定量CT纹理分析鉴别诊断透明细胞型与非透明细胞型肾癌

目的 探讨定量CT纹理分析鉴别透明细胞型肾癌和非透明细胞型肾癌的可行性。方法 回顾性分析100个透明细胞型肾癌和27个非透明细胞型肾癌病灶的CT图像，应用TexRAD软件分析各扫描期相两种类型肾癌的纹理特征。结果 增强图像上，非透明细胞型肾癌的平均灰度值、标准差、熵、正像素的平均值明显低于透明细胞型肾癌，而峰度高于透明细胞型肾癌（P均<0.001），偏度差异无统计学意义（P>0.05）。在皮髓质期的粗糙纹理上，正像素的平均值鉴别两种类型肾癌的ROC曲线下面积为0.92±0.04，敏感度为0.85，特异度为0.93，准确率为0.87。结论 透明细胞型肾癌与非透明细胞型肾癌的CT纹理特征间存在显著差异，定量CT纹理分析鉴别诊断这两种类型肾癌具有临床价值。

CT texture analysis in differential diagnosis of clear-cell and non clear-cell renal cell carcinomas

Objective To explore the value of CT texture analysis (CTTA) in differential diagnosis of non clear-cell renal cell carcinoma (non-ccRCC) and clear-cell renal cell carcinoma (ccRCC). Methods A total of 100 ccRCC and 27 non-ccRCC lesions were retrospectively analyzed. CTTA was performed on multiphasic CT images by using TexRAD software, and texture features were compared between ccRCC and non-ccRCC. Results Compared with ccRCC, the mean and standard deviation, entropy as well as the mean of positive pixels (MPP) were significantly lower, while kurtosis was higher in non-ccRCC lesions on enhanced CT images (P<0.001). No significant difference was observed in skewness between non-ccRCC and ccRCC (P>0.05). MPP at coarse texture scale on corticomedullary images identified non-ccRCC from ccRCC with an AUC of 0.92±0.04, the sensitivity was 0.85, specificity was 0.93 and accuracy was 0.87. Conclusion There are significant differences in CTTA parameters between non-ccRCC and ccRCC. CTTA has clinical value in differential diagnosis of non-ccRCC and ccRCC.