含少量脂肪的肾血管平滑肌脂肪瘤：在双回波化学位移快速低角度激发磁共振成像中与其他肿瘤的鉴别
Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MR imaging.
作者信息
Kim Jeong Kon, Kim Soo Hyun, Jang Yoon Jin, Ahn Hanjong, Kim Choung-Soo, Park Hyungkeun, Lee Jun Woo, Kim Suk, Cho Kyoung-Sik
机构信息
Departments of Radiology and Urology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
出版信息
Radiology. 2006 Apr;239(1):174-80. doi: 10.1148/radiol.2391050102. Epub 2006 Feb 28.
PURPOSE
To prospectively evaluate the diagnostic performance of double-echo gradient-echo (GRE) chemical shift magnetic resonance (MR) imaging in the differentiation of angiomyolipoma (AML) with minimal fat from other renal neoplasms, with pathologic examination or follow-up data serving as the reference standard.
MATERIALS AND METHODS
Institutional review board approval and informed consent were obtained. Double-echo GRE chemical shift MR imaging was performed in 55 patients (29 men and 26 women; mean age, 49 years +/- 14 [standard deviation]) with 55 renal tumors, including 37 (67%) pathologically proved tumors (23 renal cell carcinomas, nine AMLs, two oncocytomas, two lymphomas, and one reninoma) and 18 (33%) clinically diagnosed tumors (17 AMLs and one indeterminate malignancy). All tumors showed no intratumoral fat and had homogeneous enhancement and a prolonged or gradual enhancement pattern on biphasic helical computed tomographic scans. Signal intensity was measured in the renal tumor and spleen on in-phase and opposed-phase images. The signal intensity index and tumor-to-spleen ratio in AMLs and non-AMLs were calculated and compared with the Student t test. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic accuracy of the signal intensity index and tumor-to-spleen ratio and to extract the optimal cut-off values in the differentiation of AMLs and non-AMLs.
RESULTS
The signal intensity index and tumor-to-spleen ratio were different between AMLs (42% +/- 11 and -43% +/- 17, respectively) and non-AMLs (5% +/- 14 and -4% +/- 16, respectively) (P < .001). The area under the ROC curve was 0.975 for the signal intensity index and 0.952 for the tumor-to-spleen ratio. For differentiation of AMLs from non-AMLs, sensitivity and specificity were (a) 96% and 93%, respectively, with a signal intensity index of 25% and (b) 88% and 97%, respectively, with a tumor-to-spleen ratio of -32%.
CONCLUSION
Double-echo GRE chemical shift MR imaging can be used to differentiate AML with minimal fat from other renal neoplasms.
目的
前瞻性评估双回波梯度回波（GRE）化学位移磁共振（MR）成像在鉴别脂肪含量极少的血管平滑肌脂肪瘤（AML）与其他肾肿瘤中的诊断性能，以病理检查或随访数据作为参考标准。
材料与方法
获得机构审查委员会批准并取得知情同意。对55例患者（29例男性和26例女性；平均年龄49岁±14[标准差]）的55个肾肿瘤进行双回波GRE化学位移MR成像，其中包括37个（67%）经病理证实的肿瘤（23例肾细胞癌、9例AML、2例嗜酸细胞瘤、2例淋巴瘤和1例肾素瘤）和18个（33%）临床诊断的肿瘤（17例AML和1例未明确的恶性肿瘤）。所有肿瘤在双期螺旋计算机断层扫描上均未显示瘤内脂肪，具有均匀强化且呈延迟或渐进性强化模式。在同相位和反相位图像上测量肾肿瘤和脾脏的信号强度。计算AML和非AML的信号强度指数及肿瘤与脾脏比值，并采用Student t检验进行比较。进行受试者操作特征（ROC）分析以评估信号强度指数和肿瘤与脾脏比值的诊断准确性，并提取鉴别AML和非AML的最佳截断值。
结果
AML（分别为42%±11和-43%±17）与非AML（分别为5%±14和-4%±16）之间的信号强度指数及肿瘤与脾脏比值存在差异（P<.001）。信号强度指数的ROC曲线下面积为0.975，肿瘤与脾脏比值的ROC曲线下面积为0.952。对于鉴别AML与非AML，（a）信号强度指数为25%时，敏感性和特异性分别为96%和93%；（b）肿瘤与脾脏比值为-32%时，敏感性和特异性分别为88%和97%。
结论
双回波GRE化学位移MR成像可用于鉴别脂肪含量极少的AML与其他肾肿瘤。
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