Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, United States.
Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, United States.
Eur J Radiol. 2014 Feb;83(2):239-44. doi: 10.1016/j.ejrad.2013.10.020. Epub 2013 Oct 27.
To assess impact of size of regions-of-interest (ROI) on differentiation of RCC and renal cysts using multi-phase CT, with focus on differentiating papillary RCC (pRCC) and cysts given known hypovascularity of pRCC.
99 renal lesions (23 pRCC, 47 clear-cell RCC, 7 chromophobe RCC, 22 cysts) underwent multi-phase CT. Subjective presence of visual enhancement was recorded for each lesion. Whole-lesion (WL) ROIs, and small (≤ 5 mm(2)), medium (average size of small and large ROIs), and large (half of lesion diameter) peripherally located partial-lesion (PL) ROIs, were placed on non-contrast and nephrographic phases. Impact of ROI size in separating cysts from all RCC and from pRCC based on increased attenuation between phases was assessed using ROC analysis.
Visual enhancement was perceived in 96% of ccRCC, 61% of pRCC, and 9% of cysts. AUCs for separating all RCC and cysts for WL-ROI and small, medium, and large PL-ROIs were 91%, 96%, 91% and 93%, and among lesions without visible enhancement were 60%, 79%, 67% and 67%. AUCs for separating pRCC and cysts for WL-ROI and small, medium, and large PL-ROIs were 78%, 92%, 82% and 84%, and among lesions without visible enhancement were 64%, 88%, 69% and 69%.
Small PL-ROIs had higher accuracy than WL-ROI or other PL-ROIs in separating RCC from cysts, with greater impact in differentiating pRCC from cysts and differentiating lesions without visible enhancement. Thus, when evaluating renal lesions using multi-phase CT, we suggest placing small peripheral ROIs for highest accuracy in distinguishing renal malignancy and benign cysts.
本研究旨在评估使用多期 CT 评估 ROI 大小对 RCC 和肾囊肿鉴别诊断的影响，重点关注 RCC 中因乏血供而具有特征性表现的乳头状 RCC（pRCC）和囊肿的鉴别诊断。
99 个肾脏病变（23 个 pRCC、47 个透明细胞 RCC、7 个嫌色细胞 RCC、22 个囊肿）进行了多期 CT 检查。记录每个病变的视觉增强的主观存在。在非对比和肾实质期放置全病变（WL）ROI 以及小（≤ 5mm2）、中（小和大 ROI 的平均大小）和大（病变直径的一半）外周部分病变（PL）ROI。使用 ROC 分析评估 ROI 大小在根据各期之间的衰减差异区分囊肿和所有 RCC 以及 pRCC 中的作用。
96%的 ccRCC、61%的 pRCC 和 9%的囊肿中存在视觉增强。用于区分所有 RCC 和囊肿的 WL-ROI 和小、中、大 PL-ROI 的 AUC 分别为 91%、96%、91%和 93%，而无可见增强的病变 AUC 分别为 60%、79%、67%和 67%。用于区分 pRCC 和囊肿的 WL-ROI 和小、中、大 PL-ROI 的 AUC 分别为 78%、92%、82%和 84%，而无可见增强的病变 AUC 分别为 64%、88%、69%和 69%。
在区分 RCC 和囊肿时，小 PL-ROI 的准确性高于 WL-ROI 或其他 PL-ROI，在区分无可见增强的病变方面具有更大的影响。因此，在使用多期 CT 评估肾脏病变时，我们建议放置小的外周 ROI，以获得最高的准确性，用于区分肾脏恶性肿瘤和良性囊肿。
