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目的探讨CT多期增强扫描鉴别诊断多房囊性肾癌(MCRCC)与肾癌坏死囊变(NCRCC)的价值。方法分析经手术病理证实的20例MCRCC及41例NCRCC的CT表现及临床资料,绘制ROC曲线,得出鉴别二者的CT值阈值,并应用CT值阈值联合Bosniak分级鉴别MCRCC与NCRCC。结果 35.00%(7/20)的MCRCC Bosniak分级为ⅡF级,60.00%(12/20)为Ⅲ级,5.00%(1/20)为Ⅳ级;4.88%NCRCC(2/41)Bosniak分级为ⅡF级,36.59%(15/41)为Ⅲ级,58.54%(24/41)为Ⅳ级。CT平扫及增强扫瞄中,MCRCC的CT值均低于NCRCC(P均<0.05);以皮髓期CT值34HU为阈值,判断NCRCC的敏感度为79%,特异度为85%;联合Bosniak分级和皮髓期CT值阈值鉴别诊断MCRCC和NCRCC的敏感度、特异度分别为87%、93%。结论 MCRCC与NCRCC鉴别困难;皮髓期CT值阈值和Bosniak分级相结合,可提高鉴别诊断的敏感度及特异度。
Objective To investigate the diagnostic value of multi-compartment cystic renal cell carcinoma (MCRCC) and cystic degeneration of renal cell carcinoma (NCRCC) by multi-phase contrast enhanced CT. Methods The CT findings and clinical data of 20 cases of MCRCC and 41 cases of NCRCC confirmed by surgery and pathology were analyzed. The ROC curve was drawn and the threshold value of CT value was obtained. CT value threshold and Bosniak classification were used to identify MCRCC and NCRCC. Results The 35.00% (7/20) Bosniak grade was classified as grade ⅡF, the grade Ⅲ was 60.00% (12/20), the grade Ⅳ was 5.00% (1/20), the grade ⅡF was 4.88% for NCCCC (2/41) Bosniak Grade, 36.59% (15/41) grade Ⅲ, 58.54% (24/41) grade Ⅳ. CT scan and enhanced scan, CT value of MCRCC were lower than NCRCC (P all <0.05); the threshold value of 34HU in the psoriatic phase was used as the threshold, the sensitivity and specificity of NCRCC were 79% and 85% respectively; The sensitivity and specificity of differential diagnosis of Bosniak grade and cutaneous CT value threshold for diagnosis of MCRCC and NCRCC were 87% and 93%, respectively. Conclusion The differential diagnosis between MCRCC and NCRCC is difficult. The combination of the threshold value of CT and the Bosniak classification can improve the sensitivity and specificity of differential diagnosis.