刘磊^1,2,,
李泉林¹,
李连宏^2,,
1. 大连医科大学附属第一医院 泌尿外科，辽宁 大连 116011
2. 辽宁省肿瘤干细胞重点实验室，辽宁 大连 116044

基金项目: 大连市医学科学研究计划项目（2012007）


详细信息 作者简介: 刘 磊（1989-），男，主治医师。E-mail：liuleidmu1989@163.com



通讯作者: 李连宏，教授。E-mail：lilianhong917@163.com 中图分类号: R445.4


摘要:目的探讨双能量CT能谱数据综合分析在诊断和鉴别诊断肾透明细胞癌（clear cell renal cell carcinoma，ccRCC）和肾错构瘤（renal angiomyolipoma，RAML）中的应用价值。方法回顾性分析大连医科大学附属第一医院2011年7月至2015年3月期间接受能谱CT检查并经病理诊断的患者66例，其中RAML 23例，ccRCC 43例。应用能谱图像数据进行综合分析，在肿瘤最大横截面上划定感兴趣区，测量40～140 keV下的CT值，绘制能谱曲线并计算曲线的斜率。根据曲线斜率将曲线分为Ⅰ～Ⅲ型，分别统计ccRCC和RAML病例中3种类型曲线的例数及其构成比；测量ccRCC和RAML的基物质对浓度，包括血（水）、钙（水）、脂（水）、水（血）、水（钙）、水（脂），比较各指标间的差异。结果在40～140 keV（间隔为10 keV）单能量下，ccRCC的中位CT值均高于RAML的中位CT值，差异具有统计学意义（P＜0.01）。ccRCC的曲线斜率为0.15±0.10，RAML的曲线斜率为?0.19±0.27，差异有统计学意义（t=7.31，P＜0.01）。ccRCC与RAML的Ⅰ～Ⅲ型曲线的构成比差异有统计学意义（χ²=47.327，P＜0.01）。ccRCC与RAML的水（脂）、脂（水）、水（钙）、钙（水）、水（血）、血（水）基物质对浓度差异均有统计学意义（P＜0.01）。结论双能量CT能谱平扫数据的综合分析对于鉴别ccRCC与RAML具有一定的临床价值。
关键词: 能谱曲线/
肾细胞癌/
肾错构瘤/
基物质对浓度


Abstract:ObjectiveTo explore the clinical value of comprehensive analysis of dual energy spectral CT unenhanced images in the differential diagnosis between clear cell renal cell carcinoma (ccRCC) and renal angiomyolipoma (RAML). MethodsSixty-six cases of renal tumor were retrospectively studied from July 2011 to March 2015, who were treated in the First Affiliated Hospital of Dalian Medical University. All the patients were examined by spectral CT. Among them, 43 were pathologically diagnosed as clear cell renal cell carcinoma and 23 asrenal angiomyolipoma. The regions of interest (ROIs) were set on the cross–sectional image of the tumor. Spectral curves were created based on these ROIs, the CT values of 40-140 keV and the average slopes of the curves were calculated. The results were statistically analyzed. According to the assessment area under the ROC curve slope of renal cell carcinoma, an appropriate cutoff was determined. According to the slopes, the curves were divided into three types (type Ⅰ - Ⅲ). The number of cases of ccRCC and RAML in each type of curve was counted and the case ratio was determined for statistical analysis. The paired basic substance concentrations of ccRCCs and RAMLs were recorded, including blood (water), calcium (water), fat (water), water (blood), water (calcium), water (fat), the results were statistically analyzed using SPSS 17.0. ResultsAt 40-140 keV, the median CT values of ccRCC were higher than RAML (P＜0.01). The average slope of the curve of ccRCC was 0.15±0.10, while that of RAML was ?0.19±0.27, the difference was statistically significant(t=7.31, P＜0.01). The ratios of ccRCCs and RAMLs in different types of spectral curves were also significantly different (χ² =47.327, P＜0.01). The paired basic substance concentration of water (fat), fat (water), water (calcium), calcium (water), water (blood), blood (water) were significantly different between ccRCC and RAML (P＜0.01). ConclusionComprehensive analysis of unenhanced spectral CT scan provides a new method for diagnosis and differentiation of ccRCC and RAML.
Keywords:spectral curve/
clear cell renal cell carcinoma/
renal angiomyolipoma/
paired basic substance concentration

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