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Differentiation of Clear Cell Renal Cell Carcinoma from other Renal Cell Carcinoma Subtypes and Benign Oncocytoma Using Quantitative MDCT Enhancement Parameters

机译:用定量MDCT增强参数将透明细胞肾细胞癌的透明细胞肾细胞癌和良性儿肾细胞瘤的分化

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Background and objectives: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. Materials and Methods: A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. Results: Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555–0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, p < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively. Conclusions: Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses.
机译:背景和目标:使用非侵入性技术来预测肾肿块的组织学类型可以避免肾脏肿块活组织检查,从而具有很大的临床兴趣。我们的研究目的是评估数量的多相多种传感器计算断层摄影(MDCT)增强模式(MDCT)肾肿块(恶性和良性)的增强模式可用于通过其增强特性实现病变分化。材料和方法:用四相MDCT协议回顾性分析了总共154个肾肿瘤。我们使用肿瘤(2D分析)最常见的增强部分内的值和整个肿瘤体积(3D分析)来研究衰减值。感兴趣的区域(ROI)也置于相邻的未粘样肾皮质中,以计算相对肿瘤增强比。结果:提高和去除增强(在后区间隔阶段之间的减少量度)通过组织学,注意到了显着的差异。在透明细胞肾细胞癌(CCRCC)和乳头状之间分别分别在0.976(95%CI:0.924-0.995)和0.827(95%CI:0.752-0.887)中的最高区域(95%CI:0.924-0.995)和0.827(95%CI:0.752-0.887)。 RCC(PRCC)/癌细胞瘤。 3D分析允许使用0.643(95%CI:0.555-0.724)的CCRCC从发色度RCC(CHRRCC)的分化。证明仅用于CCRCC和癌细胞瘤之间的歧视(43.34 Vs 64.10,P <0.001)。然而,在CCRCC,PRCC和ChRRCC之间证明了对CCRCC,PRCC和ChRRCC之间的识别有用的相对肿瘤增强比(CM)和肾脏阶段)有用,该值具有0.973(95%CI:0.929-0.993)的较高AUC的CM相的值0.799(95%CI:0.721-0.864)。结论:我们的观察结果指出,成像特征可能有助于提供肾群体管理策略的预后信息。

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