螺旋CT扫描在乏脂肪肾错构瘤、小肾癌的鉴别诊断中的应用价值研究

目的 探讨螺旋CT在鉴别诊断乏脂肪肾错构瘤和小肾癌的应用价值.方法 收集2011年1月至2014年12月在本院治疗的肾脏小肿瘤患者临床和影像资料,其中小肾癌患者42例,乏脂肪肾错构瘤23例,分析各患者螺旋CT扫描表现,测量肿瘤感兴趣点(ROI) CT值,评价肿瘤平扫密度、强化程度等.结果 小肾癌平扫期ROI CT值为(33.24±10.24) Hu,明显高于乏脂肪肾错构瘤的(9.87±2.87)Hu,差异有统计学意义(P＜0.05);小肾癌和乏脂肪肾错构瘤皮质期、实质期ROI CT值差异比较无统计学意义(P＞0.05);小肾瘤和乏脂肪肾错构瘤CT影像表现在是否存在钙化、强化是否均匀、肿瘤边缘是否整齐光滑中,比较差异无统计学意义(P＞0.05);是否存在假包膜、肿瘤的强化形式在小肾瘤和乏脂肪肾错构瘤CT影像表现比较时差异有统计学意义(P＜0.05);平扫期ROI CT值ROC曲线下面积为0.970,P＜0.05,当以平扫期ROI CT值≤16.19Hu诊断乏脂肪肾错构瘤时,诊断的灵敏度为90.50％,特异度为100.00％.结论 螺旋CT在鉴别诊断乏脂肪肾错构瘤和小肾癌有重要价值,肿瘤的平扫密度、强化形式等是鉴别诊断中有价值的CT表现特点,测量平扫期ROI CT值对鉴别诊断有比较高的价值.

Application of spiral CT in differential diagnosis of minimal fat RAML and small RCC

Objectives To investigate application of spiral CT in differential diagnosis of minimal fat renal angiomyolipoma(RAML) and small renal cell carcinoma(RCC).Methods Clinical and imaging data of 65 patients with small renal tumor were collected from 2011 January to 2014 December.42 cases of smallRCC,23 cases of minimal fat RAML.Spiral CT scanning performance was analysed.region of interest circle (ROI) CT value was measured.The dencity and enhancement degree of tumor were evaluated.Results The region of interest circle (ROI) CT value was (33.24 ± 10.24)Hu,significantly higher than the minimal fat RAML(9.87 ± 2.87) Hu,the difference was statistically significant(P ＜0.05).CT values difference of small RCC and the minimal fat RAML showed no statistical significance in cortical phase and parenchymal phase ROI (P ＞ 0.05).CT imaging of small RCC and the minimal fat RAML manifested in the existence of calcification,homogeneous enhancement,edge smooth and tidy and so on,there was no significant difference(P ＞0.05).whether there was pseudocapsule,enhancement forms in CT imamaging performance of small RCC and minimal fatRAML,the difference was statistically significant(P ＜0.05).The area under the ROC curve of unenhanced phase ROI CT value was 0.970(P ＜ 0.05),when diagnosis of minimal fatRAML was diagnosed (unenhanced phase ROI CT value ≤ 16.19Hu),the diagnostic sensitivity and specificity was 90.50％,100％ respectivly.Conclusions Spiral CT has important value in the differential diagnosis of minimal fat RAML and small RCC.Unenhanced density of tumor,strengthen forms and so on would be very useful CT manifestations in the differential diagnosis,measurement of unenhanced phase ROI CT valuewould be fairly valuable in the differential diagnosis.