不均匀度在肾乏脂肪血管平滑肌脂肪瘤与肾透明细胞癌CT鉴别中的价值研究

王旭; 宋歌; 王宗平

doi:10.16766/j.cnki.issn.1674-4152.001833

不均匀度在肾乏脂肪血管平滑肌脂肪瘤与肾透明细胞癌CT鉴别中的价值研究

doi: 10.16766/j.cnki.issn.1674-4152.001833

王旭¹,
宋歌^1, ,,
王宗平²

1.
中国科学院肿瘤与基础医学研究所中国科学院大学附属肿瘤医院(浙江省肿瘤医院)放射科, 浙江杭州 310022
2.
中国科学院肿瘤与基础医学研究所中国科学院大学附属肿瘤医院(浙江省肿瘤医院)泌尿外科, 浙江杭州 310022

基金项目:

浙江省医药卫生科技计划项目 2016KYA038

详细信息

通讯作者:
宋歌，E-mail：applesong1985@sina.com

中图分类号: R737.11 R445.3
计量
- 文章访问数: 171
- HTML全文浏览量: 119
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-10
- 网络出版日期: 2022-02-19

The value in differentiation of renal angiomyolipoma with minimal fat and clear cell renal cell carcinoma by using CT heterogeneous degree

1.
Department of Radiology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China

摘要

摘要: 目的探讨不均匀度在肾乏脂肪血管平滑肌脂肪瘤(angiomyolipoma with minimal fat, mfAML)与肾透明细胞癌(clear cell renal cell carcinoma, ccRCC)鉴别诊断中的价值。方法回顾性分析中国科学院大学附属肿瘤医院(浙江省肿瘤医院)2016年1月—2019年10月经病理证实的25例mfAML和45例ccRCC患者的CT增强扫描图像, 测量肿瘤和腰大肌的不均匀度(HDT/HDP)并获得标准化肿瘤不均匀率(SHRT), 同时测量增强各期肿瘤及肾皮质的CT值并获得肿瘤强化率(ERT), 对2种肿瘤间各参数的差异进行统计学分析。绘制受试者工作特征(ROC)曲线, 评价各个参数的诊断效能。结果 mfAML的皮质期HDT及SHRT、实质期HDT、排泄期HDT及SHRT均低于ccRCC, 差异有统计学意义(均P＜0.05), 2组肿瘤的平扫HDT及SHRT、实质期SHRT间的差异无统计学意义(均P＞0.05)。mfAML的平扫CT值高于ccRCC, 而皮质期ERT低于ccRCC, 差异有统计学意义(均P＜0.05);2组肿瘤的皮质期CT值、实质期和排泄期CT值及ERT间的差异均无统计学意义(均P＞0.05)。ROC曲线显示定量参数中的皮质期HDT及皮质期SHRT的ROC曲线下面积较大, 其AUC值分别为0.85及0.82。当皮质期HDT取31.31 Hu为截断值时, 其鉴别2种肿瘤的敏感度为84.4%, 特异度为72.0%。结论不均匀度可以作为一种简便的反映强化均匀性差异的定量指标来对mfAML与ccRCC进行鉴别, 其中皮质期不均匀度的诊断价值较高。
- 不均匀度 /
- 体层摄影术, X线计算机 /
- 肾乏脂肪血管平滑肌脂肪瘤 /
- 肾透明细胞癌
Abstract: Objective To investigate the value of heterogeneous degree in differential diagnosis of renal angiomyolipoma with minimal fat (mfAML) and clear cell renal cell carcinoma (ccRCC). Methods CT scan images of mfAML (n=25) and ccRCC (n=45) confirmed by pathology in Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) were retrospectively collected and analyzed from January 2016 to October 2019. The heterogeneous degree of tumor and psoas (HDT/HDP) were measured and standardized heterogeneous rate of tumor (SHRT) was obtained. The CT value of tumor and renal cortex in each enhanced phase were measured and enhancement rate of tumor (ERT) was obtained. The difference of parameters between the two tumors were statistically analyzed. The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of each parameter. Results HDT and SHRT of cortical phase, HDT of nephrographic phase, and HDT and SHRT of excretory phase in mfAML were all lower than that in ccRCC, the difference was statistically significant (all P < 0.05). There was no statistically significant difference in HDT and SHRT of pre-contrast phase and SHRT of nephrographic phase between the two groups (all P>0.05). The CT value of pre-contrast phase in mfAML was higher than ccRCC, while the ERT of cortical phase in mfAML was lower than ccRCC, the difference was statistically significant (all P < 0.05). There was no statistically significant difference in CT value of cortical phase, CT value and ERT of nephrographic phase and CT value and ERT of excretory phase between the two tumors (all P>0.05).The ROC curve showed that the area under curve (AUC) of HDT & SHRT in cortical phase was larger, with AUC values of 0.85 and 0.82 respectively.When HDT of cortical phase took 31.31 Hu as the cutoff value, the sensitivity to distinguish these two tumors was 84.4%, and its specificity was 72.0%. Conclusion The heterogeneous degree can be used as a simple quantitative index to reflect the difference in enhanced homogeneity to distinguish mfAML from ccRCC, among which the diagnosis value of heterogeneous degree in cortical phase is higher.
- Heterogeneity /
- Tomography, X-ray computed /
- Renal angiomyolipoma /
- Clear cell renal cell carcinoma

