平扫CT密度及其直方图参数对少脂肪血管平滑肌脂肪瘤与肾嫌色细胞癌、乳头状肾细胞癌的鉴别诊断及净受益

徐黎明; 刘晓航; 王耀申; 杨孟; 彭卫军

doi:10.19732/j.cnki.2096-6210.2020.01.008

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平扫CT密度及其直方图参数对少脂肪血管平滑肌脂肪瘤与肾嫌色细胞癌、乳头状肾细胞癌的鉴别诊断及净受益

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- 平扫CT密度及其直方图参数对少脂肪血管平滑肌脂肪瘤与肾嫌色细胞癌、乳头状肾细胞癌的鉴别诊断及净受益
- The ability and net benef it of attenuation measurement and histogram analysis for the dif ferentiating minimal- fat renal angiomyolipoma from chromophobe/papillary renal cell carcinoma on unenhanced CT
- 肿瘤影像学 2020年29卷第1期页码：38-43
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- DOI：10.19732/j.cnki.2096-6210.2020.01.008
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- 网络出版：2020-02-28，
  
  纸质出版：2020-02-28
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徐黎明,刘晓航,王耀申,等. 平扫CT密度及其直方图参数对少脂肪血管平滑肌脂肪瘤与肾嫌色细胞癌、乳头状肾细胞癌的鉴别诊断及净受益[J]. 肿瘤影像学, 2020, 29(1): 38-43 https://doi.

org/10.19732/j.cnki.2096-6210.2020.01.008
徐黎明,刘晓航,王耀申,等. 平扫CT密度及其直方图参数对少脂肪血管平滑肌脂肪瘤与肾嫌色细胞癌、乳头状肾细胞癌的鉴别诊断及净受益[J]. 肿瘤影像学, 2020, 29(1): 38-43 https://doi. DOI： 10.19732/j.cnki.2096-6210.2020.01.008.

org/10.19732/j.cnki.2096-6210.2020.01.008 DOI：

摘要

目的：

探讨平扫CT平均密度及直方图分析作为诊断依据，对少脂肪血管平滑肌脂肪瘤（angiomyolipoma，AML）与肾嫌色细胞癌、乳头状肾细胞癌患者的诊断效能及净受益。

方法：

分析37例肾脏少脂肪AML（41个病灶），32例肾嫌色细胞癌，30例乳头状肾细胞癌患者的平扫CT图像，测量并计算其平均密度、直方图10%密度等参数。应用受试者工作特征（receiver operating characteristic，ROC）曲线比较以上参数对少脂肪AML与肾嫌色细胞癌、乳头状肾细胞癌鉴别诊断效能的优劣。应用决策曲线分析法（decision curve analysis，DCA）比较以上参数作为诊断依据对少脂肪AML和肾嫌色细胞癌、乳头状肾细胞癌患者的净受益。

结果：

以平均密度及10%密度鉴别少脂肪AML与肾嫌色细胞癌、乳头状肾细胞癌的ROC曲线的曲线下面积（area under curve，AUC）为0.78和0.79，二者差异无统计学意义（

＞0.05）。以平均密度及10%密度鉴别少脂肪AML与乳头状肾细胞癌的AUC为0.83和0.85，差异无统计学意义（

＞0.05）。以平均密度及10%密度鉴别少脂肪AML与肾嫌色细胞癌的AUC为0.71和0.78，差异无统计学意义（

＞0.05）。对于少脂肪AML与乳头状肾细胞癌，以平均密度和10%密度为诊断依据，将30%以上的恶性可能性作为处理阈值，则患者净受益高于全部处理。对于少脂肪AML与嫌色细胞癌，以平均密度为诊断依据，将35%以上的恶性可能性作为处理阈值，则患者净受益高于全部处理。如果以10%密度为处理依据，将任意恶性可能性为手术阈值，净受益均高于全部处理，且在45%的阈值水平下，净受益率高于根据平均密度处理的水平，但在45%~80%水平阈值，则低于依据平均密度处理者。

结论：

CT平均密度及直方图分析有助于鉴别少脂肪AML与肾嫌色细胞癌、乳头状肾细胞癌，可使患者有明确且不同的受益。

Abstract

Objective:

To investigat

e the ability of mean attenuation and histogram analysis for the differentiating minimal-fat renal angiomyolipoma (AML) from chromophobe/papillary renal cell carcinoma (RCC) and their net benef it on unenhanced CT.

Methods:

Unenhanced CT images of 37 minimal-fat AML (41 lesions)

32 chromophobe and 30 papillary RCC patients were analyzed

the mean attenuation and relative histogram parameters (10

value of attenuation) of the lesions were measured and calculated. The efficiency of the parameters for differentiating of minimal-fat AML from RCC were assessed by receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) were performed to evaluate the net benef it of the two parameters.

Results:

The area under curve (AUC) of the parameters for the differentiating minimal-fat AML from papillary RCC were 0.83 and 0.85

respectively

and no signif icant difference was observed between them. There was neither signif icant difference between the AUC of the parameters for the differentiating minimal-fat AML from chromophobe RCC 0.71 and 0.78. In the differentiating ofminimal-fat AML and papillary RCC

when the diagnosis was applied basing on mean or 10

value of attenuation with a threshold probability (malignant probability) of higher than 30%

the net benef it was higher than treating all patients. And for chromophobe RCC and minimal-fat AML

when the diagnosis was applied basing on mean attenuation with a threshold probability (malignant probability) of higher than 35%

the net benef it was higher than treating all patients. When the diagnosis was applied basing on 10

value of attenuation

the net benef it was higher than treating all at any threshold probability. The net benef it of 10

value of attenuation was higher than mean attenuation at threshold probability less than 45%

but was lower at threshold probability of 45%~80%.

Conclusion:

Unenhanced CT attenuation measurement and histogram analysi

s improved the distinguishing minimal-fat AML from chromophobe/papillary RCC

and provides def inite and difference net benef it for patients.

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