| Objective : To investigate the differential diagnosis of Dynamic CT scan common histologic subtypes of renal cell carcinoma,improve preoperative diagnostic accuracy.Method : A retrospective analysis of the scanned image of kidney cancer that the diameter is about 4.7cm,149 cases were pathologically confirmed,include CCRCC,PRCC,CRCC.CT images were comparative analysis on tumor enhancement(CT value,the absolute value enhancement,lesion enhancement percentage)and mode(even,typical and major peripheral enhancement),peak enhancement(arterial and venous phase,excretory phase CT peak)and tumor density(even,uneven),edge features(clear,irregular),calcification,necrosis,pseudocapsule prominent kidney contour and so on.Results : Between CCRCC and PRCC,CT value of CRCC showed no significant difference when unenhanced(P> 0.05).In the arterial phase enhanced scan,CT values were higher than clear cell papillary carcinoma and chromophobe cell carcinoma,the difference was statistically significant(P <0.05).But CT value papillary and chromophobe cell carcinoma in the enhanced scan showed no significant difference between periods(P> O.05).Arterial phase,CT value of clear cell carcinoma was significantly higher than papillary or chromophobe cell carcinoma;in three common kidney cancer,for the absolute value enhancement(CT value enhancing lesions-the lesions unenhanced CT value),three kinds of tumor enhancement in the arterial phase absolute value difference was statistically significant(P <0.05),venous phase,and excretion of enhancing the value of the difference was not statistically significant,in addition,papillary and chromophobe cell carcinoma in the excretion of the absolute value of the difference was statistically enhanced significance(P <0.05).Three tumor arterial lesions was statistically significant difference between the percentage(P <0.05),clear cell carcinoma and papillary adenocarcinoma in the venous phase,excretory phase difference between the percentage of lesions was statistically significant(P <0.05),this group of patients in the arterial phase of renal cell carcinoma was higher than the percentage of lesions papillary and chromophobe renal cell carcinoma,venous phase,excretion of the lesions was higher than the percentage of papillary adenocarcinoma,but the nipple carcinoma and chromophobe cell carcinoma in enhancing lesions between Strengthening the percentage difference was not statistically significant(P> O.05).The area under the ROC curve was 0.821 index strengthened and 0.897,Youden index was0.56,0.657,0.565.Clear cell carcinoma and papillary carcinoma,chromophobe cell carcinoma differences in enhancement patterns,and distributed in chromophobe and papillary carcinoma was no significant difference.Typical strengthen the chances of clear cell and papillary cancers than chromophobe cell carcinoma,the most common and homogeneous enhancement in papillary and chromophobe cell carcinoma.Mostly clear cell carcinomas appear peak enhancement in the arterial phase,and chromophobe and papillary carcinoma peak enhancement peaks appear more in the vein of.Tumor edge features,tumor pseudocapsule prominent kidney tumor and tumor calcification contour similar performance in all subtypes of renal cell carcinoma,the difference was not statistically significant(P> 0.05).Tumors and tumor necrosis density distributions are different(P <0.01)in clear cell carcinoma and papillary carcinoma.In addition,tumor necrosis in clear cell carcinoma and chromophobe cell carcinoma manifestations are different,and the difference was statistically significant(P <0.01).Conclusion: The study showed that the degree of enhancement is the most valuable parameter among kidney cancer subtypes.Different methods were used to improve the accuracy of diagnosis of renal cell carcinoma histological subtypes.In addition,the presence or absence of tumor necrosis,tumor density,enhancement patterns,strengthening phase,peak enhancement in CCRCC and non-clear cell carcinoma distributions are also different,and the difference between RCC subtypes also have a role to diagnose different renal carcinoma subtypes.. |
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