1 Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
AJR Am J Roentgenol. 2013 Nov;201(5):1017-28. doi: 10.2214/AJR.12.10204.
This study was an attempt to identify key CT features that can potentially be used to differentiate between lipid-poor renal angiomyolipoma and renal cell carcinoma (RCC).
We conducted an analysis of patients who received nephrectomy or renal biopsy from 2002 to 2011 with suspected RCC. We included tumors smaller than 7 cm with a completed three-phase CT examination. A radiologist and a urology fellow, blinded to histopathologic diagnosis, recorded the imaging findings by consensus and compared the values for each parameter between lipid-poor angiomyolipoma, RCC subtypes, and RCC as a group. Multivariate logistic regression analysis was performed for each univariate significant feature.
The sample in our study consisted of 132 patients with 135 renal tumors, including 51 men (age range, 26-84 years; mean age, 57 years) and 81 women (age range, 29-91 years; mean age, 57 years). These tumors included 33 lipid-poor angiomyolipomas, 54 clear-cell RCC, 31 chromophobe RCC, and 17 papillary RCC. Multivariate analysis revealed four significant parameters for differentiating RCC as a group from lipid-poor angiomyolipoma (angular interface, p = 0.023; hypodense rim, p = 0.045; homogeneity, p = 0.005; unenhanced attenuation > 38.5 HU, p < 0.001), five for clear-cell RCC, two for chromophobe RCC, and one for papillary RCC. Lipid-poor angiomyolipoma and clear-cell RCC showed early strong enhancement and a washout pattern, whereas chromophobe RCC and papillary RCC showed gradual enhancement over time.
Specific CT features can potentially be used to differentiate lipid-poor renal angiomyolipoma from renal cell carcinoma.
本研究旨在确定潜在的 CT 特征，以区分乏脂性肾血管平滑肌脂肪瘤和肾细胞癌（RCC）。
我们对 2002 年至 2011 年间接受肾切除术或肾活检的疑似 RCC 患者进行了分析。纳入的肿瘤直径小于 7cm，且完成了三期 CT 检查。一名放射科医生和一名泌尿科住院医师在不了解组织病理学诊断的情况下，通过共识记录影像学表现，并比较乏脂性血管平滑肌脂肪瘤、RCC 亚型和 RCC 组之间的每个参数值。对每个单变量有统计学意义的特征进行多变量逻辑回归分析。
本研究样本包括 132 例患者的 135 个肾脏肿瘤，其中 51 例男性（年龄 26-84 岁，平均年龄 57 岁）和 81 例女性（年龄 29-91 岁，平均年龄 57 岁）。这些肿瘤包括 33 个乏脂性血管平滑肌脂肪瘤、54 个透明细胞 RCC、31 个嫌色细胞 RCC 和 17 个乳头状 RCC。多变量分析显示，有 4 个参数对 RCC 组与乏脂性血管平滑肌脂肪瘤进行鉴别具有统计学意义（角状界面，p=0.023；低信号环，p=0.045；均匀性，p=0.005；未增强 CT 值>38.5HU，p<0.001），有 5 个参数对透明细胞 RCC 有鉴别意义，2 个参数对嫌色细胞 RCC 有鉴别意义，1 个参数对乳头状 RCC 有鉴别意义。乏脂性血管平滑肌脂肪瘤和透明细胞 RCC 表现为早期明显强化和廓清模式，而嫌色细胞 RCC 和乳头状 RCC 则表现为逐渐强化。
特定的 CT 特征可能有助于区分乏脂性肾血管平滑肌脂肪瘤和肾细胞癌。
