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目的探讨扩散张量成像(DTI)在肾脏实性肿瘤中的诊断与鉴别诊断价值。方法 75例肾脏实性占位患者及30名健康志愿者纳入研究,所有受检者均行常规MRI及DTI扫描。将75例肿瘤分为血管平滑肌脂肪瘤、透明细胞癌、非透明细胞肾癌三类,测量观察指标各向异性分数(FA)、表观扩散系数(ADC)。两组之间计量资料比较采用独立样本t检验;以FA值、ADC值作为透明细胞癌和血管平滑肌脂肪瘤的评估效应值,构建ROC曲线进行诊断效能评价。结果肾血管平滑肌脂肪瘤ADC值低于正常肾皮质和髓质(P<0.05),FA值低于正常肾髓质(P<0.05)。透明细胞癌及非透明细胞癌FA值、ADC值均低于正常肾脏皮质和髓质(P<0.05)。血管平滑肌脂肪瘤与透明细胞癌、非透明细胞癌的FA值差异存在统计学意义(P<0.05),与透明细胞癌ADC值差异存在统计学意义(P<0.05)。透明细胞癌与非透明细胞癌ADC值差异具有统计学意义(P<0.05)。ADC值对诊断透明细胞癌准确性较高,以ADC值为评估值,临界值取1.380×10~(-3)mm~2/s,其敏感性为97.4%、特异性为66.7%。结论DTI对鉴别肾脏实性肿瘤的良恶性及推断恶性肿瘤病理类型具有一定价值。
Objective To investigate the value of diffusion tensor imaging (DTI) in the diagnosis and differential diagnosis of renal solid tumors. Methods 75 cases of renal real occupying patients and 30 healthy volunteers were included in the study. All subjects underwent routine MRI and DTI scanning. Seventy-five tumors were divided into three groups: angiomyolipoma, clear cell carcinoma and non-clear cell renal cell carcinoma. The anisotropy fraction (FA) and apparent diffusion coefficient (ADC) were measured. The measurement data between the two groups were compared with independent sample t-test. FA value and ADC value were used as the evaluation value of clear cell carcinoma and angiomyolipoma, and ROC curve was constructed to evaluate the diagnostic efficacy. Results The ADC value of renal angiomyolipoma was lower than that of normal renal cortex and medulla (P <0.05), FA value was lower than that of normal renal medulla (P <0.05). The values of FA and ADC in clear cell carcinoma and non-clear cell carcinoma were lower than those in normal renal cortex and medulla (P <0.05). There were significant differences in FA values between angiomyolipoma and clear cell carcinoma and non-clear cell carcinoma (P <0.05), which were significantly different from those of clear cell carcinoma (P <0.05). The difference of ADC value between clear cell carcinoma and non-clear cell carcinoma was statistically significant (P <0.05). The accuracy of ADC value in the diagnosis of clear cell carcinoma was high, with the ADC value as the evaluation value. The critical value was 1.380 × 10 -3 mm 2 / s with a sensitivity of 97.4% and a specificity of 66.7%. Conclusion DTI has certain value in distinguishing benign and malignant renal solid tumors and inferring the pathological types of malignant tumors.