摘要
目的：评价MDCT肿瘤强化指数在微脂性肾血管平滑肌脂肪瘤（RAML）、透明细胞癌（ccRCC）鉴别诊断中的价值。材料与方法：回顾分析温州医学院附属第一医院2006年7月~2009年7月手术病理证实21例微脂性RAML（平均最大径4.69cm）、52例ccRCC（平均最大径4.57cm）影像资料，测量感兴趣区（ROI，包括肿瘤及正常肾皮质）平扫、三期增强（皮髓质期、肾实质期、分泌期）CT值，计算肿瘤相对肾皮质强化指数（R），R=病灶（CTpost-CTpre）/皮质（CTpost-CTpre）（其中CTpost为感兴趣区强化后CT值，CTpre为感兴趣区平扫CT值）。两组肾肿瘤患者性别比较采用卡方检验；患者年龄、肿瘤CT值、肿瘤相对强化指数采用两独立样本t检验；并应用ROC曲线评价三期R值诊断性能。结果：微脂性RAML、ccRCC组患者性别、就诊年龄、平扫CT值差异有统计学意义（P<0.05）；两组肿瘤间皮髓质期、肾实质期、分泌期CT值差异无显著性（P>0.05）；ccRCC组三期肿瘤相对强化指数R值均明显高于微脂性RAML组（P<0.01）；以ccRCC为对象，三期R值ROC曲线下面积分别为0.719、0.767、0.748，肾实质期R值界限值为0.4649，其敏感度71.2%，特异度81%；特异度为100%时，R值界限值为0.6296，此时敏感度44.2%。结论：MDCT肿瘤强化指数可用于鉴别微脂性RAML、ccRCC。
Abstract
Objective: To compare renal angiomyolipoma(RAML) with minimal fat with those of size-matched renal clear cell carcinoma(ccRCC) with three-phase tumor-to-cortex index in multiple-detectors computed tomography(MDCT). Materials and Methods: Twenty-one patients of RAML with minimal fat(confirmed by surgery and pathology) and 52 cases of RCC were evaluated. The data came from the First Affiliated Hospital of Wenzhou Medical College from July 2006 to July 2009. The attenuation of ROI(region-of-interest measurements within tumor and uninvolved renal cortex pre- and post-enhancement) was measured. The tumor to normal renal cortex enhancement index R[R=tumor(CTpost-CTpre)/cortex(CTpost-CTpre), in which CTpost was the CT value of ROI post-enhancement, CTpre was the CT value of ROI before enhancement] was calculated. χ2 test was performed for comparing patient sex. Two dependent t test was done for patient age, CT value pre- and post-enhancement, and the tumor-to-cortex enhancement index R between the two groups. The diagnostic performance of R value analysis in differentiating RAML with minimal fat from ccRCC was determined by using receiver operating characteristic(ROC) analysis. Results: The statistics differences between the RAML with mini-fat group and the RCC group in patient sex, age, and unenhanced tumor attenuation were significant(P<0.05). There was no difference between the two groups in tumor attenuation after contrast(including corticomedullary, nephrographic and excretory phase). The R value of ccRCC group was higher than that of RAML group on all three phases(P<0.01). The area under the ROC curve of corticomedullary, nephrographic and excretory phase was 0.719, 0.767, 0.748, respectively. Tumor-to-cortex enhancement index R on corticomedullary phase was the most effective parameter for distinguishing RAML from ccRCC with threshold value of 0.4649, 71.2% sensitivity and 81% specificity. Conclusion: Three-phase enhancement MDCT scan may be useful in differentiating RAML with minimal fat from ccRCC.
关键词
肾肿瘤 /
错构瘤 /
腺癌 /
透明细胞 /
体层摄影术 /
螺旋计算机
Key words
Kidney neoplasms /
Hamartoma /
Adenocarcinoma /
clear cell /
Tomography /
spiral computed
许化致;郑祥武;曹国全;叶彩儿;朱姬莹.
MDCT肿瘤强化指数在微脂性肾血管平滑肌脂肪瘤、透明细胞癌鉴别诊断中的价值[J]. 中国临床医学影像杂志. 2010, 21(11): 786-789
XU Hua-zhi;ZHENG Xiang-wu;CAO Guo-quan;YE Cai-er;ZHU Ji-ying.
The value of tumor to cortex index in MDCT in the differentiation ofangiomyolipoma with minimal fat from renal clear cell carcinoma[J]. Journal of China Clinic Medical Imaging. 2010, 21(11): 786-789
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
