[1]陈佳,张曦,龚明福,等.多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断[J].第三军医大学学报,2020,42(18):1842-1847.
 CHEN Jia,ZHANG Xi,GONG Mingfu,et al.Differential diagnosis of common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in multislice spiral CT [J].J Third Mil Med Univ,2020,42(18):1842-1847.
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多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第18期
页码:
1842-1847
栏目:
临床医学
出版日期:
2020-09-30

文章信息/Info

Title:
Differential diagnosis of common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in multislice spiral CT
 
作者:
陈佳张曦龚明福文利
陆军军医大学(第三军医大学)第二附属医院放射科
Author(s):
CHEN Jia ZHANG Xi GONG Mingfu WEN Li

Department of Radiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
肾细胞癌组织学亚型多层螺旋CT增强扫描
Keywords:
renal cell carcinoma histological subtypes multislice spiral CT enhanced scan
分类号:
R730.42;R737.11;R814.42
文献标志码:
A
摘要:

目的探讨基于螺旋CT多期扫描成像中矫正CT值及矫正相对强化率对常见4种肾细胞癌亚型鉴别的可行性。方法回顾性分析本院2017年8月至2019年6月经病理证实的肾细胞癌患者76例临床资料,其中肾透明细胞癌(clear cell renal cell carcinoma, ccRCC)28例、乳头状细胞癌(papillary renal cell carcinoma, PRCC)Ⅰ型24例、乳头状细胞癌Ⅱ型(PRCCⅡ型)6例、嫌色细胞癌(chromophobe renal cell carcinoma, ChRCC)18例,测量、计算各亚型间CT增强扫描各期矫正CT值、相对强化率,进行统计学分析并绘制受试者工作特征(receiver operator characteristic, ROC)曲线。结果各亚型平扫CT值差异均无统计学意义(P>0.05)。增强扫描ccRCC皮髓质期矫正CT值为(110.68±45.62)Hu、相对强化率为(3.19±1.41),显著高于其他亚型(P<0.01)。实质期、排泄期ccRCC矫正CT值分别为(95.36±25.02)Hu、(74.01±16.10)Hu,相对强化率分别为(2.82±1.03)、(2.19±0.71),均高于PRCCⅠ、PRCCⅡ型(P<0.05)。PRCCⅠ型与PRCCⅡ型间各期CT矫正值及相对强化率差异均无统计学意义(P>0.05)。ChRCC各期矫正CT值及相对强化率介于ccRCC与PRCC之间,皮髓质期其矫正CT值与相对强化率高于PRCCⅡ型(P<0.05),实质期矫正CT值高于PRCCⅠ型、PRCCⅡ型(P<0.05)。皮髓质期相对强化率为2.56、2.28、1.25时,ccRCC与ChRCC、PRCCⅠ型、PRCCⅡ型鉴别的敏感性分别为78.6%、95.8%、100.0%,特异性分别为94.4%、78.6%、92.9%。实质期相对强化率为1.64时,鉴别ChRCC与PRCCⅠ型、PRCCⅡ型的敏感性、特异性分别为75.0%、83.3%。结论不同肾癌亚型强化方式各有特点,螺旋CT多期扫描矫正后CT值及矫正后相对强化率有助于提升鉴别各肾癌亚型能力,但PRCCⅠ型与PRCCⅡ型的鉴别有一定困难。

Abstract:

ObjectiveTo explore the feasibility of differentiating 4 common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in spiral CT multiphase scanning. MethodsWe retrospectively analyzed the clinical data of 76 patients with pathologically confirmed renal cell carcinoma, including 28 with clear cell renal cell carcinoma (ccRCC), 24 with papillary renal cell carcinoma type Ⅰ (PRCCⅠ), 6 with papillary renal cell carcinoma type Ⅱ (PRCC Ⅱ) and 18 with chromophobe renal cell carcinoma (ChRCC). The CT values in different phases in spiral CT multiphase scanning were measured to calculate the corrected CT values and relative enhancement rates, whose sensitivity and specificity for differentiating the subtypes of renal cell carcinoma were analyzed using receiver operating characteristic (ROC) curve analysis. ResultsNo significant difference was found in unenhanced CT values among different subtypes of renal cell carcinoma. For ccRCC, the corrected CT value was 110.68±45.62 Hu and the corrected relative enhancement rate was 3.19±1.41 in the corticomedullary phase, significantly higher than those of the other subtypes (P<0.01). In the nephrographic and excretory phases, the corrected CT values of ccRCC were 95.36±25.02 Hu and 74.01±16.10 Hu and the corrected relative enhancement rates were 2.82±1.03 and 2.19±0.71, respectively, all significantly higher than those of PRCC Ⅰ and PRCC Ⅱ (P<0.05) but comparable with those of ChRCC. The corrected CT value or relative enhancement rate in each phase did not differ significantly between PRCC Ⅰ and PRCC Ⅱ. The corrected CT value and relative enhancement rate of ChRCC in each phase were lower than those of ccRCC but higher than those of PRCC; these values in the corticomedullary phase were significantly higher than those of PRCC Ⅱ (P<0.05), and the corrected CT value of ChRCC was significantly higher than that of PRCCI and PRCCII (P<0.05). At the cutoff values of 2.56, 2.28, and 1.25, the relative enhancement rates in the corticomedullary phase had sensitivities of 78.6%, 95.8% and 100.0% for differentiating ccRCC from ChRCC, PRCC Ⅰ and PRCC Ⅱ, with specificities of 94.4%, 78.6% and 92.9%, respectively. At the cutoff value of 1.64, the corrected relative enhancement rate in the nephrographic phase could effectively distinguish ChRCC from PRCC Ⅰ and PRCC Ⅱ with a sensitivity of 75.0% and a specificity of 83.3%. ConclusionThe subtypes of renal cell carcinoma have their specific enhancement characteristics. Multiphase spiral CT scanning has an important value for differentiating these subtypes, and the corrected CT value and relative enhancement rate can help to improve the accuracy of the differential diagnosis, but the differentiation between PRCC Ⅰ and PRCC Ⅱ remains difficult.

