术前MR多征象分析对肾脏囊性病灶定性诊断的价值
摘要
目的探讨术前MR多征象分析对鉴别肾脏囊性病变的可靠性。方法对郑州大学第一附属医院30例肾脏囊性病灶的术前MR资料进行回顾性分析,以病理结果为金标准(其中良性病变17例;恶性病灶13例),提取并比较MR各征象与病理结果的相关性,并建立Logistic模型筛选出对恶性肾囊性病灶的独立预测因素,以受试者工作曲线评估其对肾脏囊性病灶良恶性的鉴别诊断价值。结果在良恶性肾脏囊性病灶术前MR各征象中,病灶囊变数目、囊壁或分隔的均匀性、生长方式以及囊液信号比较,差异无统计学意义(均P>0.05);附壁结节、强化方式、囊壁或分隔的厚度比较,差异无统计学意义(均P<0.05)。Logistic模型筛选得到囊壁或分隔的厚度可作为预测肾脏恶性囊性病灶的独立预测因素(OR=1.862,P=0.028),其相应的敏感度、特异度及曲线下面积分别为76.92%、88.24%、0.873。结论术前MR多征象分析能为肾脏囊性病灶的良恶性鉴别提供重要的参考依据,良性肾囊性病灶通常表现为附壁结节少见、"延迟强化"且囊壁或分隔的厚度相对较薄。反之,则提示恶性肾囊性病灶可能性大。
引文
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[2] 程明,肖喜刚,陈文军,等.能谱CT成像在肾积水和单纯性肾囊肿鉴别中的应用价值[J].哈尔滨医科大学学报,2017,51(1):35-40.
[3] 王启飞,郑伟,王丽娜.囊性肾癌临床特点及诊治分析[J].大连医科大学学报,2014,(1):65-67.
[4] WINTERS B R,GORE J L,HOLT S K,et al.Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size[J].Urol Oncol,2015,33(12):505.e9-505.e13.
[5] 曾红春,王晓荣,王玉杰,等.超声造影对鉴别诊断肾囊性病灶良恶性的价值[J].新疆医科大学学报,2012,35(8):1096-1099.
[6] 叶玲玲,滕陈迪,黄崇权,等.囊性肾癌的CT诊断和鉴别诊断[J].放射学实践,2008,23(12):1339-1343.
[7] 赵金坤,叶兆祥,白人驹,等.囊性肾瘤和多房囊性肾癌的CT鉴别诊断[J].中华肿瘤杂志,2015,37(11):845-849.
[8] KASHAN M,GHANAAT M,H?TKER A M,et al.Cystic renal cell carcinoma:a report on outcomes of surgery and active surveillance in patients retrospectively identified on pretreatment imaging[J].J Urol,2018,200(2):275-282.
[9] WOOD C G,STROMBERG L J ,HARMATH C B,et al.CT and MR imaging for evaluation of cystic renal lesions and diseases[J].Radiographics,2015,35(1):125-141.
[10] 薛莉,孙大雪,王爱露.囊性肾癌的超声诊断与误诊分析[J].中华超声影像学杂志,2005,14(12):954-955.
[11] 李吉昌,刘绍玲,牛司华,等.囊性肾癌超声分型及其诊断价值的探讨[J].中华超声影像学杂志,2006,15(2):159-160.
[12] GRECO F,FAIELLA E,SANTUCCI D,et al.Ultrasound imaging of cystic nephroma[J].J Kidney Cancer VHL,2017,4(3):1-9.
[13] 夏威利,王立峰,魏晓艳,等.多房囊性肾癌的CT、MRI征象分析[J].临床放射学杂志,2013,32(11):1611-1614.
[14] SEVCENCO S,SPICK C,HELBICH T H,et al.Malignancy rates and diagnostic performance of the bosniak classification for the diagnosis of cystic renal lesions in computed tomography-a systematic review and meta-analysis[J].Eur Radiol,2016,27(6):1-9.