Liu Xueling, Zou Xinnong, Chen Hongwei, Fang Xiangming, Hu Xiaoyun, Sun Rongchao
Imaging Center, Wuxi People's Hospital, Nanjing Medical University, Wuxi 214023, China.
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Zhonghua Zhong Liu Za Zhi. 2015 Jan;37(1):52-6.
To explore the significance of multi-detector CT (MDCT) in differential diagnosis of papillary renal cell carcinoma and chromophobe renal cell carcinoma.
Clinical data of forty-one cases of renal cancers confirmed pathologically were collected, including 21 cases of papillary renal cell carcinoma (PRCC) (14 type I, 7 type II) and 20 cases of chromophobe renal cell carcinoma (ChRCC). Their morphological and MDCT characteristics were retrospectively analyzed. Receiver operator characteristic curve (ROC) was used to analyze the value of MDCT in differential diagnosis of PRCC and ChRCC. Two senior radiologists analyzed the morphological and the dynamic enhancement characteristics of the images. The attenuation of the lesions and the adjacent renal parenchyma were measured. The morphological indexes were compared with chi-square test and the quantitative indexes were compared with independent sample T-test. Receiver operator characteristic curve (ROC) was used to analyze the sensitivity, specificity and accuracy of diagnosis of PRCC and ChRCC.
Angioid enhancement and filled enhancement were more common in ChRCC than in PRCC, while delayed enhancement was more often seen in PRCC than in ChRCC. Calcification was more common in type I than type II PRCC. The enhancement value (ΔCT value) in corticomedullary phase was (29.08 ± 20.12) Hu for PRCC, significantly lower than the (48.29 ± 26.70) Hu for ChRCC (t = -2.611, P = 0.013). The ΔCT value of type I PRCC in corticomedullary phase was (26.36 ± 18.16) Hu, showing a significant difference from that of ChRCC (t = -2.666, P = 0.012). The lesion to kidney ratio (LKR) in corticomedullary phase was 0.44 ± 0.19 for PRCC and 0.58 ± 0.15 for ChRCC, with a significant difference between them (t = -2.587, P = 0.014). The LKR of type I PRCC in corticomedullary phase was 0.39 ± 0.15, showing a significant difference from that of ChRCC (t = -3.628, P = 0.001). The difference value (D-value) of the attenuation of lesion between corticomedullary and nephrographic phases was (-3.69 ± 8.90) Hu for PRCC and (8.39 ± 21.98) Hu for ChRCC, with a significant difference between them (t = -2.285, P = 0.031). The D-value of type I PRCC was (-4.55 ± 9.82) Hu, showing a significant difference from that of ChRCC (t = -2.323, P = 0.028). There was no significant difference between the ΔCT, LKR and D-value of the type II PRCC and ChRCC (P > 0.05 for all). The area under the curve (AUC) for ΔCT value, LKR value in corticomedullary phase, and D-value were 0.718, 0.751 and 0.668, respectively, and there were no significant differences among them (z values were 0.896, 0.683 and 0.559, respectively, and P values were 0.370, 0.495 and 0.576, respectively). Using 49.350 Hu as the cutoff value for ΔCT value in corticomedullary phase, resulted in a sensitivity, specificity and accuracy of 50.0%, 90.5% and 70.7%, respectively. Corresponding values were 65.0%, 81.0% and 73.2%, when using a cutoff value of 0.532 for LKR in corticomedullary phase, and were 60.0%, 76.2% and 68.3%, when using a D-value of 0.400 Hu.
The ΔCT value, LKR value in corticomedullary phase, and the D-value are all useful indexes for the differentiation of PRCC and ChRCC.
探讨多排螺旋CT（MDCT）在鉴别诊断乳头状肾细胞癌和嫌色细胞肾细胞癌中的意义。
收集41例经病理证实的肾癌患者的临床资料，其中乳头状肾细胞癌（PRCC）21例（I型14例，II型7例），嫌色细胞肾细胞癌（ChRCC）20例。回顾性分析其形态学及MDCT特征。采用受试者操作特征曲线（ROC）分析MDCT在PRCC和ChRCC鉴别诊断中的价值。由两位资深放射科医生分析图像的形态学及动态增强特征，测量病变及相邻肾实质的衰减值。形态学指标采用卡方检验比较，定量指标采用独立样本T检验比较。采用ROC曲线分析PRCC和ChRCC诊断的敏感性、特异性和准确性。
嫌色细胞肾细胞癌中血管样强化和填充强化较乳头状肾细胞癌更常见，而延迟强化在乳头状肾细胞癌中较嫌色细胞肾细胞癌更常见。I型PRCC钙化较II型更常见。PRCC皮质髓质期强化值（ΔCT值）为（29.08±20.12）Hu，显著低于ChRCC的（48.29±26.70）Hu（t=-2.611，P=0.013）。I型PRCC皮质髓质期ΔCT值为（26.36±18.16）Hu，与ChRCC有显著差异（t=-2.666，P=0.012）。PRCC皮质髓质期病变与肾脏比值（LKR）为0.44±0.19，ChRCC为0.58±0.15，两者有显著差异（t=-2.587，P=0.014）。I型PRCC皮质髓质期LKR为0.39±\alpha0.15，与ChRCC有显著差异（t=-3.628，P=0.001）。PRCC皮质髓质期与肾实质期病变衰减差值（D值）为（-3.69±8.90）Hu，ChRCC为（8.39±21.98）Hu，两者有显著差异（t=-2.285，P=0.031）。I型PRCC的D值为（-4.55±9.82）Hu，与ChRCC有显著差异（t=-2.323，P=0.028）。II型PRCC与ChRCC的ΔCT、LKR和D值无显著差异（P均>0.05）。皮质髓质期ΔCT值、LKR值和D值的曲线下面积（AUC）分别为0.718、0.751和0.668，三者之间无显著差异（z值分别为0.896、0.683和0.559，P值分别为0.370、0.495和0.576）。以皮质髓质期ΔCT值49.350 Hu为截断值时，敏感性、特异性和准确性分别为50.0%、90.5%和70.7%。以皮质髓质期LKR值0.532为截断值时，相应值分别为65.0%、81.0%和73.2%；以D值0. Hu为截断值时，相应值分别为60.0%、76.2%和68.3%。
皮质髓质期ΔCT值、LKR值和D值均是鉴别PRCC和ChRCC的有用指标。
