MRI灰阶比值在肾乏脂性血管平滑肌脂肪瘤与透明细胞癌鉴别诊断中的价值
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摘要
目的探讨MRI灰阶比值在肾乏脂性血管平滑肌脂肪瘤(AMLmf)与肾透明细胞癌(CCRCC)鉴别诊断中的价值。方法回顾性分析经手术病理证实的最大径≤3.0 cm的18例20枚AMLmf与30例30枚CCRCC的MRI增强资料,通过RADinfo阅片系统灰阶直方图软件,测量增强各期病灶和对侧同层面肾皮质灰阶值,计算病灶与肾皮质灰阶比值(LGS/CGS),采用t检验及χ~2检验对两组比值进行分析,并通过受试者工作特征曲线(ROC)获得鉴别AMLmf与CCRCC最佳比值的阈值。结果 20枚AMLmf与30枚CCRCC的LGS/CGS值在皮质期、髓质期和排泄期中分别为(0.660±0.159)/(0.878±0.208)(t=3.740,P=0.001)、(0.645±0.208)/(0.810±0.198)(t=2.968,P=0.005)、(0.658±0.123)/(0.775±0.195)(t=2.428,P=0.019),AMLmf三期比值为"持续性"强化,CCRCC为"快进快出"强化。皮质期、髓质期和排泄期的LGS/CGS值鉴别AMLmf与CCRCC的曲线下面积和最佳阈值分别为0.804和0.755、0.747和0.844、0.684和0.844,相应的敏感度和特异度分别为76.7%和82.4%、53.3%和100.0%、43.3%和100.0%;联合皮质期或髓质期、皮质期或排泄期、髓质期或排泄期LGS/CGS的最佳阈值来鉴别CCRCC,其敏感度和特异度分别为80.0%和80.0%、76.7%和85.0%、56.7%和95.0%。结论 MRI灰阶比值是鉴别AMLmf与CCRCC的重要参数,且联合增强各期相灰阶比值能有效提高CCRCC诊断的敏感度,减少漏诊的发生。
Objective To investigate the value of MRI Gray Scale ratio in the differential diagnosis of angiomyolipomas with minimal fat(AMLmf) and clear cell renal carcinoma(CCRCC). Methods Contrast-enhanced MRI data of 18 cases surgical and pathological comfirmed of 20 AMLmf and 30 cases of proven 30 CCRCC with the diameter ≤3 cm were retrospectively analyzed. According to the gray-scale value of lesions in each phase of the post-contrast sequences and the same level of contralateral renal cortex through RADinfo Reading System, then Lesion Gray Scale/Cortex Gray Scale ratio(LGS/CGS) was reformed. Using t test and χ~2 test the two groups of data were analyzed. The threshold value of the optimal ratio to identify AMLmf and CCRCC was obtained through the ROC curve. Results The LGS/CGS ratio of 20 AMLmf and 30 CCRCC were(0.660±0.159)/(0.878±0.208)(t=3.740,P=0.001)、(0.645±0.208)/(0.810±0.198)(t=2.968,P=0.005)、(0.658±0.123)/(0.775±0.195)(t=2.428,P=0.019)in the cortical phase,medulla phase and excretion phase, respectively. AMLmf showed nearly continuous enhancement,while the ratio of CCRCC showed an early washout pattern. The area under the curves and optimal threshold in the identification of AMLmf and CCRCC respectively were 0.804 and 0.755,0.747 and 0.844,0.684 and 0.844,while the corresponding sensitivity and specificity were 76.7% and 82.4%,53.3% and 100.0%,43.3% and 100.0% through ROC curve analysis. The sensitivity and specificity in diagnosis of CCRCC combination with cortical or medullary phase,cortical or excretion phase,medullary or excretion phase were 80.0% and 80.0%,76.7% and 85.0%,56.7% and 95.0% respectively. Conclusion The Gray Scale ratio of MRI is an important parameter to identify AMLmf and CCRCC. It can improve the sensitivity to diagnose CCRCC through combination with different enhanced phases and reduce the occurrence of missed diagnosis.
Objective To investigate the value of MRI Gray Scale ratio in the differential diagnosis of angiomyolipomas with minimal fat(AMLmf) and clear cell renal carcinoma(CCRCC). Methods Contrast-enhanced MRI data of 18 cases surgical and pathological comfirmed of 20 AMLmf and 30 cases of proven 30 CCRCC with the diameter ≤3 cm were retrospectively analyzed. According to the gray-scale value of lesions in each phase of the post-contrast sequences and the same level of contralateral renal cortex through RADinfo Reading System, then Lesion Gray Scale/Cortex Gray Scale ratio(LGS/CGS) was reformed. Using t test and χ~2 test the two groups of data were analyzed. The threshold value of the optimal ratio to identify AMLmf and CCRCC was obtained through the ROC curve. Results The LGS/CGS ratio of 20 AMLmf and 30 CCRCC were(0.660±0.159)/(0.878±0.208)(t=3.740,P=0.001)、(0.645±0.208)/(0.810±0.198)(t=2.968,P=0.005)、(0.658±0.123)/(0.775±0.195)(t=2.428,P=0.019)in the cortical phase,medulla phase and excretion phase, respectively. AMLmf showed nearly continuous enhancement,while the ratio of CCRCC showed an early washout pattern. The area under the curves and optimal threshold in the identification of AMLmf and CCRCC respectively were 0.804 and 0.755,0.747 and 0.844,0.684 and 0.844,while the corresponding sensitivity and specificity were 76.7% and 82.4%,53.3% and 100.0%,43.3% and 100.0% through ROC curve analysis. The sensitivity and specificity in diagnosis of CCRCC combination with cortical or medullary phase,cortical or excretion phase,medullary or excretion phase were 80.0% and 80.0%,76.7% and 85.0%,56.7% and 95.0% respectively. Conclusion The Gray Scale ratio of MRI is an important parameter to identify AMLmf and CCRCC. It can improve the sensitivity to diagnose CCRCC through combination with different enhanced phases and reduce the occurrence of missed diagnosis.
