Kim Cherry, Choi Hyuck Jae, Cho Kyoung-Sik
From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Comput Assist Tomogr. 2014 Mar-Apr;38(2):268-73. doi: 10.1097/RCT.0b013e3182aa672a.
This study aimed to evaluate the diagnostic performance of multidetector computed tomography (MDCT) for preoperative evaluation of perinephric fat invasion in patients with renal cell carcinomas (RCCs).
A total of 408 consecutive patients with surgically confirmed RCC who underwent MDCT were included in this study. Image analysis was first performed with axial-only CT images. A second analysis was then performed with both axial and coronal CT images. A qualitative analysis was then conducted by 2 reviewers who reached consensus. The reference standard was pathologic evaluation.
The areas under the curve of the receiver operating characteristic analysis were 0.786 and 0.877 for axial-only images and 0.805 and 0.836 for combined images in both readers. The area under the curve of tumor size was 0.833, a similar value to that of the reviewers. In multivariate analysis, tumor size, a linear-nodular or nodular type of fat infiltration, and an irregular tumor margin were independent predicting factors for perinephric fat invasion.
The MDCT shows relatively high diagnostic performance in detecting perinephric fat invasion of RCC, but suffers from a relatively low positive predictive value. Tumor size, fat infiltration with a nodular appearance, and an irregular tumor margin were predictors for perinephric invasion.
本研究旨在评估多排螺旋计算机断层扫描（MDCT）对肾细胞癌（RCC）患者术前肾周脂肪浸润评估的诊断性能。
本研究纳入了408例经手术证实的RCC且接受了MDCT检查的连续患者。首先仅使用轴向CT图像进行图像分析。然后使用轴向和冠状CT图像进行第二次分析。随后由2名达成共识的阅片者进行定性分析。参考标准为病理评估。
在两位阅片者中，仅轴向图像的受试者操作特征分析曲线下面积分别为0.786和0.877，联合图像的曲线下面积分别为0.805和0.836。肿瘤大小的曲线下面积为0.833，与阅片者的结果相似。在多变量分析中，肿瘤大小、线性结节状或结节状脂肪浸润类型以及不规则肿瘤边缘是肾周脂肪浸润的独立预测因素。
MDCT在检测RCC的肾周脂肪浸润方面显示出相对较高的诊断性能，但阳性预测值相对较低。肿瘤大小、结节状脂肪浸润以及不规则肿瘤边缘是肾周浸润的预测因素。
