320 层动态容积 CT 灌注成像鉴别乏脂性血管平滑肌脂肪瘤与肾细胞癌。

Fat poor angiomyolipoma differentiation from renal cell carcinoma at 320-slice dynamic volume CT perfusion.

机构信息

Department of Radiology, PLA Army General Hospital, No. 5 Nanmencang Hutong, Dongcheng District, Beijing, 100700, China.

Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, 200433, China.

出版信息

Abdom Radiol (NY). 2018 May;43(5):1223-1230. doi: 10.1007/s00261-017-1286-1.

DOI:10.1007/s00261-017-1286-1

PMID:28828638

Abstract

PURPOSE

To compare various CT perfusion features of fat poor angiomyolipoma (AML) with those of size-matched renal cell carcinoma (RCC).

METHODS

One hundred and seventy-four patients [16 with fat poor AML (mean diameter, 3.1 cm; range, 1.5-5.5 cm) and 158 with RCC (mean diameter, 3.2 cm; range, 2.4-5.4 cm)] who had undergone 320-slice dynamic volume CT perfusion were evaluated. Equivalent blood volume (BV ), permeability surface-area product (PS), and blood flow (BF) of tumor were measured and analyzed. Fat poor AML was compared with each subtype of RCC (132 clear cell, 9 papillary, and 17 chromophobe). Receiver operating characteristic (ROC) curve analysis was performed for the comparison of fat poor AML and RCC. ROC curve analysis was not performed for the papillary RCC subtype because of the small number of masses of this subtype.

RESULTS

BV and BF were significantly lower in fat poor AML than in clear cell RCC (P < 0.05 for both). Fat poor AML had higher BV , PS, and BF than papillary RCC (P < 0.05 for all). PS and BF in fat poor AML significantly exceeded those in chromophobe RCC (P < 0.05 for both). For differentiating fat poor AML from clear cell RCC, area under the ROC curve (AUC) of BV and BF were 0.82 and 0.69. Using the optimal threshold value, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.82, 0.81, 0.35, 0.97 for BV and 0.71, 0.75, 0.24, 0.96 for BF, respectively. For differentiating fat poor AML from chromophobe RCC, AUC of PS and BF were 0.77 and 0.79, respectively. The optimal sensitivity, specificity, PPV, and NPV were 0.77, 0.75, 0.75, 0.76 for PS and 0.71, 0.81, 0.72, 0.80 for BF, respectively.

CONCLUSIONS

Fat poor AML and subtypes of RCCs demonstrate different perfusion features at 320-slice dynamic volume CT, allowing their differentiations with BV , PS, and BF being valuable perfusion parameters.

摘要

目的

比较乏脂性血管平滑肌脂肪瘤（AML）与大小匹配的肾细胞癌（RCC）的各种 CT 灌注特征。

方法

对 174 例患者[16 例乏脂性 AML（平均直径 3.1cm；范围 1.5-5.5cm）和 158 例 RCC（平均直径 3.2cm；范围 2.4-5.4cm）]进行了 320 层动态容积 CT 灌注评估。测量并分析肿瘤的等效血容量（BV）、渗透性表面积乘积（PS）和血流（BF）。将乏脂性 AML 与 RCC 的每种亚型（132 例透明细胞、9 例乳头状和 17 例嫌色细胞）进行比较。对乏脂性 AML 和 RCC 进行受试者工作特征（ROC）曲线分析。由于乳头状 RCC 亚型的肿块数量较少，因此未对其进行 ROC 曲线分析。

结果

乏脂性 AML 的 BV 和 BF 明显低于透明细胞 RCC（均 P<0.05）。乏脂性 AML 的 BV、PS 和 BF 均高于乳头状 RCC（均 P<0.05）。PS 和 BF 在乏脂性 AML 中显著高于嫌色细胞 RCC（均 P<0.05）。用于区分乏脂性 AML 和透明细胞 RCC，BV 和 BF 的 ROC 曲线下面积（AUC）分别为 0.82 和 0.69。使用最佳阈值，BV 的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 0.82、0.81、0.35、0.97，BF 分别为 0.71、0.75、0.24、0.96。用于区分乏脂性 AML 和嫌色细胞 RCC，PS 和 BF 的 AUC 分别为 0.77 和 0.79。PS 和 BF 的最佳灵敏度、特异性、PPV 和 NPV 分别为 0.77、0.75、0.75、0.76 和 0.71、0.81、0.72、0.80。