3.0T MRI对无瘢痕的肾嗜酸细胞腺瘤与实性肾透明细胞癌的鉴别诊断价值

Value of 3.0T MRI in differential diagnosis of scarless-RO and solid clear cell renal cell carcinoma

目的探讨3.0T磁共振表观扩散系数ADC值及动态增强特征在无瘢痕的(肿块质地均匀,中心无星芒状瘢痕)肾嗜酸细胞腺瘤(renal oncocytoma,RO)与实性肾透明细胞癌(clear cell renal cell carcinoma,CCRCC)鉴别诊断的价值。方法选取经手术病理证实的42例无瘢痕的RO和实性CCRCC,其中15例为无瘢痕的RO(无瘢痕RO组)和27例实性CCRCC(CCRCC组)患者的资料。所有患者术前均行MRI扩散加权成像及增强扫描。对ADC值及增强扫描各期强化程度值进行定量测量,采用多因素Logistic回归分析确定ADC比值及增强皮质-排泄期信号强度比值鉴别两种肿瘤的独立影响因素,以病理结果为金标准,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC)并做比较。结果RO患者的ADC比值高于CCRCC患者,差异有统计学意义(P<0.05),ADC测量的ROC AUC、灵敏度和特异度分别为0.727、75.6%和72.1%;RO患者的皮质-排泄期信号强度比值低于CCRCC患者,差异有统计学意义(P<0.05),对应比值测量的ROC AUC、灵敏度和特异度分别为0.846、91.2%和89.6%。ADC值联合皮质-排泄期信号强度比值的ROC分析发现,鉴别两者的AUC、敏感度及特异度分别为0.895、93.6%、91.3%。结论磁共振表观扩散系数ADC比值及皮质-排泄期信号强度比值均有助于鉴别无瘢痕的RO和CCRCC,两种参数结合能更好的鉴别这两种肿瘤。

Objective To investigate the value of MRI apparent diffusion coefficient(ADC)and dynamic enhanced characteristic inthe differential diagnosis of scarless renal oncocytoma(RO)and solid clear cell renal cell carcinoma(CCRCC).Methods Clinical and imaging data of 42 cases pathologically confirmed Scarless-RO(n=15)and solid CCRCC(n=27)were retrospectively studied.All the patients underwent MRI diffusion weighted imaging(DWI)and dynamic contrast-enhanced(DCE)before operation.The ADC ratio and extent of enhancement were assessed quantitatively.Multivariate Logistic regression was used to determine the independent factors for differential diagnosis of the two tumors by ADC ratio combined with the cortex to excretory phase enhanced ratio.The ROC curve was drawn,and the area under the curve(AUC)was calculated and compared.Results The ADC ratio of Scarless-RO was higher than that of solid CCRCC(P<0.05).The ROC AUC,sensitivity and specificity of signal intensity were 0.727,75.6%and 72.1%respectively;The cortex to excretory phase enhanced ratio of Scarless-RO was lower than that of solid CCRCC(P<0.05).The AUC,sensitivity and specificity were 0.846,91.2%and 89.6%respectively.ROC analysis of ADC ratio combined with the cortex to excretory phase enhanced ratio showed that the AUC,sensitivity and specificity were 0.895,93.6%and 91.3%respectively.Conclusion The ADC ratio and the cortex to excretory phase enhanced ratio are helpful to distinguish Scarless-RO from solid CCRCC.The combination of the two parameters can improve the efficacy of differential diagnosis of the two tumors.