MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌鉴别诊断价值

目的探讨MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌的鉴别诊断价值。方法选取经临床病理证实的并有完整临床和CT资料的21例乏脂肪RAML与14例嫌色细胞肾癌,回顾性分析其MSCT表现,测量病灶的各期CT值,并测量病灶相同层面皮质的CT值,并计算病灶CT值与其邻近皮质CT值的比值,统计分析各期CT值及其比值的统计学差异。结果乏脂肪RAML 21例,嫌色细胞肾癌14例,乏脂肪RAML呈等高密度影16例,嫌色细胞肾癌呈等高密度10例;乏脂肪RAML与嫌色细胞肾癌在平扫、皮质期、髓质期及分泌期CT值以及平扫、髓质期病灶与相近皮质比值均差异有明显统计学意义(P<0.05),皮质期及分泌期病灶与邻近皮质比值差异无统计学意义(P>0.05),皮质期ROC曲线下面积最大(0.871),当皮质期CT值选择为106 HU时,鉴别RAML和ThRCC的敏感度为74%,特异性为91%,Youden指数为0.66。结论MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌鉴别中具有一定的价值,特别是皮质期的病灶CT值具有良好的鉴别诊断价值。

Differential diagnosis of angiomyolipoma with minimal fat and chromophobe renal cell carcinoma by dynamic contrast-enhanced MSCT

Objective To explore the diagnostic value of dynamic contrast-enhanced CT(DCE-CT)in the differential diagnosis of angiomyolipoma with minimal fat and Chromophobe renal cell carcinoma.Methods Renal angiomyolipoma with minimal fat and chromophobe renal cell carcinoma(ChRCC)with complete clinical and CT data were selected from our hospital and the first affiliated hospital of wenzhou medical university.We retrospectively stuided these imaging of DCE-CT,measured the CT values of lesions and nomal renal cortex in any phase,and calculated these ratios.Statistical analysis of the differential diagnosis value of CT values and the ratio in any phase was conducted.Results 21 cases renal angiomyolipoma with minimal fat and 14 cases chromophobe renal cell carcinoma were selected,16 cases of RAML and 14 cases of ChRCC represented isodensity and high density in plain scan in MSCT.The CT values in plain scan,corticomedullary phase nephrographic phase and excretory phase and the ratio in plain scan and nephrographic phase had significant statistical differences in differential diagnosis of angiomyolipoma with minimal fat and chromophobe renal cell carcinoma(ChRCC)(P<0.05);The ratios in corticomedullary phase and excretory phase had no statistic significance in differential diagnosis of angiomyolipoma with minimal fat and chromophobe renal cell carcinoma(ChRCC)(P>0.05);As the threshold CT value of the lesion on corticomedullary phase was 106 HU,the sensitivity was 74%,specificity was 91%and Youden index was 0.66,the area of ROC was 0.871.Conclusion Multi-phase dynamic contrast-enhanced CT had a certain value in differential diagnosis of angiomyolipoma with minimal fat and ChRCC.Particularly,the CT values in corticomedullary phase had significant differential diagnosis values.