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最大径≤3 cm的乏脂肪肾脏血管平滑肌脂肪瘤与肾透明细胞癌的MRI鉴别 被引量:8

Value of MRI in the Differentiation between Angiomyolipomas with Minimal Fat and Clear Cell Renal Cell Carcinoma Whose Maximum Diameter is Less Than 3 cm
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摘要 目的探讨MRI在最大径≤3 cm的乏脂肪肾脏血管平滑肌脂肪瘤(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最大径≤3 cm的18例20枚AMLmf与30例30枚CCRCC的MRI资料,通过受试者工作特征(ROC)曲线确定最小径/最大径比值对AMLmf与CCRCC诊断的最佳阈值,采用χ~2检验分析T2WI信号、劈裂征、脂肪信号、假包膜、囊变或坏死、最小径/最大径的比值、DWI及强化方式在AMLmf与CCRCC中的分布差异。结果 ROC曲线显示病灶最小径/最大径比值鉴别AMLmf与CCRCC的面积为0. 851,当最小径/最大径比值为0. 870时,鉴别AMLmf与CCRCC的敏感性为86. 7%,特异性为70. 0%。AMLmf与CCRCC在T2WI低信号、劈裂征、假包膜、囊变或坏死、DWI低信号及延迟性强化方面分别为15/20(75. 0%)和5/30(16. 7%)(χ~2=17. 014,P=0. 000)、14/20 (70. 0%)和6/30 (20. 0%)(χ~2=6. 400,P=0. 011)、4/20(20. 0%)和25/30(83. 3%)(χ~2=19. 759,P=0. 000)、0/20 (0. 0%)和17/30 (56. 7%)(χ~2=17. 172,P=0. 000)、10/20(50. 0%)和5/30 (16. 7%)(χ~2=6. 349,P=0. 012)、16/20 (80. 0%)和12/30 (40. 0%)(χ~2=7. 792,P=0. 005),差异有统计学意义(P <0. 05),脂肪信号在两者之间的差异无统计学意义(P> 0. 05)。结论 T2WI低信号、劈裂征、DWI低信号、最小径/最大径比值<0. 870、延迟性强化有助于AMLmf的诊断,假包膜、囊变或坏死、最小径/最大径比值> 0. 870有助于CCRCC的诊断,准确识别这些征象对两者的鉴别有重要意义。 Objective To explore the value of MRI in the differential diagnosis of angiomyolipomas with minimal fat( AMLmf) and clear cell renal carcinoma( CCRCC) whose size is smaller than 3 cm. Methods MRI data of 18 cases of surgically and pathologically comfirmed 20 AMLmf and 30 cases of proven 30 CCRCC with the diameter ≤3 cm were restrospectively analyzed. The best threshold of minimum/maximum diameter ratio for AMLmf and CCRCC diagnosis was determined by receiver operating characteristic( ROC) curve. The differences in distribution of signal intensity on T2 WI between them lesions,split sign,presence of lipid component,pseudocapsule,cystic degeneration or necrosis,minimum/maximum diameter ratio,signal intensity on DWI and enhancement pattern were observed by chi-test. Results The ROC curve analysis yielded area under the curves of 0. 851 using the minimum/maximum diameter ratio of the lesion,using 0. 870 as the minimum/maximum diameter ratio resulted in the sensitivity and specificity of 86. 7% and 70%. In respective order,the distribution between AMLmf and CCRCC about low signal intensity on T2WI、split sign、pseudocapsule、cystic degeneration or necrosis、low signal intensity on DWI and prolonged enhancement pattern was 15/20( 75. 0%) and 5/30( 16. 7%)( χ~2=17. 014,P = 0. 000) 、14/20( 70. 0%) and 6/30( 20. 0%)( χ~2= 6. 400,P = 0. 011) 、4/20( 20. 0%) and 25/30( 83. 3%)( χ~2= 19. 759,P = 0. 000) 、0/20( 0. 0%) and 17/30( 56. 7%)( χ~2= 17. 172,P = 0. 000) 、10/20( 50. 0%) and 5/30( 16. 7%)( χ~2= 6. 349,P = 0. 012) 、16/20( 80. 0%) and 12/30( 40. 0%)(( χ~2= 7. 792,P = 0. 005),which had statistical significance( P < 0. 05). While there was no significant difference in presence of lipid component between the two. Conclusion The low signal intensity on T2 WI,split sign,low signal intensity on DWI,minimum/maximum diameter ratio <0. 870,prolonged enhancement pattern were useful for diagnosing AMLmf,while pseudocapsule,cystic degeneration or necrosis,minimum/maximum diameter ratio > 0. 870 contribute to the
作者 张丽青 韩志江 ZHANG Liqing;HAN Zhijiang(Department of Radiology,Hangzhou First People’s Hosptial,Hangzhou,Zhejiang Province 310006,P. R. China)
出处 《临床放射学杂志》 CSCD 北大核心 2019年第1期132-135,共4页 Journal of Clinical Radiology
关键词 乏脂肪肾脏血管平滑肌脂肪瘤 肾透明细胞癌 肾肿瘤 磁共振成像 Angiomylipoma with minimal fat Clear cell renal cell carcinoma Renal tumor Magnetic resonance imaging
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