Moldovanu Claudia-Gabriela, Petresc Bianca, Lebovici Andrei, Tamas-Szora Attila, Suciu Mihai, Crisan Nicolae, Medan Paul, Buruian Mircea Marian
Department of Radiology and Medical Imaging, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania.
Department of Radiology, Emergency Clinical County Hospital of Cluj-Napoca, 400006 Cluj-Napoca, Romania.
Medicina (Kaunas). 2020 Oct 28;56(11):569. doi: 10.3390/medicina56110569.
: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. : A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. : Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924-0.995) and 0.827 (95% CI: 0.752-0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555-0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929-0.993) and 0.799 (95% CI: 0.721-0.864), respectively. : Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses.
使用非侵入性技术预测肾肿块的组织学类型可避免进行肾肿块活检，因此具有重大临床意义。我们研究的目的是评估肾肿块（恶性和良性）的多期多层螺旋计算机断层扫描（MDCT）定量增强模式是否有助于通过其增强特征来鉴别病变。
采用四期MDCT方案对154例肾肿瘤进行回顾性分析。我们使用肿瘤增强最明显部分内的值（二维分析）和整个肿瘤体积内的值（三维分析）来研究衰减值。还在相邻未受累的肾皮质中放置感兴趣区（ROI）以计算相对肿瘤增强率。
根据组织学观察，增强和消退（对比剂注射后各期之间衰减测量值的减小）值存在显著差异。在透明细胞肾细胞癌（ccRCC）和乳头状肾细胞癌（pRCC）/嗜酸细胞瘤之间，分别显示出最高的受试者工作特征曲线下面积（AUC），分别为0.976（95%CI：0.924 - 0.995）和0.827（95%CI：0.752 - 0.887）。三维分析能够区分ccRCC与嫌色肾细胞癌（chrRCC），AUC为0.643（95%CI：0.555 - 0.724）。洗脱值仅对区分ccRCC和嗜酸细胞瘤有用（43.34对64.10，<0.001）。然而，相对肿瘤增强率（皮质髓质期（CM）和肾实质期）对区分ccRCC、pRCC和chrRCC有用，CM期的值具有更高的AUC，分别为0.973（95%CI：0.929 - 0.993）和0.799（95%CI：0.721 - 0.864）。
我们的观察结果指出，影像学特征可能有助于提供对肾肿块管理策略有用的预后信息。
