Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA.
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Abdom Radiol (NY). 2017 Jul;42(7):1911-1918. doi: 10.1007/s00261-017-1091-x.
To investigate whether multiphasic MDCT enhancement can help differentiate type 1 papillary renal cell carcinoma (RCC) from type 2 papillary RCC.
With IRB approval for this HIPAA-compliant retrospective study, we derived a cohort of 36 type 1 papillary RCCs and 33 type 2 papillary RCCs with preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory) from 2000 to 2013. Following segmentation, a computer-assisted detection (CAD) algorithm selected a 0.5 cm-diameter region of maximal attenuation within each lesion in each phase; a 0.5 cm-diameter region of interest was manually placed on uninvolved renal cortex in each phase. The relative attenuation of each lesion was calculated as [(Lesion attenuation-cortex attenuation)/cortex attenuation] × 100. Absolute and relative attenuation values were compared using Mann-Whitney tests with Bonferroni correction for multiple comparisons.
Relative excretory phase attenuation of type 2 papillary RCCs was significantly greater than that of type 1 papillary RCCs (2.0 vs. -18.3, p = 0.005). Relative excretory phase attenuation differentiated type 1 papillary RCCs from type 2 papillary RCCs with an accuracy of 73% (36/49), sensitivity of 87% (26/30), positive predictive value of 74% (26/35), and negative predictive value of 71% (10/14).
Multiphasic MDCT enhancement may assist in differentiating type 1 papillary RCCs from type 2 papillary RCCs, if prospectively validated.
探讨多期 MDCT 增强是否有助于鉴别 1 型和 2 型乳头状肾细胞癌（RCC）。
本 HIPAA 合规性回顾性研究经机构审查委员会批准，我们从 2000 年至 2013 年的多期 MDCT（包括平扫、皮质期、肾实质期和排泄期）中提取了 36 例 1 型和 33 例 2 型乳头状 RCC 患者的队列。分割后，计算机辅助检测（CAD）算法在每个相位的每个病变中选择最大衰减直径为 0.5cm 的区域；在每个相位的正常肾皮质中手动放置一个 0.5cm 直径的感兴趣区。病变的相对衰减值计算为 [(病变衰减-皮质衰减)/皮质衰减]×100。使用 Mann-Whitney 检验比较相对和绝对衰减值，并使用 Bonferroni 校正进行多重比较。
2 型乳头状 RCC 的排泄期相对衰减明显大于 1 型（2.0 对-18.3，p=0.005）。排泄期相对衰减鉴别 1 型和 2 型乳头状 RCC 的准确率为 73%（36/49），灵敏度为 87%（26/30），阳性预测值为 74%（26/35），阴性预测值为 71%（10/14）。
如果前瞻性验证，多期 MDCT 增强可能有助于鉴别 1 型和 2 型乳头状 RCC。
