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目的探讨肾脏上皮样血管平滑肌脂肪瘤(EAML)的CT表现及其与肾透明细胞癌(ccRCC)、肾血管平滑肌脂肪瘤(AML)的鉴别诊断。方法回顾性分析经病理证实的EAML 28例、ccRCC 32例、AML 22例患者的CT征象并运用随机森林模型(RF)进行鉴别诊断。结果 EAML 28例中,男7例,女21例。平均发病年龄为42.5岁。25例发生在单侧肾脏;24例为单发,15例可见脂肪成分。CT平扫、增强动脉期及静脉期CT值分别为43.8HU、92.0 HU、77.0 HU。增强动静脉期CT差值12.8 HU。4例出现粗大血管。EAML与ccRCC进行鉴别诊断,其RF准确率为97.30%,EAML无囊变,约50%病例中含脂肪成分,发病年龄为42.5岁,平扫CT值为43.8 HU,动静脉期CT值差值为12.8 HU。约94%ccRCC发生囊变,无脂肪,发病年龄为57.8岁,平扫CT值为36.7 HU,动静脉期CT值差值为27 HU。EAML与AML进行鉴别诊断,其RF准确率为70.97%:EAML较AML发病年龄年轻,肿瘤直径大,动静脉期CT值差大。结论 EAML主要发生在青年女性,平扫CT值较肾实质高,呈快进-慢出强化方式。EAML与ccRCC鉴别诊断主要从囊变、脂肪、年龄、平扫CT值、动静脉期CT值差值进行鉴别。EAML与AML主要从静脉期CT值、动脉期CT值、年龄、肿瘤直径、动静脉期CT值差值鉴别。
Objective To investigate the CT findings of renal epithelioid angiomyolipoma (EAML) and their differential diagnosis with renal clear cell carcinoma (ccRCC) and renal angiomyolipoma (AML). Methods The CT findings of 28 pathologically confirmed cases of EAML, 32 cases of ccRCC and 22 cases of AML were analyzed retrospectively. Randomized forest models (RFs) were used to detect the CT signs. Results EAML 28 cases, 7 males and 21 females. The average age of onset was 42.5 years. 25 cases occurred in unilateral kidney; 24 cases of solitary fat, 15 cases of visible fat composition. CT scan, enhanced arterial phase and venous phase CT values were 43.8HU, 92.0 HU, 77.0 HU. Enhanced arteriovenous phase CT difference 12.8 HU. 4 cases of thick blood vessels. EAML and ccRCC differential diagnosis, the RF accuracy was 97.30%, EAML no cystic change, fat content in about 50% of cases, the age of onset was 42.5 years, CT scan value was 43.8 HU, arteriovenous phase CT value difference Is 12.8 HU. About 94% ccRCC cystic change, no fat, the age of onset was 57.8 years old, CT scan value was 36.7 HU, arteriovenous phase CT value difference of 27 HU. EAML and AML differential diagnosis, the RF accuracy rate of 70.97%: EAML younger than the age of onset of AML, tumor diameter, arteriovenous phase CT value difference. Conclusions EAML mainly occurs in young females. The CT scan value is higher than that of renal parenchyma and shows a fast-forward-slow-out enhancement mode. EAML and ccRCC differential diagnosis mainly from cystic change, fat, age, CT scan value, arteriovenous phase CT value differential identification. EAML and AML mainly from venous phase CT value, arterial phase CT value, age, tumor diameter, arteriovenous phase CT value difference.