Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta-lesion attenuation difference (ALAD) on contrast-enhanced CT
Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta-lesion attenuation difference (ALAD) on contrast-enhanced CT
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DOI：
10.1007/s11547-020-01199-7
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发表时间：
2020-05-08
影响因子：
8.9
通讯作者：
de Filippo, Massimo
中科院分区：
文献类型：
--
作者：
Gentili, Francesco;Bronico, Ilaria;de Filippo, Massimo
目的探讨在肾小肿块（直径< 4 cm）中，病变与皮质的比值（L/C）衰减和主动脉-病变衰减差（ALAD）在鉴别癌细胞瘤与透明细胞癌中的应用价值。方法回顾性分析2014年1月至2018年12月期间，因可疑肾小肿块术前行CT检查的76例患者，病理诊断为癌细胞瘤（ROs） 21例，透明细胞rcc 25例，憎色细胞rcc 7例，乳头状rcc 7例，多室囊性rcc 7例，血管平滑肌脂肪瘤7例，平滑肌瘤2例。由两名放射科医生分别获得肿瘤、正常肾皮质和主动脉的CT衰减值，并在同一片上放置圆形感兴趣区域（ROI）。结果皮质-髓质期，肾皮质ROs呈等密度增强（L/C比值0.92 +/- 0.12），透明细胞rcc呈低密度增强（L/C比值0.69 +/- 0.20,p < 0.01），诊断RO的准确率为80%。肾显像期的L/C衰减比ROs的皮质髓质期低（0.78 +/- 0.11），显示早期冲洗模式，而透明细胞rcc的L/C与皮质髓质期相似（0.69 +/- 0.13;p = 0.025，诊断RO的准确率为65%）。在排泄期，L/C衰减率在ROs和透明细胞rcc之间有相当大的重叠（p = 0.27）。肾造影期ROs的平均ALAD值为21.95 +/- 16.24，透明细胞rcc的平均ALAD值为36.96 +/- 30.53 （p = 0.049）。结论皮质髓质期L/C衰减可作为鉴别RO与透明细胞RCC的指标。
Purpose We investigate the use of ratio of lesion to cortex (L/C) attenuation and aorta-lesion attenuation difference (ALAD) on multiphase contrast-enhanced CT to help distinguish oncocytoma from clear cell RCC in small renal masses (diameter < 4 cm). Methods We retrospectively identified 76 patients that undergo CT before surgery for a suspicious small renal mass between January 2014 and December 2018 with pathological diagnosis of 21 oncocytomas (ROs), 25 clear cell RCCs, 7 chromophobe RCCs, 7 papillary RCCs, 7 multilocular cystic RCCs, 7 angiomyolipomas and 2 leiomyomas. CT attenuation values were obtained for the tumor, the normal renal cortex and the aorta, placing a circular region of interest (ROI) in the same slice by two radiologists, independently. Results In the corticomedullary phase, ROs showed isodense enhancement to the renal cortex (ratio L/C 0.92 +/- 0.12), while clear cell RCCs appeared hypodense to the renal cortex (ratio L/C 0.69 +/- 0.20; p < 0.01) with an accuracy of 80% for diagnosing RO. In nephrographic phase, the ratio L/C attenuation was lower than the corticomedullary phase in ROs (0.78 +/- 0.11) showing an early washout pattern, while the ratio L/C was similar to the corticomedullary phase in clear cell RCCs (0.69 +/- 0.13; p = 0.025, with an accuracy of 65% for diagnosing RO). The ratio L/C attenuation showed considerable overlap between ROs and clear cell RCCs in the excretory phase (p = 0.27). Mean ALAD values in the nephrographic phase were 21.95 +/- 16.24 for ROs and 36.96 +/- 30.53 for clear cell RCCs (p = 0.049). Conclusion The ratio L/C attenuation in corticomedullary phase may be useful to differentiate RO from clear cell RCC.