Young Jonathan R, Young Jocelyn A, Margolis Daniel J A, Sauk Steven, Sayre James, Pantuck Allan J, Raman Steven S
Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437.
Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7437.
Acad Radiol. 2017 Oct;24(10):1226-1232. doi: 10.1016/j.acra.2017.03.017. Epub 2017 May 18.
To investigate whether imaging features on multiphasic multidetector computed tomography (MDCT) can help discriminate sarcomatoid renal cell carcinoma (RCC) and collecting duct carcinoma (CDC) from other solid renal masses.
With institutional review board approval for this HIPAA-compliant study, we derived a cohort of 7 sarcomatoid RCCs, 4 CDCs, 165 clear cell RCCs, 56 papillary RCCs, 22 chromophobe RCCs, 49 oncocytomas, and 16 lipid-poor angiomyolipomas with preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory). Each lesion was reviewed for contour, spread pattern, pattern of enhancement, neovascularity, and calcification.
Sarcomatoid RCCs and CDCs were more likely than other solid renal masses to have an irregular contour (64% vs 2%, P < 0.001) and an infiltrative spread pattern, defined as infiltration into adjacent renal parenchyma, collecting system, or neighboring structures (82% vs 7%, P < 0.001). When used to discriminate sarcomatoid RCC and CDC from other solid renal masses, an infiltrative spread pattern had a specificity of 93% (287/308) and sensitivity of 82% (9/11), and an irregular contour had a specificity of 98% (303/308) and sensitivity of 64% (7/11).
Solid renal lesions with an irregular contour or an infiltrative spread pattern are suspicious for sarcomatoid RCC or CDC.
研究多期多层螺旋计算机断层扫描（MDCT）的影像特征是否有助于鉴别肾肉瘤样肾细胞癌（RCC）和集合管癌（CDC）与其他实性肾肿块。
经机构审查委员会批准进行这项符合健康保险流通与责任法案（HIPAA）的研究，我们纳入了一组病例，其中包括7例肾肉瘤样RCC、4例CDC、165例透明细胞RCC、56例乳头状RCC、22例嫌色细胞RCC、49例嗜酸细胞瘤和16例乏脂性血管平滑肌脂肪瘤，所有病例术前行多期MDCT检查，最多包括四期（平扫、皮髓质期、肾实质期和排泄期）。对每个病变的轮廓、扩散方式、强化方式、新生血管和钙化情况进行评估。
肾肉瘤样RCC和CDC比其他实性肾肿块更易出现不规则轮廓（64% 对2%，P < 0.001）和浸润性扩散方式，浸润性扩散方式定义为浸润至相邻肾实质、集合系统或邻近结构（82% 对7%，P < 0.001）。当用于鉴别肾肉瘤样RCC和CDC与其他实性肾肿块时，浸润性扩散方式的特异性为93%（287/308），敏感性为82%（9/11）；不规则轮廓的特异性为98%（303/308），敏感性为64%（7/11）。
具有不规则轮廓或浸润性扩散方式的实性肾病变怀疑为肾肉瘤样RCC或CDC。
