能谱CT多参数成像在肾透明细胞癌病理分级中的应用价值

Application Value of Energy Spectral CT Multi-Parameter in Pathological Grade of Clear Cell Renal Cell Carcinoma

目的探讨能谱CT多参数成像在肾透明细胞癌病理分级中的价值。方法回顾性分析行能谱CT实质期及皮质期扫描并经病理证实的38例cc RCC患者的影像资料,其中低级别(Ⅰ-Ⅱ级)28例,高级别(Ⅲ-Ⅳ级)10例。对两组ccRCC的常规CT表现及能谱CT参数(包括NIC值、70kev单能量CT值、能谱曲线斜率K与有效原子序数)进行统计学处理,同时用ROC曲线对各参数的诊断效能展开分析,得出最佳诊断效能参数及阈值,并计算敏感度及特异度。结果在皮质期及实质期,低级别ccRCC的NIC值、70kev单能CT值、能谱曲线斜率K与有效原子序数(EAN)较高级别ccRCC皆显著偏大(P﹤0.05);在诊断效能方面,皮质期NIC值最高,曲线下面积AUC为0.857,最佳诊断阈值为0.28,敏感度、特异度分别为85.71%、70%。在肾盂或肾周侵犯、肿瘤最大径方面,对比两组发现存在显著区别。结论能谱CT的多参数定量分析在鉴别肾透明细胞癌病理分级中具有较高的准确性,能够有效指导临床治疗方案的选择。

Objective To explore the value of multi-parameters of energy spectrum CT in pathological grade of clear cell carcinoma of the kidney.Methods Retrospective analysis of the imaging data of 38 patients with pathologically confirmed ccRCC who underwent energy spectral CT-based parenchymal and cortical scans,including 28 cases of low-grade ccRCC,10 cases of high-grade ccRCC.The conventional CT features and spectral CT value in two groups of ccRCC,including normalized iodine concentration(NIC),70kev single-energy CT,energy spectrum curve slope(K)、effective atomic numbers(Zeff),were statistically analyzed.The diagnostic efficiency and optimal diagnostic threshold of each parameter value were evaluated by reciever operating characteristic(ROC)curve,and area under the curve(AUC),the corresponding sensitivity and specificity of each parameter were calculated.Results In the cortical and parenchymal phase,NIC value,70kev single-energy CT value,K value,Zeff value were siglificantly higher among low-grade than among high-grade ccRCC(P﹤0.05).The AUC of NIC for identifying low-grade and high-grade ccRCC was 0.857,with optimal threshold of 0.28,sensitivity and specificity was 85.71%and 70%,respectively.The tumor maximum diameter,renal sinus and perirenal fat invasion differed significantly between the two groups(P﹤0.05).Conclusion Energy spectral CT with quantitative analysis of muti-parameter has high accuracy for detecting high-grade ccRCC,which can be effectively to guide the clinical doctor for preoperative therapy selection.