透明细胞型肾细胞癌Fuhrman分级及与血管平滑肌脂肪瘤鉴别诊断的能谱CT表现和临床病理研究

发布时间：2018-05-05 06:15

本文选题：宝石CT能谱成像 + 透明细胞型肾细胞癌　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的：通过对透明细胞型肾细胞癌(Clear cell renal cell carcinoma, CCRCC)和肾血管平滑肌脂肪瘤(Renal angiomyolipoma, RAML)行能谱CT成像,将其数据进行后处理分析并与临床病理资料相对比,探讨能谱CT成像对于透明细胞型肾细胞癌恶性度分级以及与血管平滑肌脂肪瘤的鉴别诊断价值。方法：收集2012年10月至2014年1月经手术或穿刺病理证实的44例透明细胞型肾细胞癌和27例血管平滑肌脂肪瘤患者,均行能谱成像模式二期增强扫描并完成图像重建,在动脉期、静脉期单能谱图像上获得肾脏病灶及腹主动脉不同keV下的CT值,计算不同keV下病灶与腹主动脉CT比值(标准CT值)；利用单能量图像的能谱分析功能获得以碘和水为基物质的碘基图和水基图、以脂肪和水为基物质对的脂肪图和水基图,并测量病灶与腹主动脉相应的碘含量、水含量和脂肪含量,计算病灶与腹主动脉比值。并对所获得数据进行统计学分析。结果： 1、从年龄构成、性别及肿瘤的发生部位(左侧或右侧)不能区分透明细胞型肾细胞癌各分级,P0.05。 2、透明细胞型肾细胞癌的恶性度分级在有无静脉瘤栓的差别有统计学意义,P0.05。(两两比较)：2级与3级、2级与4级在有无静脉瘤栓的差别有统计学意义,2级有静脉瘤栓的比例低于3级、4级。 3、keV在40-100时透明细胞型肾细胞癌各级的动脉期单能量平均值的差别有统计学意义,P0.05；在110-140keV时无统计学意义,P0.05。 4、keV在40-140时透明细胞型肾细胞癌分级的静脉期单能量平均值的差别无统计学意义,P0.05。 5、RAML和透明细胞型肾细胞癌在发病部位的差别无统计学意义,P0.05。 6、动脉期标准碘浓度、动脉期标准脂浓度在透明细胞型肾细胞癌不同分级的差别有统计学意义,P0.05。 7、动脉期标准碘浓度、静脉期标准碘浓度、动脉期水浓度、动脉期标准脂浓度、静脉期标准值浓度在透明细胞型肾细胞癌和血管平滑肌脂肪瘤的差别有统计学意义,P0.05。透明细胞型肾细胞癌各指标浓度高于血管平滑肌脂肪瘤。结论：宝石能谱成像检查对透明细胞型肾细胞癌和血管平滑肌脂肪瘤的鉴别诊断及对透明细胞型肾细胞癌恶性度分级具有一定的价值。透明细胞型肾细胞癌中2级出现静脉瘤栓的几率明显低于3级和4级；在40-100keV时,GSI动脉期单能量平均值、动脉期标准碘浓度、动脉期标准脂浓度可区分透明细胞型肾细胞癌各分级；动脉期标准碘浓度、静脉期标准碘浓度、动脉期水浓度、动脉期标准脂浓度、静脉期标准值浓度在透明细胞型肾细胞癌和血管平滑肌脂肪瘤的差别有统计学意义。
[Abstract]:Objective: Clear cell renal cell carcinoma, CCRCC) and Renal angiomyolipoma (RAMLL) of clear renal cell carcinoma (RCC) were examined by energy dispersive computed tomography (EDS). The data were analyzed by post-processing and compared with the clinicopathological data. To evaluate the diagnostic value of energy dispersive CT in the grade of malignancy of clear cell renal cell carcinoma and its differential diagnosis with angiomyolipoma. Methods: From October 2012 to January 2014, 44 cases of clear cell renal cell carcinoma and 27 cases of angiomyolipoma confirmed by operation or puncture pathology were collected. The CT values of renal lesions and abdominal aorta under different keV were obtained on single energy spectrum images of venous phase. The ratio of focus to abdominal aorta under different keV (standard CT value) was calculated. The iodine and water based images were obtained by using the energy spectrum analysis function of single energy images, and the fat and water base maps with fat and water as base substances were obtained. The corresponding iodine content, water content and fat content were measured and the ratio of focus to abdominal aorta was calculated. And the obtained data were statistically analyzed. Results: 1. According to age composition, sex and location of tumor (left or right), the grade of clear cell renal cell carcinoma could not be distinguished (P 0.05). 2. The grade of malignancy of clear cell renal cell carcinoma was significantly different in the presence or absence of venous thrombus (P 0.05). The difference between grade 2 and grade 3, grade 2 and grade 4 in the presence of venous thrombus was statistically significant, and the proportion of grade 2 and grade 2 with venous thrombus was lower than that of grade 3 or grade 4. 3There was significant difference in the mean value of single energy between 40 and 100 in all stages of clear cell renal cell carcinoma (P0.05), but there was no significant difference in P0.05in 110-140keV. (4) there was no significant difference in the mean value of single energy in venous phase between 40 and 140 in clear cell renal cell carcinoma grade (P 0.05). There was no significant difference between RAML and clear cell renal cell carcinoma (RCC). 6. Standard iodine concentration in arterial phase and standard lipid concentration in arterial phase were significantly different in different grades of clear cell renal cell carcinoma (P0.05). 7. The difference of standard iodine concentration in arterial phase, water concentration in arterial phase, standard lipid concentration in arterial phase and venous phase in clear cell renal cell carcinoma and angiomyolipoma was statistically significant (P 0.05). The index concentration of clear cell renal cell carcinoma was higher than that of angiomyolipoma. Conclusion: Gem EDS is valuable in the differential diagnosis of clear cell renal cell carcinoma and angiomyolipoma and in the grade of malignancy of clear cell renal cell carcinoma. In clear cell renal cell carcinoma, the incidence of venous thrombus in grade 2 was significantly lower than that in grade 3 and grade 4, and the mean value of single energy in arterial phase and the standard iodine concentration in arterial phase were significantly lower than those in grade 3 and grade 4 in 40-100keV. The grade of clear cell renal cell carcinoma can be distinguished by standard lipid concentration in arterial phase, standard iodine concentration in arterial phase, water concentration in arterial phase, and standard lipid concentration in arterial phase. There was significant difference in venous phase standard concentration between clear cell renal cell carcinoma and angiomyolipoma.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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