CT动态增强扫描鉴别肾嫌色细胞癌与肾嗜酸细胞瘤的价值

Differential Diagnosis of Chromophobic Renal Cell Carcinoma and Renal Oncocytoma: Dynamic Contrast-Enhanced CT Analysis

目的探讨CT动态增强扫描鉴别肾嫌色细胞癌与肾嗜酸细胞瘤的价值。资料与方法回顾性分析经病理证实的24例肾嫌色细胞癌与17例肾嗜酸细胞瘤的影像学特点,比较两种病变增强扫描后皮髓质期、实质期CT值变化的百分比(简称病灶强化百分比),以及肿瘤病灶相对于肾皮质的强化指数。结果肾嫌色细胞癌CT动态增强扫描后皮髓质期、实质期病灶强化百分比分别为(132.8±39.8)%、(99.2±32.5)%,肿瘤-肾皮质强化指数分别为0.31±0.11、0.30±0.12;肾嗜酸细胞瘤皮髓质期、实质期病灶强化百分比分别为(234.1±129.1)%、(195.4±87.1)%,肿瘤-肾皮质强化指数分别为0.66±0.33、0.68±0.28。两种肿瘤病灶强化百分比及肿瘤-肾皮质强化指数之间差异均有统计学意义(P<0.05)。实质期肿瘤-肾皮质强化指数阈值为0.44时,鉴别两种肿瘤的敏感度为82.4%,特异度为91.7%,Youden指数为0.74。结论 CT动态增强扫描,特别是实质期肿瘤-肾皮质强化指数有助于肾嫌色细胞癌与嗜酸细胞瘤的鉴别诊断。

Purpose To explore the diagnostic value of dynamic contrast-enhanced CT （DCE-CT） in the differential diagnosis of chromophobic renal cell carcinoma （CRCC） and renal oncocytoma （RO）. Materials and Methods A retrospective study was carried out on the DCE-CT findings of 24 patients with pathologically-proved CRCCs and 17 patients with pathologically-confirmed ROs. The enhancement percentage （EP） and the enhancement index （EI） of both types of lesions were compared on corticomedullary phase and nephrographic phase. Results CRCCs on corticomedullary phase and nephrographic phase： EP （ 132.8 ±39.8）% and （99.2 ±32.5）%, respectively; EI 0.31 ±0.11and 0.30±0.12, respectively. ROs on corticomedullary phase and nephrographic phase： EP （234.1±129.1）% and （195.4±87.1）%, respectively; El 0.66±0.33 and 0.68±0.28, respectively. Both EP and EI of CRCCs and ROs showed statistical difference （P〈0.05）. As the threshold value of El on nephrograhic phase was 0.44, the sensitivity was 82.4%, specificity was 91.7% and Youden index was 0.74. Conclusion Imaging features of DCE-CT, especially El on nephrographic phase, are helpful in the differential diagnosis of CRCC and RO.