能谱CT多参数在高级别肾透明细胞癌与Ⅱ型乳头状肾细胞癌鉴别诊断中的价值

The Value of Spectral CT Multi-Parameters in Differential Diagnosis of High-Grade Renal Clear Cell Carcinoma and Type Ⅱ Papillary Renal Cell Carcinoma

目的探讨能谱CT多参数在高级别肾透明细胞癌与Ⅱ型乳头状肾细胞癌鉴别诊断中的价值,提高术前诊断准确率,为制定最佳的治疗方案提供依据(临床意义)。方法搜集经手术与病理证实的22例高级别肾透明细胞癌与18例Ⅱ型乳头状肾细胞癌,术前均行能谱CT皮质期与实质期扫描,采用双盲法记录所有病例的能谱CT参数,包括70 keV(HU)值、标准化碘浓度(NIC)、能谱曲线斜率;所有肿瘤均行手术切除,切除标本进行HE染色及免疫组织化学染色。术后对所有病例进行影像特征与病理对照分析。用SPSS 23.0统计学软件对所有数据进行统计学分析。结果高级别透明细胞癌70 keV(HU)值高于Ⅱ型乳头状肾细胞癌,且差异具有统计学意义(皮质期:104.80±14.72 vs 84.36±9.72,P=0.001;实质期:92.77±9.75 vs 72.57±4.75,P=0.004);高级别透明细胞癌NIC值高于Ⅱ型乳头状肾细胞癌,且差异具有统计学意义(皮质期:0.58±0.14 vs 0.52±0.08,P=0.003;实质期:0.52±0.08 vs 0.36±0.49,P=0.045);高级别透明细胞癌能谱曲线斜率值高于Ⅱ型乳头状肾细胞癌,且差异具有统计学意义(皮质期:4.82±0.57 vs 3.82±0.57,P<0.001;实质期:4.34±0.47 vs 3.84±0.49,P=0.029);肿瘤出血、肿瘤包膜、肿瘤形态、肿瘤边界、淋巴结转移、栓子形成、肾盂侵犯、肿瘤钙化两者之间差异无统计学意义;肿瘤个数两者之间差异有统计学意义(P=0.019);皮质期,NIC对两者的鉴别诊断效能最高,敏感性为78.9%,特异性为77.0%。结论能谱CT参数对高级别肾透明细胞癌与Ⅱ型乳头状肾细胞癌的鉴别诊断有价值。

Objective To investigate the value of multi-parameter CT in the differential diagnosis of high-grade renal clear cell carcinoma and typeⅡpapillary renal cell carcinoma,and to improve the accuracy of preoperative diagnosis.Methods 22 high-grade clear cell renal carcinoma and 18 typeⅡpapillary renal cell carcinoma confirmed by surgery and pathology from 1 st June 2014 to 1 st January,2019 treated at Lanzhou University Hospital were collected.CT cortical and parenchymal scans were performed,and the energy spectrum CT parameters of all cases were recorded by double-blind method.All tumors were surgically removed,and the specimens were excised for HE staining and immunohistochemical staining.The imaging features and pathology were analyzed in all cases after operation.All data were statistically analyzed using Spss 23.0 statistical software.Results The 70 keV(HU)of high-grade clear cell carcinoma were higher than those of type II papillary renal cell carcinoma(cortical phases:104.80±14.72 vs 84.36±9.72,P=0.001;parenchymal phases:92.77±9.75 vs 72.57±4.75,P=0.004);the NIC of high-grade clear cell carcinoma were higher than those of type Ⅱ papillary renal cell carcinoma(cortical phases:0.58±0.14 vs 0.52±0.08,P=0.003;parenchymal phases:0.52±0.08 vs 0.36±0.49,P=0.045);the energy spectrum curves of high-grade clear cell carcinoma were higher than those of typeⅡpapillary renal cell carcinoma(cortical phases:4.82±0.57 vs 3.82±0.57,P<0.001;parenchymal phases:4.34±0.47 vs3.84±0.49,P=0.029).There was no statistically significant difference between tumor hemorrhage,tumor capsule,tumor morphology,tumor boundary,lymph node metastasis,embolization,renal pelvis invasion,and tumor calcification.The number of tumors was statistically significant(P=0.019).In the cortical phase,NIC has the highest differential diagnosis efficiency,with sensitivity of 78.9%and specificity of 77.0%.Conclusion The spectral CT parameters are valuable for the differential diagnosis of high-grade renal clear cell carcinoma and typeⅡpapillary renal cell carcinoma.