Ankara City Hospital, Üniversiteler mh. Bilkent cd. No: 1, 06800 Çankaya, Ankara, Turkey.
Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Zeynep Kamil mh. Dr. Burhanettin Üstünel Sokağı No: 10, 34668 Üsküdar, İstanbul, Turkey.
Niger J Clin Pract. 2021 Apr;24(4):489-495. doi: 10.4103/njcp.njcp_242_20.
To investigate the accuracy of multidetector computed tomography (MDCT) findings, and the effect of tumor volume in determining the perinephric and renal sinus invasion in clear cell renal cell carcinomas (ccRCCs).
Fifty patients with ccRCCs underwent non-contrast and nephrographic-phase contrast-enhanced MDCT examination before total nephrectomy. The following MDCT features were used to diagnose perinephric fat tissue invasion: perinephric stranding, perinephric vascularity, and irregular contour. The following MDCT features were used to diagnose renal sinus fat invasion: elongation of tumor into renal sinus, invasion, or compression of pelvicalyceal system. Histopathologic examinations were used as a gold standard.
Fourteen out of 50 ccRCCs patients (28%) had histopathological-proven perinephric fat tissue invasion. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in the detection of perinephric fat tissue invasion were found 64%, 58%, 38%, 80%, and 60%, respectively. Seven out of 50 ccRCCs patient (14%) had histopathological-proven renal sinus invasion. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in the detection of renal sinus invasion were found 85%, 65%, 28%, 96%, and 68%, respectively. The area under of curve (AUC) value of tumor volume in the detection of perinephric fat invasion was 0.631. The AUC value of tumor volume in the detection of renal sinus invasion was 0.803.
MDCT has a good sensitivity for detection of renal sinus fat invasion, but low PPV and specificity in patients with ccRCC. Tumor volume, and invasion into the pelvicalyceal structures can aid in the diagnosis of renal sinus fat invasion preoperatively.
探讨多层螺旋 CT（MDCT）检查结果的准确性，以及肿瘤体积在确定透明细胞肾细胞癌（ccRCC）肾周脂肪和肾窦侵犯中的作用。
50 例 ccRCC 患者在根治性肾切除术前均行非增强及肾实质期增强 MDCT 检查。以下 MDCT 特征用于诊断肾周脂肪组织侵犯：肾周条索影、肾周血管影和不规则轮廓。以下 MDCT 特征用于诊断肾窦脂肪侵犯：肿瘤延伸至肾窦、侵犯或压迫肾盂肾盏系统。组织病理学检查作为金标准。
44 例 ccRCC 患者中有 14 例（28%）经组织病理学证实存在肾周脂肪组织侵犯。MDCT 检测肾周脂肪组织侵犯的敏感性、特异性、PPV、NPV 和准确性分别为 64%、58%、38%、80%和 60%。50 例 ccRCC 患者中有 7 例（14%）经组织病理学证实存在肾窦侵犯。MDCT 检测肾窦侵犯的敏感性、特异性、PPV、NPV 和准确性分别为 85%、65%、28%、96%和 68%。肿瘤体积检测肾周脂肪侵犯的曲线下面积（AUC）值为 0.631。肿瘤体积检测肾窦侵犯的 AUC 值为 0.803。
MDCT 对肾窦脂肪侵犯的检测具有较好的敏感性，但在 ccRCC 患者中 PPV 和特异性较低。肿瘤体积及侵犯肾盂肾盏结构有助于术前诊断肾窦脂肪侵犯。