HTML全文

图 1 测定肿瘤及腰大肌SD值的ROI放置方法

注：A、B、C、D分别为排泄期、平扫、皮质期及实质期图像。首先在排泄期确定肿瘤边界，ROI(红色)应尽量包括肿瘤的全部范围，边缘距肿瘤边缘2~3 mm，再依据排泄期的位置在平扫、皮质期及实质期放置相同大小的ROI；同时在同层面腰大肌内放置合适的ROI(黄色)测定HDP，ROI面积约50~100 mm²。

下载: 全尺寸图片幻灯片

图 2 各定量参数的ROC曲线图

下载: 全尺寸图片幻灯片

表 1 2组肿瘤患者一般资料比较

组别	例数	性别(例)		年龄(x±s，岁)	位置(例)		最大径(x±s，cm)
组别	例数	男性	女性	年龄(x±s，岁)	左肾	右肾	最大径(x±s，cm)
mfAML	25	6	19	49.60±10.95	12	13	2.68±0.56
ccRCC	45	28	17	53.67±10.52	21	24	2.92±0.68
统计量		9.399^a		1.527^b	0.011^a		1.506^b
P值		0.002		0.131	0.915		0.137
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组肿瘤患者肿瘤的不均匀度结果比较(x ±s)

组别	例数	平扫HDT	平扫HDP	平扫SHRT	皮质期HDT	皮质期HDP	皮质期SHRT
mfAML	25	13.40±5.19	7.98±2.01	1.74±0.73	28.01±8.77	9.91±1.93	2.91±1.00
ccRCC	45	11.30±3.08	7.86±1.32	1.47±0.44	42.75±13.14	9.89±1.62	4.40±1.31
统计量		-1.850^a	-0.275^a	-1.726^a	5.016^a	-0.048^a	4.928^a
P值		0.073	0.785	0.093	＜0.001	0.962	＜0.001

组别	例数	实质期HDT	实质期HDP	实质期SHRT[M(P₂₅, P₇₅)]	排泄期HDT	排泄期HDP	排泄期SHRT[M(P₂₅, P₇₅)]
mfAML	25	19.78±8.28	7.98±1.86	2.50(1.73, 3.00)	15.88±5.45	8.04±1.53	1.78(1.59, 2.16)
ccRCC	45	25.49±7.02	8.41±1.29	2.84(2.33, 3.79)	19.97±5.42	8.08±1.38	2.49(1.89, 3.05)
统计量		3.054^a	1.159^a	-1.955^b	3.019^a	0.120^a	-3.083^b
P值		0.003	0.250	0.051	0.004	0.905	0.002
注：^a为t值，^b为Z值。

下载: 导出CSV

表 3 2组肿瘤患者肿瘤的常规CT值结果比较(x ±s)

组别	例数	平扫CT值	皮质期CT值[M(P₂₅, P₇₅)]	皮质期ERT	实质期CT值[M(P₂₅, P₇₅)]	实质期ERT	排泄期CT值	排泄期ERT
mfAML	25	38.69±5.58	144.60(133.60, 165.50)	0.78±0.13	101.70(89.40, 111.60)	0.69±0.08	85.88±11.30	0.60±0.11
ccRCC	45	32.70±6.19	153.40(136.80, 189.80)	0.88±0.20	103.70(94.80, 116.40)	0.72±0.13	86.60±17.64	0.64±0.09
统计量		-4.014^a	-1.348^b	2.611^a	-0.503^b	1.390^a	0.184^a	1.229^a
P值		＜0.001	0.178	0.011	0.615	0.169	0.855	0.223
注：^a为t值，^b为Z值。

下载: 导出CSV

参考文献(20)

