摘要
目的探讨肾脏上皮样血管平滑肌脂肪瘤(EAML)的CT表现及其与肾透明细胞癌(ccRCC)、肾血管平滑肌脂肪瘤(AML)的鉴别诊断。方法回顾性分析经病理证实的EAML 28例、ccRCC 32例、AML 22例患者的CT征象并运用随机森林模型(RF)进行鉴别诊断。结果 EAML 28例中,男7例,女21例。平均发病年龄为42.5岁。25例发生在单侧肾脏;24例为单发,15例可见脂肪成分。CT平扫、增强动脉期及静脉期CT值分别为43.8HU、92.0 HU、77.0 HU。增强动静脉期CT差值12.8 HU。4例出现粗大血管。EAML与ccRCC进行鉴别诊断,其RF准确率为97.30%,EAML无囊变,约50%病例中含脂肪成分,发病年龄为42.5岁,平扫CT值为43.8 HU,动静脉期CT值差值为12.8 HU。约94%ccRCC发生囊变,无脂肪,发病年龄为57.8岁,平扫CT值为36.7 HU,动静脉期CT值差值为27 HU。EAML与AML进行鉴别诊断,其RF准确率为70.97%:EAML较AML发病年龄年轻,肿瘤直径大,动静脉期CT值差大。结论 EAML主要发生在青年女性,平扫CT值较肾实质高,呈快进-慢出强化方式。EAML与ccRCC鉴别诊断主要从囊变、脂肪、年龄、平扫CT值、动静脉期CT值差值进行鉴别。EAML与AML主要从静脉期CT值、动脉期CT值、年龄、肿瘤直径、动静脉期CT值差值鉴别。
Objective To study the CT features of Renal Epithelioid Angiomyolipoma （EAML） and itg differential diagnosis with angiomyolipoma （AML） and clear cell renal carcinoma （ccRCC）. Methods Clinical data and CT images from 28 cases of EAML, 32 cases of ccRCC and 22 cases of AML were retrospectively analysed. The differential diagnosis among them was determined by the random forest model （RF）. Results EAML Clinical manifestation： 7 cases male, 21 cases female. Mean Age of EAML is 42.5. CT features of EAM L： 25 cases of EAML are in one kindey, 85.71% of the cases are single lesions, and 53.57% of the cases have fat. Plain CT scan, arterial phase and venous phase HU is 43.8 HU, 92.0 HU, 77.0 HU respectively. The difference between arterial phase and venous phase is 12.8 HU. 14.29% of the cases are vascular. The differential diagnosis between EAML and ccRCC is easy ; the forecast accuracy of random forest model was 97%. About 50% EAML has fat and not cystic; the plain scan, the arterial ＆ venous phase HU of EAML is 42.5, 43.8 HU, 12.8 HU respectively. About 94% ccRCC have cystic degeneration, no fat; plain scan, arterial and venous phase of ccRCC is 57.8, 36.7 HU, 27 HU respectively. The differential diagnosis of EAML from AML is difficult; the forecast accuracy of random forest model was 70.97%. The age, the diameter, the arterial and venous phase HU of EAML is younger, bigger and greater than AML respectively. Conclusion EAML occurs mainly in young women. Plain CT manifestation of EAML is a mass with a higher density than renal parenchyma. Contrast-enhanced CT features were rap- id wash-in to slow washout. The differential diagnosis between EAML and ccRCC is determined by cystic changes, fat, age, plain scan, arterial and venous phase HU. The differential diagnosis between EAML and AML is determined by the ve- nous phase and arterial phase HU, age abddiameter of the tumor.
作者
刘小华
徐凯
李绍东
宋强
何鹏
鹿彩銮
LIU Xiaohua XU Kai LI Shaodong et al(Department of Radiology, The Affiliated Hospital of Xuzhou Medical College,XuZhou 221002, P. R. China)
出处
《临床放射学杂志》
CSCD
北大核心
2016年第11期1693-1697,共5页
Journal of Clinical Radiology
