MSCT对肾脏嗜酸细胞腺瘤和透明细胞癌的鉴别诊断价值

Differentiation of renal oncocytoma and clear-cell renal cell carcinomas by MSCT

目的:探讨多层螺旋CT(Multi-slice spiral computed tomography,MSCT)四期扫描对肾脏嗜酸细胞腺瘤(Renal oncocytoma,RO)和透明细胞癌(Clear-cell renal cell carcinomas,ccRCC)的鉴别诊断价值。方法:搜集因肾脏占位行肾脏CT平扫和三期增强扫描患者79例共80枚瘤灶,经术后病理证实RO 29例,ccRCC 50例,并回顾性分析两组病例的影像表现,采用SPSS 19.0软件对肿瘤CT值、校正CT值、皮质期与实质期CT差值及增强廓清率进行独立样本t检验分析。采用Fisher确切概率法对肿瘤部位、形态、平扫特点、强化程度、强化方式、皮质期与实质期强化CT值差异、节段增强反转等征象进行统计分析。结果:RO和ccRCC皮质期CT值、皮质期校正CT值、皮质期与实质期CT差值和增强廓清率差异有统计学意义(P<0.05),平扫、实质期、排泄期CT值校正CT值差异均无统计学意义(P>0.05)。中央星状低密度影、强化程度、强化均匀度、轮辐状强化、皮质期与实质期强化CT值差异及节段增强反转等征象差异有统计学意义(P<0.05),部位、形态、钙化,病灶周边絮状和条索状影等征象差异无统计学意义(P>0.05)。结论:在MSCT多期扫描表现中,皮质期CT值、皮质期校正CT值、皮质期与实质期CT差值和增强廓清率、中央星状低密度影、强化程度、强化均匀度、轮辐状强化、皮质期与实质期强化CT值差异及节段增强反转等征象对于RO、ccRCC二者的鉴别具有重要价值。

Objective:To discuss the value of 4 phase MSCT in distinguishing renal oncocytoma(RO)from clear-cell renal cell carcinomas(ccRCC).Methods:Eighty masses from 79 patients underwent plain and enhanced CT scans due to renal mass.Twenty-nine cases of RO and fifty cases of ccRCC were confirmed by pathology.The imaging findings of the two groups were retrospectively analyzed.Attenuation values,corrected attenuation values in 4 phases,differences of the attenuation values between cortical phase and nephrographic phase,enhance clearance rates were analyzed by the Student’s t-test in SPSS 19.0 software.Locations,shapes,characteristics of plain scan,degrees of enhancement,patterns of enhancement,differences of the attenuation values between cortical phase and nephrographic phase and segmental enhancement inversions were analyzed by the Fisher’s exact test.Results:There were statistically significant differences between RO and ccRCC in attenuation values and corrected attenuation values in cortical phase,differences of the attenuation values between cortical phase and nephrographic phase,enhance clearance rates(P<0.05).The attenuation values and corrected attenuation values in unenhancement scan,nephrographic phase and excretory phase had no statistically significant differences between RO and ccRCC(P>0.05).There were statistically significant differences between RO and ccRCC in central stellate low densities,degrees of enhancement,homogeneous degree of enhancement,spoke-wheel-like enhancement,differences between the attenuation values in cortical phase and nephrographic phase and segmental enhancement inversions(P<0.05).Positions,shapes,calcifications,flocculent and streaky shadowings around the lesions had no statistically significant differences between RO and ccRCC(P>0.05).Conclusion:MSCT shows important value in preoperative distinguishing RO from ccRCC.The attenuation values and corrected attenuation values in cortical phase,differences between the attenuation values in cortical phase and nephrographic phase,enhancement clearance rates,central stellate low densities,degrees of enhancement,homogeneous degree of enhancement,spoke-wheel-like enhancement,differences between the attenuation values in cortical phase and nephrographic phase and segmental enhancement inversions can contribute to the differentiation of the RO and ccRCC.