【摘要】 目的评价应用能谱CT的能谱曲线及碘浓度值鉴别肾透明细胞癌(ccRCC)病理Fuhrman级别的可行性。方法回顾性分析62例经病理证实的ccRCC 64个病灶的常规CT表现及增强皮髓质期(CMP)能谱CT表现,能谱CT主要参数包括能谱曲线斜率、标准化能谱曲线、碘浓度及标准化碘浓度(NIC),其中Fuhrman分级低级别(Ⅰ~Ⅱ级)35例,病灶37个,高级别(Ⅲ~Ⅳ级)27例,病灶27个,依据不同病理Fuhrman级别对肿物常规CT表现及能谱CT各参数进行统计学分析,并应用受试者工作特征曲线(ROC)和二项Logistic回归分析评价单独使用能谱CT或联合常规CT特征鉴别高级别和低级别ccRCC的能力。结果 CMP高级别ccRCC的碘浓度值和NIC值显著低于低级别ccRCC(碘浓度36.57±9.62 mg/ml和49.65±11.42 mg/ml,P<0.001;NIC 0.61±0.13和0.92±0.16,P<0.001)。碘浓度和NIC诊断高级别ccRCC ROC曲线下面积分别为0.811、0.935。最佳阈值、敏感度和特异度分别为:碘浓度0.811 mg/ml、81.1%、77.8%;NIC 0.745、86.5%、92.6%。采用二项Logistic回归分析,肿瘤大小(P=0.011)和肾周脂肪浸润(P=0.002)等常规CT影像学特征能作为鉴别高级别ccRCC的独立危险因素,将NIC列入Logistic回归模型可显著提高诊断高级别ccRCC的准确率(P=0.001)。结论高级别ccRCC的碘浓度值和NIC值显著低于低级别ccRCC,结合常规CT表现,可以提高鉴别高级别和低级别ccRCC的准确率,有助于治疗方案的选择和制定。更多还原

【Abstract】 Objective The purpose of our study was to assess the utility of the spectrum curve and iodine concentration of spectral CT in distinguishing low-grade and high-grade clear cell renal cell carcinoma( ccRCC). Methods The cases of 62 patients with pathologically proven ccRCC who underwent preoperative CT,including CT spectral imaging,were retrospectively assessed. Spectral CT values were obtained from CT spectral images( principal parameters include spectrum curve,iodine concentration). Lesions were also evaluated for an array of conventional CT features. A single expert uropathologist reviewed all slides to determine Fuhrman grade. The utility of Spectral CT for detecting high-grade ccRCC,alone and in combination with conventional CT features,was assessed using receiver operating characteristic( ROC) analysis and binary logistic regression. Results CMP iodine concentration and normalized iodine concentration( NIC) were significantly lower among high-grade than among low-grade ccRCC( 36. 57 ± 9. 62 mg / ml vs 49. 65 ± 11. 42 mg / ml for iodine concentration,P < 0. 001; 0. 61 ± 0. 13 vs 0. 92 ± 0. 16 for NIC,P < 0. 001). The area under the ROC curve for identifying high-grade ccRCC was 0. 811,0. 935 respectively,with optimal thresholds,sensitivity,and specificity as follows: iodine concentration: 0. 811 mg / ml,81. 1%,77. 8%; NIC: 0. 745,86. 5%,92. 6%. Using multivariate logistic regression,only size( P = 0. 011) and perinephric fat invasion( P = 0. 002) were retained among conventional imaging features as independent risk factors for high-grade ccRCC. The accuracy of the logistic regression model for predicting high-grade ccRCC was significantly improved by inclusion of NIC( P = 0. 001). Conclusion iodine concentration value and NIC value is significantly lower in high-grade ccRCC compared with low-grade ccRCC and increases the accuracy for detecting high-grade ccRCC compared to conventional CT features alone. This system may be helpful in clinical decision-making about the care of patients treated by surgical or nonsurgical approaches.更多还原