校正CT值在CT诊断肾癌中的应用

目的：探讨校正 CT 值在 CT 诊断肾癌中的应用价值。方法对我院近期83例肾癌患者的CT资料进行回顾性分析。所有患者均实施手术治疗，病理诊断透明细胞癌69例、乳头状细胞癌14例。分析内容包括测量CT扫描各期肿瘤最大截面直径、肿瘤的平均CT值（TNC、TCP和TPP代表肿瘤平扫期、皮质期和实质期的CT值）、主动脉CT值（ANC、ACP、APP代表主动脉平扫期、皮质期和实质期的CT值）和正常肾实质CT值（KNC、KCP、KPP代表肾实质平扫期、皮质期和实质期的CT值）。计算4个校正CT值（R 代表）：R1＝（TCP-TNC）/（ACP-ANC），R2＝（TPP-TNC）/（APP-ANC），R3＝（TCP-TNC）/（KCP-KNC），R4＝（TPP-TNC）/（KPP-KNC）。对透明细胞癌组和乳头状细胞癌组的各种CT检查参数进行比较，应用受试者工作特征曲线（receiver operating characteristic，ROC）分析各种检查参数的诊断效能。结果两组的TNC无统计学差异（P＝0.261），但透明细胞癌组的TCP、TPP和校正CT值均显著高于乳头状细胞癌组（均P＜0.05）。ROC曲线下面积值（area under the ROC curve，AUC），R1的AUC最高，其次为TCP。结论校正CT值不仅消除了患者内在因素对肿瘤增强的影响，而且与TCP、TPP联合应用时有助于肾癌亚型的鉴别。

Application of the corrected CT value in the diagnosis of renal cell carcinoma

Objective To investigate the corrected CT value in the diagnosis of renal cell carcinoma. Methods Retrospective analysis was conducted on the 83 CT data of renal cell carcinoma operated in our hospital.. Clear cell carcinomas diagnosed by pathology were 69 cases, and papillary cell carcinomas were 14 cases. The analysis included average maximum tumor diameter, CT values of the tumor, the aorta and the renal parenchyma in different phases of CT scanning. TNC, TCP and TPP represented CT values in the unenhanced, vascular and parenchyma phase respectively;ANC, ACP and APP represented CT values of aorta in the unenhanced, vascular and parenchyma phase respectively;KNC, KCP and KPP represented CT values of normal renal parenchyma in the unenhanced, vascular and parenchyma phase respectively. The four corrected CT values（R represented a corrected CT value）were calculated： R1=（TCP-TNC） / （ACP-ANC）, R2=（TPP-TNC）/（APP-ANC）, R3=（TCP-TNC） /（KCP-KNC）, R4=（TPP-TNC）/（KPP-KNC）. These parameters of CT were compared between the clear cell carcinomas and papillary cell carcinomas. The receiver operating characteristic（ROC）were used to assess diagnostic efficiency of various parameters. Results There was no significant difference between the TNC of renal clear cell carcinoma and TNC of papillary carcinoma cells （P〉0.05）. But, the TCP, TPP and the four corrected CT values of clear cell carcinoma were significantly higher than those of papillary renal cell carcinoma （P〈0.05）. According to area under the ROC curve （AUC）, the AUC of R1 was the biggest, followed by TCP. Conclusion The corrected CT values in the diagnosis of renal cell carcinoma can not only eliminate the intrinsic factors of patients with the effect on the degree of tumor enhancement, but also contribute to distinguishing the subtype of renal cell carcinoma when they were combination with TCP and TPP.