CAJ | 학술논문

目的探讨肾囊肿CT多期增强扫描中假强化征象的特征.方法回顾性分析行B超、CT检查,临床诊断为肾囊肿的91例(112个)患者资料.测量CT扫描各期相(平扫、动脉期、静脉期和排泌期)囊肿及肾实质的CT值,计算囊肿增强扫描各期相假强化程度,并分别以假强化程度＞10、＞15和＞18 HU为阈值判断肾囊肿假强化的符合率.观察囊肿直径并根据囊肿在肾实质中的比例进行分型(Ⅰ型、Ⅱ型和Ⅲ型).增强扫描各期相间、不同直径组间和不同分型间囊肿CT值和(或)假强化程度的比较采用Kruskal-Wallis秩和检验.采用Spearman法分析肾囊肿直径与各期增强扫描假强化程度间的相关性.结果 112个肾囊肿平扫、动脉期、静脉期和排泌期的CT值中位数分别为6、11、12和12 HU,差异有统计学意义(x2=53.32,P＜0.01),增强扫描各期CT值均高于平扫期.增强后囊肿CT值变化为-10～ 31 HU,假强化程度范围为1～5、6～ 10HU两组囊肿较多.动脉期、静脉期和排泌期的假强化程度中位数分别为4、5和6 HU,差异有统计学意义(x2=10.062,P＜0.01).以＞10、＞15和＞18 HU为阈值,判断假强化的符合率分别为83.0％(239/288)、95.1％(274/288)和96.9％(279/288).直径≤10 mm组囊肿假强化程度高于直径＞10 mm各组(P均＜0.05).Ⅰ型、Ⅱ型和Ⅲ型肾囊肿分别为62、23和27个,Ⅰ型肾囊肿动脉期、静脉期和排泌期的假强化程度中位数分别为5.0、6.0和8.0 HU,均高于Ⅱ型和Ⅲ型肾囊肿(P均＜0.05).动脉期、静脉期和排泌期囊肿的假强化程度和直径均呈低度负相关(r值分别为-0.326、-0.332和-0.447,P均＜0.01).结论假强化程度与囊肿大小、分型和扫描期相等均相关,诊断时需综合考虑.
목적 탐토신낭종CT다기증강소묘중가강화정상적특정.방법 회고성분석행B초、CT검사,림상진단위신낭종적91례(112개)환자자료.측량CT소묘각기상(평소、동맥기、정맥기화배비기)낭종급신실질적CT치,계산낭종증강소묘각기상가강화정도,병분별이가강화정도＞10、＞15화＞18 HU위역치판단신낭종가강화적부합솔.관찰낭종직경병근거낭종재신실질중적비례진행분형(Ⅰ형、Ⅱ형화Ⅲ형).증강소묘각기상간、불동직경조간화불동분형간낭종CT치화(혹)가강화정도적비교채용Kruskal-Wallis질화검험.채용Spearman법분석신낭종직경여각기증강소묘가강화정도간적상관성.결과 112개신낭종평소、동맥기、정맥기화배비기적CT치중위수분별위6、11、12화12 HU,차이유통계학의의(x2=53.32,P＜0.01),증강소묘각기CT치균고우평소기.증강후낭종CT치변화위-10～ 31 HU,가강화정도범위위1～5、6～ 10HU량조낭종교다.동맥기、정맥기화배비기적가강화정도중위수분별위4、5화6 HU,차이유통계학의의(x2=10.062,P＜0.01).이＞10、＞15화＞18 HU위역치,판단가강화적부합솔분별위83.0％(239/288)、95.1％(274/288)화96.9％(279/288).직경≤10 mm조낭종가강화정도고우직경＞10 mm각조(P균＜0.05).Ⅰ형、Ⅱ형화Ⅲ형신낭종분별위62、23화27개,Ⅰ형신낭종동맥기、정맥기화배비기적가강화정도중위수분별위5.0、6.0화8.0 HU,균고우Ⅱ형화Ⅲ형신낭종(P균＜0.05).동맥기、정맥기화배비기낭종적가강화정도화직경균정저도부상관(r치분별위-0.326、-0.332화-0.447,P균＜0.01).결론 가강화정도여낭종대소、분형화소묘기상등균상관,진단시수종합고필.
Objective To evaluate the rules and features of the pseudoenhancement phenomenon of renal cysts during the multi-phases of contrast enhanced MSCT scan.Methods Ninety one patients with 112 simple renal cysts with B-ultrasound,CT examination,improved clinically enrolled in this retrospective study.The attenuation of the renal cysts were measured blindly in the images of CT plain scan and scans of arterial,venal and secrete phases,and the attenuation change of the cysts between pre-and post-enhanced scans were calculated; the accuracies of pseudoenhancement judging were calculated with 10 HU,15 HU and 18 HU as a threshold;the size were recorded; degree of intra renal parenchyma of the cyst were also confirmed,and so renal cysts were divided into three groups:type Ⅰ,Ⅱ and Ⅲ; The differences of attenuation among 3 enhancement phases,different size,different type were analyzed statistically with the Kruskal-wallis rank sum test,the correlation between the diameter and the pseudoenhancement in each enhancement phases were analyzed statistically with Spearman test.Results The attenuation median of the 112 cysts in plain scan,arterial,venal and secrete phase was 6.0 HU,11.0 HU,12.0 HU and 12.0 HU respectively,there was significant difference(x2=53.32,P＜0.01).The attenuation of the cysts in enhanced phases was higher than unenhanced.The range of attenuation change of the cysts between pre-and postenhanced scans was-10 to 31 HU,the number of cysts in groups of pseudoenhancement of 1 to 5 HU and 6 to 10 HU in each enhanced phase was dominant.The pseudoenhancement median of arterial,venal and secrete phase was 4.0 HU,5.0 HU and 6.0 HU respectively,There was significant difference among three groups(x2=10.062,P＜0.01).Taking 10 HU,15 HU and 18 HU as threshold for judging pseudoenhancement,the accuracy was 83.0％(239/288),95.1％(274/288) and 96.9％(279/288) respectively; Pseudoenhancement of small cysts(≤10 mm) was higher than other groups in each enhancement phase,and there was significant difference(P＜0.05).Type Ⅰ,Ⅱ and Ⅲ renal cysts were 62,23 and 27 respectively,the pseudoenhancement median of type Ⅰ renal cyst was 5.0 HU,6.0 HU and 8.0 HU respectively in arterial,venous,and excretion phase,which were higher than Type Ⅱ and Ⅲ (P＜0.05).It showed low negative correlation between pseudoenhancemen and diameter in arterial,venous and secrete phase(r =-0.326,-0.332 and-0.447,P＜ 0.01).Conclusion The pseudoenhancement correlated with the renal cyst size,the type and the enhance phases,which should be considered when making diagnosis.