引文
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12 Ferl GZ,Xu L,Friesenhahn M,et al.An automated method for nonparametric kinetic analysis of clinical DCE-MRI data:application to glioblastoma treated with bevacizumab[J].Magnetic Resonance in Medicine,2010,63:1366-1375.
13 Walker-Samuel S,Leach MO,Collins DJ.Evaluation of response to treatment using DCE-MRI:the relationship between initial area under the gadolinium curve (IAUGC) and quantitative pharmacokinetic analysis[J].Physics in Medicine & Biology,2006,51:3593-3602.
14 康钦钦,马超,张火俊,等.肾脏乏脂肪血管平滑肌脂肪瘤与透明细胞癌的高分辨螺旋CT特征分析[J].中华泌尿外科杂志,2013,34:732-737.
15 陈浩军,韩志江,吴志远,等.乏脂性肾血管平滑肌脂肪瘤的CT表现[J].全科医学临床与教育,2014,12:287-289.
2 唐光健,许燕.肾血管平滑肌脂肪瘤与肾癌的CT鉴别诊断[J].中华放射学杂志,2004,38:1090-1093.
3 Park JJ,Kim CK.Small(<4cm) Renal Tumors With Predominantly Low Signal Intensity on T2-Weighted Images:Differentiation of Minimal-Fat Angiomyolipoma From Renal Cell Carcinoma[J].AJR,2017,208:124-130.
4 王海屹,叶惠义,袁静,等.乏脂肪肾血管平滑肌脂肪瘤的MR表现[J].中华放射学杂志,2010,44:1268-1271.
5 Verma SK,Mitchell DG,Yang R,et al.Exophytic renal masses:angular interface with renal parenchyma for distinguishing benign from malignant lesions at MR imaging[J].Radiology,2010,255:501-507.
6 Kim JK,Park SY,Shon JH,et al.Angiomyolipoma with minimal fat:differentiation from renal cell carcinoma at biphasic helical CT[J].Radiology,2004,230:677-684.
7 Sung CK,Kim SH,Woo S,et al.Angiomyolipoma with minimal fat:differentiation of morphological and enhancement features from renal cell carcinoma at CT imaging[J].Acta Radiol,2016,57:1114-1122.
8 卢晓玲,丁建国,王培军.乏脂肪性肾血管平滑肌脂肪瘤的CT与MRI表现[J].临床放射学杂志,2008,27:368-371.
9 Sasiwimonphan K,Takahashi N,Leibovich B C,et al.Small (<4 cm) renal mass:differentiation of angiomyolipoma without visible fat from renal cell carcinoma utilizing MR imaging[J].Radiology,2012,263:160-169.
10 韩文斐,花蒨蒨,王亮,等.3.0TMR对肾透明细胞癌和血管平滑肌脂肪瘤的鉴别诊断价值[J].医学影像学杂志,2014,24:445-450.
11 Schieda N,Dilauro M,Moosavi B,et al.MRI evaluation of small (<4cm) solid renal masses:multivariate modeling improves diagnostic accuracy for angiomyolipoma without visible fat compared to univariate analysis [J].European Radiology,2016,26:2242-2251.
12 Ferl GZ,Xu L,Friesenhahn M,et al.An automated method for nonparametric kinetic analysis of clinical DCE-MRI data:application to glioblastoma treated with bevacizumab[J].Magnetic Resonance in Medicine,2010,63:1366-1375.
13 Walker-Samuel S,Leach MO,Collins DJ.Evaluation of response to treatment using DCE-MRI:the relationship between initial area under the gadolinium curve (IAUGC) and quantitative pharmacokinetic analysis[J].Physics in Medicine & Biology,2006,51:3593-3602.
14 康钦钦,马超,张火俊,等.肾脏乏脂肪血管平滑肌脂肪瘤与透明细胞癌的高分辨螺旋CT特征分析[J].中华泌尿外科杂志,2013,34:732-737.
15 陈浩军,韩志江,吴志远,等.乏脂性肾血管平滑肌脂肪瘤的CT表现[J].全科医学临床与教育,2014,12:287-289.