能谱CT成像诊断肾透明细胞癌术前分级的准确性研究
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摘要
目的探讨能谱CT成像诊断肾透明细胞癌术前分级的准确性。方法回顾性分析我院2017年1月～2018年9月100例经病理组织学诊断为肾透明细胞癌患者能谱CT成像双期扫描资料,以病理结果为金标准,分析能谱CT成像肾透明细胞癌术前分级诊断结果。结果不同病理分级动脉期与髓质期能谱参数CT值比值、碘浓度比值、能谱曲线斜率结果比较,均为Ⅰ级>Ⅱ级>Ⅲ级(P <0.05);以患者动脉期与髓质期能谱参数为变量,患者肾透明细胞癌级别为状态量,绘制ROC曲线,病理分级Ⅰ、Ⅱ级诊断中,动脉期能谱曲线斜率AUC=0.952,高于动脉脉期CT值比值AUC=0.752、碘浓度比值AUC=0.855以及髓质期CT值比值AUC=0.898、碘浓度比值AUC=0.829、能谱曲线斜率AUC=0.786,差异有统计学意义(P <0.05);病理分级Ⅱ、Ⅲ级诊断中髓质期能谱曲线斜率AUC=0.993,高于动脉期能谱曲线斜率AUC=0.888,CT值比值AUC=0.811、碘浓度比值AUC=0.821以及髓质期CT值比值AUC=0.810、碘浓度比值AUC=0.895,差异有统计学意义(P <0.05)。结论能谱CT成像对于术前肾透明细胞癌术前分级诊断有重要的临床价值。
Objective To explore the accuracy of energy spectrum CT imaging in the diagnosis of preoperative grading of renal clear cell carcinoma. Methods The dual-phase scanning data of energy spectrum CT imaging of 100 patients who were diagnosed as renal clear cell carcinoma by histopathology in our hospital from January 2017 to September 2018 were retrospectively analyzed. The pathological results were taken as the gold standard, and the diagnostic results of preoperative grading of renal clear cell carcinoma were analyzed by energy spectrum CT imaging. Results CT value ratio of energy spectrum parameters, iodine concentration ratio and slope of energy spectrum curve of arterial phase and medullary phase in different pathological grades showed that those of grade I were more than those of grade II, followed by grade III. The difference was statistically significant(P < 0.05). ROC curve was drawn by taking the energy spectrum parameters of patients in the arterial and medullary phase as variables and the grade of patients with renal clear cell carcinoma as status quantity. In the pathological grade I and II diagnosis, the slope of energy spectrum curve AUC in the arterial phase was 0.952, higher than the CT value ratio AUC(0.752) andthe ratio of iodine concentration AUC was 0.855. CT value ratio AUC in the medullary phase was 0.898, the iodine concentration ratio AUC was 0.829 and the slope of energy spectrum curve AUC was 0.786.The difference was statistically significant(P < 0.05).In the pathological grade II and III diagnosis, the slope of energy spectrum curve AUC in the medullary phase was 0.993, higher than that in the arterial phase 0.888, CT value ratio AUC in the arterial phase 0.811, iodine concentration AUC in the arterial phase 0.821, CT value ratio AUC in the medullary phase 0.810 and iodine concentration AUC in the medullary phase 0.895. The differences were statistically significant(P < 0.05). Conclusion Energy spectrum CT imaging has important clinical values for diagnosis of preoperative grading of renal clear cell carcinoma.
Objective To explore the accuracy of energy spectrum CT imaging in the diagnosis of preoperative grading of renal clear cell carcinoma. Methods The dual-phase scanning data of energy spectrum CT imaging of 100 patients who were diagnosed as renal clear cell carcinoma by histopathology in our hospital from January 2017 to September 2018 were retrospectively analyzed. The pathological results were taken as the gold standard, and the diagnostic results of preoperative grading of renal clear cell carcinoma were analyzed by energy spectrum CT imaging. Results CT value ratio of energy spectrum parameters, iodine concentration ratio and slope of energy spectrum curve of arterial phase and medullary phase in different pathological grades showed that those of grade I were more than those of grade II, followed by grade III. The difference was statistically significant(P < 0.05). ROC curve was drawn by taking the energy spectrum parameters of patients in the arterial and medullary phase as variables and the grade of patients with renal clear cell carcinoma as status quantity. In the pathological grade I and II diagnosis, the slope of energy spectrum curve AUC in the arterial phase was 0.952, higher than the CT value ratio AUC(0.752) andthe ratio of iodine concentration AUC was 0.855. CT value ratio AUC in the medullary phase was 0.898, the iodine concentration ratio AUC was 0.829 and the slope of energy spectrum curve AUC was 0.786.The difference was statistically significant(P < 0.05).In the pathological grade II and III diagnosis, the slope of energy spectrum curve AUC in the medullary phase was 0.993, higher than that in the arterial phase 0.888, CT value ratio AUC in the arterial phase 0.811, iodine concentration AUC in the arterial phase 0.821, CT value ratio AUC in the medullary phase 0.810 and iodine concentration AUC in the medullary phase 0.895. The differences were statistically significant(P < 0.05). Conclusion Energy spectrum CT imaging has important clinical values for diagnosis of preoperative grading of renal clear cell carcinoma.
