摘要
目的 评估螺旋CT多期增强模式及增强参数对肾嗜酸细胞腺瘤(RO)和肾透明细胞癌(ccRCC)的鉴别诊断价值.方法 回顾性收集经手术病理证实的30例RO(共31个病灶)和47例ccRCC临床及影像资料,分析两组病例CT特征、增强模式及增强参数,包括增强三期病灶平均强化峰值、病灶-皮质相对强化比(L/C)及肿瘤峰值早期强化率(PEER),并进行ROC分析评估鉴别诊断价值.结果 RO病灶多边界清晰且中央瘢痕常见,而ccRCC更易出现囊变坏死(P＜0.05);肿瘤生长方式、钙化、出血征象组间差异无统计学意义.ccRCC组45例(95.7％)为早期廓清强化模式,RO组21例(64.5％)呈持续强化模式;两组病灶的平均强化峰值均出现在皮质期,且ccRCC皮质期平均强化峰值、皮质期L/C、PEER均高于RO(P＜0.001);使用皮质期L/C＜1.01及PEER＜0.995为截断值诊断RO具有较高的准确性、特异性.结论 肿瘤增强模式、增强参数、中央瘢痕、囊变坏死及肿瘤边界是否清晰有助于区分RO和ccRCC.
Abstract
Objective To evaluate the diagnostic value of enhancement patterns and parameters for distinguishing renal oncocytoma(RO)from renal clear cell carcinoma(ccRCC)using Multidetector Computed Tomography(MDCT).Methods Clinical and imaging data of 30 cases of RO(31 lesions in total)and 47 cases of ccRCC confirmed by surgical pathology were retrospectively collected.The CT features,enhancement patterns and enhancement parameters were analyzed for both groups,including the mean peak enhancement of lesions in the three phases of enhancement,the lesion-to-cortical relative enhancement ratio(L/C),and the Peak Early Enhancement Ratio(PEER)of the tumors.The differential diagnostic value was evaluated by ROC analysis.Results RO lesions had distinct boundaries and central scarring was common,while ccRCC was more prone to cystic necrosis(P＜0.05);There was no statistically significant distinction in tumor growth pattern,calcification,and hemorrhage between the two groups.ccRCC group had an early contouring pattern of enhancement in 45 cases(95.7％),and the RO group had a persistent pattern of enhancement in 21 cases(64.5％);The mean peak enhancement of the lesions in both the RO and ccRCC groups appeared during the corticomedullary phase;However,ccRCC had significantly higher mean peak enhancements and L/C during the corticomedullary phase as well as PEER values compared to RO(P＜0.001).The diagnosis of RO using the cutoff values of cortical phase L/C＜1.01 and PEER＜0.995 had high accuracy and specificity.Conclusion Tumor enhancement pattern,enhancement parameters,central scarring,cystic necrosis,and clarity of the tumor boundary help distinguish RO from ccRCC.
维普
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