| Part I Study on 320-slice dynamic volume CT perfusion in different pathologic types of renal tumorsObjective To investigate microcirculatory differences between different pathologic types of renal tumors using 320-slice dynamic volume CT perfusion. Methods Perfusion imaging with 320-slice dynamic volume CT was prospectively performed in 211 patients with pathologically proven clear cell renal cell carcinoma (RCC) (n=165), papillary RCC (PRCC) (n=11), chromophobe RCC (CRCC) (n=19), angiomyolipoma with minimal fat (AML with minimal fat) (n=16), or RCC (n=195). Equivalent blood volume (Equiv BV), permeability surface-area product (Ps), and blood flow (BF) of tumor and normal renal cortex were measured and analyzed statistically. Results The mean Equiv BV (ml/100 g) of normal renal cortex, CCRCC, PRCC, CRCC, AML with minimal fat, and RCC were 93.1±16.1,76.0±21.7,27.23±8.7,41.9±17.6,53.5±14.9, and 69.9±25.4, respectively. The mean Ps (ml/100 g/min) of normal renal cortex, CCRCC, PRCC, CRCC, AML with minimal fat, and RCC were 199.9±90.0,96.0±63.4,57.7±27.3,58.8±39.7,87.4±35.4, and 90.2±61.4, respectively. The mean BF (ml/100 g/min) of normal renal cortex, CCRCC, PRCC, CRCC, AML with minimal fat, and RCC were 284.7±60.0,243.7±100.3,62.3±40.7, 117.8±66.8,187.0±84.5, and 221.2±109.2, respectively. There was a significant difference in all three parameters between tumors and normal renal cortex (P<0.001 for all). Equiv BV was significantly different between RCC and AML with minimal fat (P=0.003). Mean Equiv BV and BF were significantly higher in CCRCC than in PRCC (P<0.001 for both). Mean Equiv BV, Ps, and BF were higher in CCRCC than in CRCC (P<0.001, P=0.003, and P<0.001). There was a significant difference in Equiv BV between CCRCC and AML with minimal fat (P<0.001). The PRCC showed significantly lower BF value than the AML with minimal fat (P=0.011). Mean Ps was lower in CRCC than in AML with minimal fat (P=0.047). Conclusion Perfusion imaging using 320-slice dynamic volume CT can be used to evaluate hemodynamic features of the whole kidney and renal tumors, which may be useful in the differential diagnosis of these four pathologic types of renal tumors.Part II Study of DWI and PWI in the renal tumorsObjective To investigate the value of ADC and PWI parameters in the differential diagnosis of renal tumors. Materials and Methods DWI was prospectively performed in 70 patients with pathologically proven renal cell carcinoma (RCC) (n=64), angiomyolipoma with minimal fat (n=3), and other pathologic types (n=3). The tumors were devided into 3 groups:clear cell RCC(CCRCC) (n=50), non-CCRCC (n=20), and chromophobe RCC (CRCC) (n=10). The ADC values of tumors were measured and analyzed statistically. PWI was prospectively performed in 51 patients with pathologically proven clear cell renal cell carcinoma (RCC) (n=35) and other pathologic types (n=16). The tumors were devided into 2 groups:CCRCC and non-CCRCC. Semi-quantitative parameters including Percentage ratio of peak enhancement, Time to peak, Washout slope, and Kinetic curve type of tumors were measured and analyzed statistically. Quantitative parameters including Ktrans, Kep, and Ve of tumors and normal renal parenchyma were measured and analyzed statistically. Correlation between semi-quantitative and quantitative parameters were analysed. Results The mean ADC value was significantly higher in CCRCC than in non-CCRCC and CRCC (P<0.001 for both). Percentage ratio of peak enhancement was significantly different between CCRCC and non-CCRCC (P< 0.001). The washout Kinetic curve type was more frequent in CCRCC than in non-CCRCC (63% VS 31%, P=0.036). CCRCC showed higher Ktrans and Kep compared to non-CCRCC (P<0.05 for both). Semi-quantitative parameters revealed no significant correlation with quantitative parameters(P>0.05). Percentage ratio of peak enhancement showed higher AUC in distinguishing CCRCC from non-CCRCC compared to Ktrans (Z=2.091, P< 0.05). The sensitivity were more than 0.90 by combination of semi-quantitative and quantitative parameters in parallel and the specificity were more than 0.90 in sequence. Conclusion ADC and PWI may be useful in differentiation of renal tumors. Semi-quantitative parameters can't directly reflect the physiological information of the tumors as quantitative parameters. Percentage ratio of peak enhancement is superior to Ktrans for differentiation of renal tumors. The combination of semi-quantitative and quantitative parameters could improve the value of differentiation of renal tumors.Part ? Comparison and correlation among CTPI, DWI and PWI in the differential diagnosis of renal tumorsObjective To compare the value of CTPI, DWI and PWI parameters in the differential diagnosis of renal tumors. Materials and Methods CTPI and DWI were prospectively performed in 33 patients with pathologically proven clear cell renal cell carcinoma (CCRCC) (n=27), papillary RCC (PRCC) (n=1), and chromophobe RCC (CRCC) (n=5). The tumors were devided into 2 groups:CCRCC (n=27) and non-CCRCC (n=6). The perfusion parameters and ADC values of tumors were measured and analyzed statistically. Statistical analysis was performed with receiver operation characteristic curve analysis. DWI and PWI were prospectively performed in 51 patients with pathologically proven CCRCC (n=35) and non-CCRCC (n=16). The ADC and PWI parameters values of tumors were measured and analyzed statistically. Statistical analysis was performed with receiver operation characteristic curve analysis. Twelve patients with CCRCC and two patients with CRCC were examined with CTPI, DWI, and PWI. Correlation between CTPI parameters, ADC, and PWI parameters was analysed. Results CTPI parameters showed similar area under the curve (AUC) in distinguishing CCRCC from non-CCRCC compared to ADC (AUC>0.90 for all). The sensitivity were more than 0.90 by combination of CTPI and DWI in parallel. ADC showed higher AUC in distinguishing CCRCC from non-CCRCC compared to Ktrans and Kep (P<0.05 for both). The sensitivity were more than 0.89 by combination of DWI and PWI in parallel and the specificity were more than 0.90 in sequence. There was significant correlation between CTPI parameters, ADC, and PWI parameters. Conclusion CTPI and DWI are of similar ability in differentiation of renal tumors. BV, Ps, and BF as well as water content may change the ADC. ADC is superior to Ktrans and Kep for differentiation of renal tumors. The combination of the two of CTPI, DWI, and PWI could improve the value of differentiation of renal tumors. There were significant correlation between CTPI parameters, ADC, and PWI parameters. |
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