增强CT鉴别诊断乏脂性肾血管平滑肌脂肪瘤与肾癌的影像特征及临床价值

Imaging features and clinical value of CECT in differential diagnosis of AML and renal cell carcinoma

目的探讨增强CT(CECT)鉴别诊断乏脂性肾血管平滑肌脂肪瘤(AML)与肾癌的临床价值。方法选取具有完整CECT影像资料的肾癌和乏脂性AML患者96例,根据病理学检查结果将患者分为肾癌组(n=63)和乏脂性AML组(n=33),对比两组患者的CECT影像特征,并以病理学检查结果为金标准计算CECT对乏脂性AML与肾癌的诊断效能。结果肾癌组患者的病灶增强程度、病灶增强均匀程度、假包膜征阳性率、杯口征阳性率、劈裂征阳性率与乏脂性AML组比较,差异均有统计学意义(P﹤0.01);肾癌组患者的病灶CT值高于乏脂性AML组,差异有统计学意义(P﹤0.05);CECT诊断肾癌的灵敏度为82.54%,特异度为81.82%,漏诊率为17.46%,误诊率为18.18%。结论乏脂性AML与肾癌分别具有典型的CECT影像学特征,CECT作为一种无创检查手段具有较高的临床价值。

Objective To explore the clinical value of contrast-enhanced CT（CECT） in the differential diagnosis on asteatotic renal angiomyolipoma（AML） and renal cell carcinoma. Method Nighty-six patients with renal cancer or asteatotic AML with complete CECT imaging data were selected. According to the pathological examination results, the patients were divided into renal cancer group（n=63） and asteatotic AML group（n=33）. The CECT image characteristics of patients from the two groups were compared. The diagnostic efficacy of CECT for asteatotic AML and renal cell carcinoma was calculated taking pathological examination as golden standard. Result The degree of lesion enhancement, uniformity of lesion enhancement, positive rate of pseudocapsule sign, positive rate of cup sign, and positive rate of split sign in renal cell carcinoma group were significantly different from those in asteatotic AML group（P〈0.01）. The CT value of the lesions in patients with renal cell carcinoma was higher than that in patients of asteatotic AML group（P〈0.05）. The sensitivity of CECT in the differential diagnosis of renal cell carcinoma was 82.54%, the specificity was 81.82%, the missed diagnosis rate was 17.46%, and the misdiagnosis rate was 18.18%. Conclusion Asteatotic AML and renal cell carcinoma have typical CECT imaging features, and CECT has high clinical value as a non-invasive method.