[1]	SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1): 7-30. doi: 10.3322/caac.21332
[2]	PARK B K. Renal Angiomyolipoma: radiologic classification and imaging features according to the amount of fat[J]. AJR Am J Roentgenol, 2017, 209(4): 826-835. doi: 10.2214/AJR.17.17973
[3]	SASAGURI K, TAKAHASHI N. CT and MR imaging for solid renal mass characterization[J]. Eur J Radiol, 2018, 99: 40-54. doi: 10.1016/j.ejrad.2017.12.008
[4]	HODGDON T, MCINNES M D, SCHIEDA N, et al. Can quantitative CT texture analysis be used to differentiate fat-poor renal angiomyolipoma from renal cell carcinoma on unenhanced CT images?[J]. Radiology, 2015, 276(3): 787-796. doi: 10.1148/radiol.2015142215
[5]	ISHIGAMI K, PAKALNISKIS M G, LEITE L V, et al. Characterization of renal cell carcinoma, oncocytoma, and lipid-poor angiomyolipoma by unenhanced, nephrographic, and delayed phase contrast-enhanced computed tomography[J]. Clin Imaging, 2015, 39(1): 76-84. doi: 10.1016/j.clinimag.2014.09.008
[6]	GUREL S, NARA V, ELSAYES K M, et al. Subtypes of renal cell carcinoma: MRI and pathological features[J]. Diagn Interv Radiol, 2013, 19(4): 304-311. http://pdfs.semanticscholar.org/bf71/bb822574260b60d86e0f6e37dc4c69beb011.pdf
[7]	王旭, 宋歌, 徐一鹏, 等. ≤4 cm非均质性肾乏脂肪型血管平滑肌脂肪瘤与肾透明细胞癌的CT诊断与鉴别[J]. 中国现代医生, 2017, 55(29): 90-94. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201729027.htm
[8]	LIM R S, FLOOD T A, MCINNES M D F, et al. Renal angiomyolipoma without visible fat: Can we make the diagnosis using CT and MRI?[J]. Eur Radiol, 2018, 28(2): 542-553. doi: 10.1007/s00330-017-4988-4
[9]	张亚楠, 高炜, 赵博, 等. 多排螺旋CT多期扫描鉴别常见的小肾癌[J]. 中华肿瘤杂志, 2015, 37(11): 850-854. doi: 10.3760/cma.j.issn.0253-3766.2015.11.011
[10]	王慧, 花蒨蒨, 马腾, 等. 直径≤4 cm肾脏富血供偶发肿瘤的CT鉴别诊断价值[J]. 医学影像学杂志, 2016, 26(3): 481-486. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201603035.htm
[11]	王栋, 曹娜, 唐桂林, 等. 螺旋CT对肾透明细胞癌与乏脂肪血管平滑肌脂肪瘤的诊断价值[J]. 河北医药, 2018, 40(10): 1520-1523. doi: 10.3969/j.issn.1002-7386.2018.10.018
[12]	张靖, 陆建环, 汤晓静, 等. CT对肾脏嫌色细胞癌、嗜酸细胞瘤、乏脂肪血管平滑肌脂肪瘤的诊断价值[J]. 医学影像学杂志, 2016, 26(11): 2038-2042. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201611028.htm
[13]	王超, 王龙胜, 田莹, 等. 肾透明细胞癌与乏脂肪血管平滑肌脂肪瘤的CT鉴别诊断[J]. 实用放射学杂志, 2018, 34(2): 245-248. https://cdmd.cnki.com.cn/Article/CDMD-10366-1016149959.htm
[14]	HERTS B R, COLL D M, NOVICK A C, et al. Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys[J]. AJR Am J Roentgenol, 2002, 178(2): 367-372. http://www.ajronline.org/content/178/2/367.full.pdf
[15]	JUNG S C, CHO J Y, KIM S H. Subtype differentiation of small renal cell carcinomas on three-phase MDCT: usefulness of the measurement of degree and heterogeneity of enhancement[J]. Acta Radiol, 2012, 53(1): 112-118. http://www.onacademic.com/detail/journal_1000037799680510_997e.html
[16]	林燕, 杨学东, 马占姝, 等. CT值不均匀度诊断肾透明细胞癌[J]. 中国医学影像技术, 2015, 31(12): 1894-1897. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201512046.htm
[17]	KIM S H, KIM C S, KIM M J, et al. Differentiation of clear cell renal cell carcinoma from other subtypes and fat-poor angiomyolipoma by use of quantitative enhancement measurement during three-phase MDCT[J]. AJR Am J Roentgenol, 2016, 206(1): 21-28.
[18]	XIE P, YANG Z, YUAN Z. Lipid-poor renal angiomyolipoma: Differentiation from clear cell renal cell carcinoma using wash-in and washout characteristics on contrast-enhanced computed tomography[J]. Oncol Lett, 2016, 11(3): 2327-2331. http://europepmc.org/abstract/MED/26998171
[19]	KOCAK B, YARDIMCI A H, BEKTAS C T, et al. Textural differences between renal cell carcinoma subtypes: Machine learning-based quantitative computed tomography texture analysis with independent external validation[J]. Eur J Radiol, 2018, 107: 149-157. http://www.sciencedirect.com/science/article/pii/S0720048X18302821
[20]	YAN L F, LIU Z Y, WANG G Y, et al. Angiomyolipoma with minimal fat: differentiation from clear cell renal cell carcinoma and papillary renal cell carcinoma by texture analysis on CT images[J]. Acad Radiol, 2015, 22(9): 1115-1121. http://or.nsfc.gov.cn/bitstream/00001903-5/367850/1/1000013622407.pdf