 cm的肾非富脂血管平滑肌脂肪瘤(AML与肾透明细胞癌(CCRCC)的鉴别诊断价值。方法 回顾性分析2018年9月至2022年7月期间就诊于佳木斯大学附属第一医院最终经病理证实且具有MDCT多期扫描检查资料的CCRCC 30例及AML 20例,对影像学图像进行分析,并利用受试者工作特性曲线评价诊断效能。结果 AML与CCRCC性别、年龄、包膜、囊变坏死区、强化均匀性、病灶强化均值达顶点期相、平扫呈高密度、杯口征及劈裂征比较差异有统计学意义(P<0.05)。当皮质期CT值、皮质期强化百分比、实质期强化百分比、排泄期强化百分比分别取108.135 Hu、2.123%、1.495%、0.952%为阈值时,鉴别非富脂AML与CCRCC的约登指数最大,敏感度分别为93.3%、96.7%、86.7%、96.7%。结论 MDCT多期增强扫描在≤4 cm的非富脂AML与CCRCC的鉴别诊断具有重要意义及临床应用价值;病灶在皮质期CT值≤108.135 Hu时,对肾非富脂AML有较高的诊断价值。Objective To investigate the differential diagnostic value of MDCT-enhanced scans in the differential diagnosis of non-lipid-rich renal vascular smooth muscle lipoma≤4 cm in diameter from renal clear cell carcinoma.Methods A retrospective study of 30 cases of renal clear cell carcinoma and 20 cases of renal vascular smooth muscle lipoma that were seen at the First Affiliated Hospital of Jiamusi University between September 2018 and July 2022 that were finally pathologically confirmed and had MDCT multistage scan examination data,and the diagnostic efficacy was evaluated using subject working characteristic curves.Results There were statistically significant differences(P<0.05)between non-lipid-rich renal vascular smooth muscle lipoma and renal clear cell carcinoma in terms of gender,age,envelope,cystic necrotic area,enhancement uniformity,peak enhancement phase,high density on flat scan,cupula sign and cleavage sign.The Jorden index for differentiating non-lipid-rich AML from CCRCC was greatest when the thresholds of cortical phase CT value,cortical phase enhancement percentage,parenchymal phase enhancement percentage,and excretion phase enhancement percentage were taken as 108.135 Hu,2.123%,1.495%,and 0.952%,respectively,with sensitivities of 93.3%,96.7%,86.7%,and 96.7%,respectively.Conclusion MDCT multi-phase enhancement scans are of great significance and clinical application in the differential diagnosis of non-lipid-rich AML≤4 cm from CCRCC;lesions with CT values≤108.135 Hu in the cortical phase have a high diagnostic value for renal non-lipid-rich vascular smooth muscle lipoma.

关 键 词：肾 肌 平滑 血管 脂肪瘤 癌 肾细胞 体层摄影术 X线计算机 

分 类 号：R737.11[医药卫生—肿瘤]