引文
[1]陈安良,刘爱连,刘静红,等.平扫CT能谱成像对乏脂肪肾血管平滑肌脂肪瘤与肾透明细胞癌的鉴别价值[J].临床放射学杂志,2016,35(2):245-249.
[2]李雪霜,姜荣兴,王贝贝,等.双源CT碘定量评价肾透明细胞癌病理分级[J].临床放射学杂志,2016,35(10):1542-1545.
[3]韩引萍,张玉婷,王丹,等.能谱CT成像对侵袭性胸腺瘤与纵隔淋巴瘤的鉴别诊断价值[J].中国医学影像学杂志,2016,24(6):464-467.
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[7]韦炜,邓克学,赵英明,等.腹部双能量能谱CT成像中混合能量模式与单能量模式重建图像的比较研究[J].安徽医科大学学报,2016,51(11):1650-1653.
[8]岳倩倩,王新怡,杨志强,等.富血供肝脏转移瘤与肝细胞肝癌的能谱CT成像定量分析[J].山东大学学报:医学版,2016,54(7):50-55.
[9]刘海静,夏远舰,申兵,等.宝石能谱CT成像技术对食管胃底静脉曲张血管的评估价值[J].山东医药,2018,17(12).13-14.
[10]赵金坤,张鹏,叶兆祥,等.能谱CT碘浓度鉴别肾透明细胞癌病理Fuhrman分级[J].临床放射学杂志,2016,35(11):1684-1689.
[11]杨晓彤,刘屹,赵宇.能谱CT定量分析鉴别诊断肾透明细胞癌与肾脏乏脂肪血管平滑肌脂肪瘤的临床应用[J].临床军医杂志,2016,44(9):938-942.
[12]刘月华,朱绍成,史大鹏,等.CT能谱成像术前评估食管鳞状细胞癌病理分级的临床价值[J].中华医学杂志,2017,97(43):19-22.
[13]张连宇,陈雁,王绎忱,等.CT能谱成像与MR扩散加权成像评价肾透明细胞癌病理分级的价值比较[J].医学影像学杂志,2018,17(4):13-15.
[14]王微,柳林,张孟超.分次团注对比增强能谱CT成像:肾透明细胞癌的显示及辐射剂量研究[J].影像诊断与介入放射学,2016,25(3):179-183.
[15]徐明哲,刘爱连,孙美玉,等.单源双能CT平扫能谱曲线对不典型小肝癌与异常灌注灶鉴别的价值[J].中国临床医学影像杂志,2017,28(1):44-48.
[2]李雪霜,姜荣兴,王贝贝,等.双源CT碘定量评价肾透明细胞癌病理分级[J].临床放射学杂志,2016,35(10):1542-1545.
[3]韩引萍,张玉婷,王丹,等.能谱CT成像对侵袭性胸腺瘤与纵隔淋巴瘤的鉴别诊断价值[J].中国医学影像学杂志,2016,24(6):464-467.
[4]郭金龙,程琦,许实成,等.能谱CT成像与Ki-67联合评价肾透明细胞癌核分级[J].安徽医科大学学报,2016,51(2):292-296.
[5]马亮,许晓雯,王金红,等.磁敏感加权成像与灌注加权成像在肾透明细胞癌分级诊断中的应用[J].第二军医大学学报,2016,37(2):153-158.
[6]罗昆,董仟,杨明,等.双低对比剂联合能谱CT成像技术在门静脉成像中的应用研究[J].临床放射学杂志,2016,35(11):1759-1763.
[7]韦炜,邓克学,赵英明,等.腹部双能量能谱CT成像中混合能量模式与单能量模式重建图像的比较研究[J].安徽医科大学学报,2016,51(11):1650-1653.
[8]岳倩倩,王新怡,杨志强,等.富血供肝脏转移瘤与肝细胞肝癌的能谱CT成像定量分析[J].山东大学学报:医学版,2016,54(7):50-55.
[9]刘海静,夏远舰,申兵,等.宝石能谱CT成像技术对食管胃底静脉曲张血管的评估价值[J].山东医药,2018,17(12).13-14.
[10]赵金坤,张鹏,叶兆祥,等.能谱CT碘浓度鉴别肾透明细胞癌病理Fuhrman分级[J].临床放射学杂志,2016,35(11):1684-1689.
[11]杨晓彤,刘屹,赵宇.能谱CT定量分析鉴别诊断肾透明细胞癌与肾脏乏脂肪血管平滑肌脂肪瘤的临床应用[J].临床军医杂志,2016,44(9):938-942.
[12]刘月华,朱绍成,史大鹏,等.CT能谱成像术前评估食管鳞状细胞癌病理分级的临床价值[J].中华医学杂志,2017,97(43):19-22.
[13]张连宇,陈雁,王绎忱,等.CT能谱成像与MR扩散加权成像评价肾透明细胞癌病理分级的价值比较[J].医学影像学杂志,2018,17(4):13-15.
[14]王微,柳林,张孟超.分次团注对比增强能谱CT成像:肾透明细胞癌的显示及辐射剂量研究[J].影像诊断与介入放射学,2016,25(3):179-183.
[15]徐明哲,刘爱连,孙美玉,等.单源双能CT平扫能谱曲线对不典型小肝癌与异常灌注灶鉴别的价值[J].中国临床医学影像杂志,2017,28(1):44-48.