CTU简易评分对肾实质浸润性肾盂癌与肾盂浸润性肾细胞癌鉴别诊断的临床研究

Clinical study of CTU simple score in differential diagnosis of renal parenchymal infiltrating renal pelvis carcinoma and renal pelvis infiltrating renal cell carcinoma

目的:分析肾实质浸润性肾盂尿路上皮癌(肾盂癌)与肾盂浸润性肾细胞癌在计算机体层成像尿路造影(computed tomography urography,CTU)中的影像学表现,提高术前诊断的准确度。方法:回顾并分析术后明确诊断的78例肾盂癌与肾细胞癌的患者资料,手术前所有的患者在首都医科大学附属北京友谊医院行640层螺旋CT平扫及3期增强扫描。研究指标包括性别、年龄、是否有血尿及CTU中肿瘤的特征[肿瘤部位、肿瘤长径、平扫及增强各期强化程度、是否伴有肾积水、肿瘤轮廓外凸、肾脏体积增大、肾盂(盏)内可强化的充盈缺损、结石]。比较两组间各项指标的差异,对差异有统计学意义的指标采用logistic回归分析,筛选独立危险因素,建立简易评分模型,采用受试者工作特征(receiver operating characteristic,ROC)曲线计算评分系统诊断效能。结果:两组患者在平扫及增强各期强化程度、是否肾积水、肿瘤轮廓外凸、肾脏体积增大、肾盂(盏)内肿物、血尿、结石方面差异均有统计学意义(P<0.05),其中肾积水、肾脏体积增大、肾盂(盏)内肿物、血尿、结石指标为肾盂癌的独立危险因素,每一项给予0分或1分构成CTU简易评分系统,总分0~5分,以≥3分为参数,术前诊断肾盂癌效能最高,其灵敏度为0.919,特异度为0.829,准确度为0.872。结论:CTU简易评分有助于鉴别肾实质浸润性肾盂癌与肾盂浸润性肾细胞癌,可提高诊断效能。

Objective: To explore the difference of imaging manifestations between renal parenchymal infiltrating urothelial carcinoma(renal pelvis carcinoma) and renal pelvis infiltrating renal cell carcinoma(renal cell carcinoma) in multi-slice spiral computed tomography urography(CTU), and to improve the accuracy of preoperative diagnosis. Methods: The clinical data of 78 patients with renal pelvis carcinoma and renal cell carcinoma diagnosed after operation were retrospectively analyzed. Before operation, all patients underwent 64-slice spiral CT plain scan and three-phase enhanced scan in Beijing Friendship Hospital Affiliated to Capital Medical University. The research indicators included: gender, age, hematuria, and the characteristics of tumors in CTU [tumor location, tumor length, enhancement degree of plain scan and enhancement, whether hydronephrosis, tumor contour protrusion, kidney volume enlargement, fllling defect in renal pelvis(calyces) that can be enhanced, and stones]. Comparing the differences between the two groups, the statistically signiflcant indicators were analyzed by logistic regression, independent risk factors were screened, a simple scoring model was established, and the diagnostic efficiency of the scoring system was calculated by receiver operating characteristic(ROC) curve. Results: There were signiflcant differences between the two groups in enhancement degree, hydronephrosis, protruding tumor contour, enlarged kidney volume, tumor in renal pelvis(calyces), hematuria, and calculus(P<0.05). Among them, hydronephrosis, enlargement of kidney volume, tumor in renal pelvis(calyces), hematuria and calculus are independent risk factors for renal pelvis cancer. Each item is given 0 or 1 to form a CTU simple scoring system, with a total score of 0~5. With ≥3 as a parameter, preoperative diagnosis of renal pelvis cancer has the highest efficiency. The sensitivity is 0.919,the speciflcity is 0.829 and the accuracy is 0.872. Conclusion CTU simple score is helpful to distinguish intrarenal transitional cell carcinoma from central renal cell carcinoma, and can improve the diagnostic efficiency.