参考文献/References:

[1]LOW G, HUANG G, FU W, et al. Review of renal cell carcinoma and its common subtypes in radiology[J]. World J Radiol, 2016, 8(5): 484-500. DOI: 10.4329/wjr.v8.i5.484.

[2]CHING B C, TAN H S, TAN P H, et al. Differential radiologic characteristics of renal tumours on multiphasic computed tomography[J]. Singapore Med J, 2017, 58(5): 262-266. DOI: 10.11622/smedj.2016081.

[3]OUYANG A M, WEI Z L, SU X Y, et al. Relative computed tomography (CT) enhancement value for the assessment ofmicrovascular architecture in renal cell carcinoma[J]. Med Sci Monit, 2017, 23: 3706-3714. DOI: 10.12659/MSM.902957.

[4]ERTEKIN E, AMASYALI A S, EROL B, et al. Role of contrast enhancement and corrected attenuation values of renal tumors in predicting renal cell carcinoma (RCC) subtypes: protocol for atriphasic multislice computed tomography (CT) procedure[J]. Pol J Radiol, 2017, 82: 384-391. DOI: 10.12659/PJR.901957.

[5]RUPPERTKOHLMAYR A J, UGGOWITZER M, MEISSNITZER T, et al. Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters[J]. Am J Roentgenol, 2004, 183(5): 1387-1391. DOI: 10.2214/ajr.183.5.1831387.

[6]VELOSO GOMES F, MATOS A P, PALAS J, et al. Renal cell carcinoma subtype differentiation using singlephasecorticomedullary contrastenhanced CT[J]. Clin Imaging, 2015, 39(2): 273-277. DOI: 10.1016/j.clinimag.2014.09.007.

[7]YOUNG J R, MARGOLIS D, SAUK S, et al. Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT[J]. Radiology, 2013, 267(2): 444-453. DOI: 10.1148/radiol.13112617.

[8]朱黎, 李迎春, 赵新湘. 不同亚型肾细胞癌的MRI及CT表现[J]. 临床放射学杂志, 2018, 37(5): 793-797. DOI: 10.13437/j.cnki.jcr.2018.05.019.

ZHU L, LI Y C, ZHAO X X. The performance of MRI and CT in the diagnosis of different subtypes of renal cell carcinoma[J]. J Clin Radiol, 2018, 37(5): 793-797. DOI: 10.13437/j.cnki.jcr.2018.05.019.

[9]OKALJ I, MAROTTI M, KOLARIC' B. Pretreatment differentiation of renal cell carcinoma subtypes by CT: the influence of different tumor enhancement measurementapproaches[J]. Int Urol Nephrol, 2014, 46(6): 1089-1100. DOI: 10.1007/s1125501306318.

[10]COY H, YOUNG J R, DOUEK M L, et al. Association of qualitative and quantitative imaging features on multiphasicmultidetector CT with tumor grade in clear cell renal cell carcinoma[J]. Abdom Radiol, 2019, 44(1): 180-189. DOI: 10.1007/s0026101816888.

[11]BINDAYI A, MCDONALD M L, BEKSAC A T, et al. Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2?[J]. Turkish J Urol, 2018, 44(4): 316-322. DOI: 10.5152/tud.2018.28938.

[12]王君广, 周赵霞, 张夏, 等. 不同亚型乳头状肾细胞癌CT影像鉴别与病理对照研究[J]. 实用放射学杂志, 2019, 35(3): 418-421. DOI: 10.3969/j.issn.10021671.2019.03.020.

WANG J G, ZHOU Z X, ZHANG X, et al. Differential and pathological study of different subtypes of papillary renal cell carcinoma by CT imaging [J]. J Pract Radiol, 2019, 35(3): 418-421. DOI: 10.3969/j.issn.10021671.2019.03.020.

[13]RAMAN S P, JOHNSON P T, ALLAF M E, et al.Chromophobe renal cell carcinoma: multiphase MDCT enhancement patterns and morphologic features[J]. Am J Roentgenol, 2013, 201(6): 1268-1276. DOI: 10.2214/AJR.13.10813.

[14]KIM J H, BAE J H, LEE K W, et al. Predicting the histology of small renal masses using preoperative dynamic contrastenhanced magnetic resonance imaging[J]. Urology, 2012, 80(4): 872-876. DOI: 10.1016/j.urology.2012.06.001.

[15]张学勇, 王明杰, 李旭丹, 等. 肾脏嫌色细胞癌的影像学分析[J]. 医学影像学杂志, 2018, 28(5): 790-793.

ZHANG X Y, WANG M J, LI X D, et al. Imaging analysis of chromophobe renal cell carcinoma[J]. J Med Imaging, 2018, 28(5): 790-793.

[16]刘学玲, 邹新农, 陈宏伟, 等. 多排螺旋CT动态增强扫描对乳头状肾细胞癌与嫌色细胞肾癌的鉴别诊断价值[J]. 中华肿瘤杂志, 2015, 37(1): 52-56. DOI: 10.3760/cma.j.issn.02533766.2015.01.011.

LIU X L, ZOU X N, CHEN H W, et al. Diagnostic value ofmultdetector CT for papillary renal cell carcinoma and chromophobe renal cell carcinoma[J]. Chin J Oncol, 2015, 37(1): 52-56. DOI: 10.3760/cma.j.issn.02533766.2015.01.011.

更新日期/Last Update: 2020-09-22