多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断

陈佳; 张曦; 龚明福; 文利

doi:10.16016/j.1000-5404.202004008

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多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断

临床医学 | 更新时间：2026-01-09

- 多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断
- Differential diagnosis of common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in multi-slice spiral CT
- 第三军医大学学报 2020年42卷第18期页码：1842-1847
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院放射科
- 作者简介：
  
  [ 文利，E-mail:cqzdwl@163.com WEN Li, E-mail:cqzdwl@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202004008
  中图分类号： R730.42; R737.11; R814.42
- 收稿：2020-04-01，
  
  修回：2020-06-05，
  
  纸质出版：2020-09-30
- 稿件说明：
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陈佳, 张曦, 龚明福, 等. 多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断[J]. 第三军医大学学报, 2020,42(18):1842-1847.

Jia CHEN, Xi ZHANG, Mingfu GONG, et al. Differential diagnosis of common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in multi-slice spiral CT[J]. Journal of Third Military Medical University, 2020, 42(18): 1842-1847.
陈佳, 张曦, 龚明福, 等. 多层螺旋CT矫正CT值及矫正相对强化率对常见肾细胞癌亚型的鉴别诊断[J]. 第三军医大学学报, 2020,42(18):1842-1847. DOI： 10.16016/j.1000-5404.202004008.

Jia CHEN, Xi ZHANG, Mingfu GONG, et al. Differential diagnosis of common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in multi-slice spiral CT[J]. Journal of Third Military Medical University, 2020, 42(18): 1842-1847. DOI： 10.16016/j.1000-5404.202004008.

摘要

目的

探讨基于螺旋CT多期扫描成像中矫正CT值及矫正相对强化率对常见4种肾细胞癌亚型鉴别的可行性。

方法

回顾性分析本院2017年8月至2019年6月经病理证实的肾细胞癌患者76例临床资料，其中肾透明细胞癌(clear cell renal cell carcinoma

ccRCC)28例、乳头状细胞癌(papillary renal cell carcinoma

PRCC)Ⅰ型24例、乳头状细胞癌Ⅱ型(PRCCⅡ型)6例、嫌色细胞癌(chromophobe renal cell carcinoma

ChRCC)18例，测量、计算各亚型间CT增强扫描各期矫正CT值、相对强化率，进行统计学分析并绘制受试者工作特征(receiver operator characteristic

ROC)曲线。

结果

各亚型平扫CT值差异均无统计学意义(

0.05)。增强扫描ccRCC皮髓质期矫正CT值为(110.68±45.62)Hu、相对强化率为(3.19±1.41)，显著高于其他亚型(

0.01)。实质期、排泄期ccRCC矫正CT值分别为(95.36±25.02)Hu、(74.01±16.10)Hu，相对强化率分别为(2.82±1.03)、(2.19±0.71)

均高于PRCCⅠ、PRCCⅡ型(

0.05)。PRCCⅠ型与PRCCⅡ型间各期CT矫正值及相对强化率差异均无统计学意义(

0.05)。ChRCC各期矫正CT值及相对强化率介于ccRCC与PRCC之间，皮髓质期其矫正CT值与相对强化率高于PRCCⅡ型(

0.05)，实质期矫正CT值高于PRCCⅠ型、PRCCⅡ型(

0.05)。皮髓质期相对强化率为2.56、2.28、1.25时，ccRCC与ChRCC、PRCCⅠ型、PRCCⅡ型鉴别的敏感性分别为78.6%、95.8%、100.0%

特异性分别为94.4%、78.6%、92.9%。实质期相对强化率为1.64时，鉴别ChRCC与PRCCⅠ型、PRCCⅡ型的敏感性、特异性分别为75.0%、83.3%。

结论

不同肾癌亚型强化方式各有特点，螺旋CT多期扫描矫正后CT值及矫正后相对强化率有助于提升鉴别各肾癌亚型能力，但PRCCⅠ型与PRCCⅡ型的鉴别有一定困难。

Abstract

Objective

To explore the feasibility of differentiating 4 common subtypes of renal cell carcinoma based on corrected CT value and relative enhancement rate in spiral CT multi-phase scanning.

Methods

We retrospectively analyzed the clinical data of 76 patients with pathologically confirmed renal cell carcinoma

including 28 with clear cell renal cell carcinoma (ccRCC)

24 with papillary renal cell carcinoma type Ⅰ (PRCCⅠ)

6 with papillary renal cell carcinoma type Ⅱ (PRCC Ⅱ) and 18 with chromophobe renal cell carcinoma (ChRCC). The CT values in different phases in spiral CT multi-phase scanning were measured to calculate the corrected CT values and relative enhancement rates

whose sensitivity and specificity for differentiating the subtypes of renal cell carcinoma were analyzed using receiver operating characteristic (ROC) curve analysis.

Results

No significant difference was found in unenhanced CT values among different subtypes of renal cell carcinoma. For ccRCC

the corrected CT value was 110.68±45.62 Hu and the corrected relative enhancement rate was 3.19±1.41 in the corticomedullary phase

significantly higher than those of the other subtypes (

0.01). In the nephrographic and excretory phases

the corrected CT values of ccRCC were 95.36±25.02 Hu and 74.01±16.10 Hu and the corrected relative enhancement rates were 2.82±1.03 and 2.19±0.71

respectively

all significantly higher than those of PRCC Ⅰ and PRCC Ⅱ (

0.05) but comparable with those of ChRCC. The corrected CT value or relative enhancement rate in each phase did not differ significantly between PRCC Ⅰ and PRCC Ⅱ. The corrected CT value and relative enhancement rate of ChRCC in each phase were lower than those of ccRCC but higher than those of PRCC; these values in the corticomedullary phase were significantly higher than those of PRCC Ⅱ (

0.05)

and the corrected CT value of ChRCC was significantly higher than that of PRCCI and PRCCII (

0.05). At the cutoff values of 2.56

2.28

and 1.25

the relative

enhancement rates in the corticomedullary phase had sensitivities of 78.6%

95.8% and 100.0% for differentiating ccRCC from ChRCC

PRCC Ⅰ and PRCC Ⅱ

with specificities of 94.4%

78.6% and 92.9%

respectively. At the cutoff value of 1.64

the corrected relative enhancement rate in the nephrographic phase could effectively distinguish ChRCC from PRCC Ⅰ and PRCC Ⅱ with a sensitivity of 75.0% and a specificity of 83.3%.

Conclusion

The subtypes of renal cell carcinoma have their specific enhancement characteristics. Multi-phase spiral CT scanning has an important value for differentiating these subtypes

and the corrected CT value and relative enhancement rate can help to improve the accuracy of the differential diagnosis

but the differentiation between PRCC Ⅰ and PRCC Ⅱ remains difficult.

关键词

Keywords

references

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