摘要
目的:分析多模态超声和增强CT(CECT)在透明肾细胞癌(ccRCC)和非透明肾细胞癌(non-cc RCC)的影像特征,并比较两种影像技术的诊断效能。方法:选取2013年1月至2023年2月于温州医科大学附属第一医院术前均行多模态超声和CECT检查的125例肾细胞癌(RCC)患者,分析其临床资料和影像特征,比较多模态超声和CECT在ccRCC和non-cc RCC间的诊断性能。结果:多因素Logistic回归分析显示,多模态超声中液化坏死区(OR=2.744,95%CI=1.022~7.369,P=0.045)、实质期强化程度(OR=4.102,95%CI=1.154~14.573,P=0.029)和消退方式(OR=0.226,95%CI=0.083~0.613,P=0.004)是鉴别ccRCC和non-ccRCC的独立预测因子。CECT的参数包括坏死(OR=3.163,95%CI=1.181~8.468,P=0.022)、动脉期强化(OR=4.103,95%CI=1.192~14.117,P=0.025)和增强程度(OR=4.942,95%CI=1.587~15.382,P=0.006)是区分ccRCC和non-ccRCC的独立预测因子。多模态超声和CECT在鉴别ccRCC和non-ccRCC时均显示比较好的诊断性能:灵敏度分别为81.8%和80.7%,特异度分别为75.7%和81.1%,ROC曲线下面积分别为0.832、0.838,两种影像学方法比较差异无统计学意义(P=0.875)。此外,多模态超声和CECT诊断准确率分别为82.4%、76.8%,差异无统计学意义(P=0.620)。多模态超声和CECT诊断观察者间一致性的加权kappa值均为0.706~1.000。结论:多模态超声和CECT在鉴别ccRCC和non-ccRCC方面均有较好的诊断效能,在RCC的评估方面多模态超声能够作为CECT的重要补充,尤其是碘造影剂过敏和肾功能不全的患者。
Objective:To compare and analyze the diagnostic performance of multimodal ultrasound and contrast-enhanced computed tomography(CECT)in differentiating clear cell renal cell carcinoma(ccRCC)from non-clear cell renal cell carcinoma(non-ccRCC).Methods:This study included 121 patients with renal cell carcinoma(RCC)and 125 renal lesions,including 88 ccRCCs and 37 non-ccRCCs.Preoperative multimodal ultrasonography and CECT were performed in all patients,whose postoperative pathological results were obtained.Clinical data and imaging variables of all tumors were analyzed to compare the diagnostic performance of multimodal ultrasound and CECT in ccRCC and non-ccRCC.Weighted kappa statistics was used to estimate the interobserver agreement.Results:Univariate and multivariate analyses showed that tumor cystic changes(OR=2.744,95%CI=1.022-7.369,P=0.045),parenchymal phase enhancement(OR=4.102,95%CI=1.154-14.573,P=0.029)and the wash-out pattern(OR=0.226,95%CI=0.083-0.613,P=0.004)in multimodal ultrasound were independent predictors for distinguishing ccRCC from non-ccRCC.CECT parameters including tumor necrosis(OR=3.163,95%CI=1.181-8.468,P=0.022),arterial phase enhancement(OR=4.103,95%CI=1.192-14.117,P=0.025)and peak enhancement(OR=4.942,95%CI=1.587-15.382,P=0.006)were independent predictors for ccRCC and non-ccRCC.Multimodal ultrasound and CECT both showed good diagnostic properties in distinguishing ccRCC from non-ccRCC,with sensitivity being 81.8%and 80.7%,specificity being 75.7%and 81.1%,and areas under the receiver operating curve being 0.832 and 0.838,respectively.There was no significant difference between the two methods.In addition,the diagnostic accuracy of multimodal ultrasound and CECT was 82.4%and 76.8%,respectively,with no statistical difference(P=0.620).The weighted kappa values of the interobserver agreement for multimodal ultrasound and CECT both ranged from 0.706-1.000.Conclusion:Both multimodal ultrasound and CECT have excellent diagnostic performance in distinguishing between ccRCC and non-ccRCC.Multimodal ultrasound can be used as an important supplement to CECT in the evaluation of renal cell carcinoma,especially in patients with iodinated contrast agent allergy and renal insufficiency.
作者
赵娇凤
夏永升
陈顺平
季文斌
ZHAO Jiaofeng;XIA Yongsheng;CHEN Shunping;JI Wenbin(Department of Ultrasonography,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;Department of Radiology,Affiliated Taizhou Hospital of Wenzhou Medical University,Taizhou 317000,China)
出处
《温州医科大学学报》
CAS
2023年第10期807-813,共7页
Journal of Wenzhou Medical University
关键词
透明细胞癌
非透明细胞癌
超声检查
体层摄影术
X线计算机
clear cell renal cell carcinoma
non-clear cell renal cell carcinoma
ultrasonography
tomography,X-ray computed
作者简介
赵娇凤,住院医师,Email:1047315804@qq.com;通信作者:季文斌,主任医师,Email:jiwenbin2016@163.com。
