To Investigate The Relationship Between CT Fingings And Fuhrman Grading Of Clear Cell Renal Cell Carcinoma And CT Differential Diagnosis Of Angiomyolipoma With Minimal Fat

The study was divided into two partsPart one: To Investigate the Relationship between CT Fingings and Fuhrman Grading of Clear Cell Renal Cell CarcinomaObjective To analyze the correlation between CT feature and Fuhrman nuclear grades of clear cell renal cell carcinoma(CCRCC). Methods CT feature of 55 patients with CCRCC which were pathologically confirmed were analyzed. For each lesion, unenhanced CT value, the maximum CT value in corticomedullary phase, the CT value of the same location in parenchymal phase and excretion phase, attenuation value(△P1, △P2, △P3), contrast rate( △ R1、 △ R2、 △ R3), maximum diameter, tumor pseudocapsule and hyper-enhancement rim in corticomedullary phase were compared and evaluated with Fuhrman nuclear grades. Results The maximum CT value of low-grade group(Ⅰ—Ⅱ grade) was significantly higher than that of thehigh-grade group(Ⅲ—Ⅳ grade) in corticomedullary phase(t=3.214, P=0.002). the unenhanced CT value, CT value in parenchymal phase and excretory phase showed no statistically significant difference between high-grade group and low-grade group(both P > 0.05) 。 The △P2(corticomedullary phase and excretory phase) of low-grade group was significantly higher than that of the high-grade group(t=3.363,P=0.001), but the value of △P1(corticomedullary phase and parenchymal phase), △P3(parenchymal phase and excretory phase) showed no statistically significant difference between high-grade group and low-grade group(both P>0.05). The △R1、△R2 of low-grade group was significantly higher than that of the high-grade group(t=3.740,P<0.001;t=2.596,P=0.012), but the value of △ R3 showed no statistically significant difference between high-grade group and low-grade group(t=1.951,P=0.056). The maximum CT value in corticomedullary phase, △P1, △P2,△P3,△R1,△R2 and △R3showed no statistically significant difference between Ⅰ grade and Ⅱ grade(all P>0.05). The constitution ratio of pseudocapsule and hyper-enhancement rim showed statistical difference between high-grade group and low-grade group(χ2=4.935,P=0.026;χ2=6.727,P=0.009).There is no statistical difference among pseudocapusle characteristics of different nuclear grade lesions(χ2=0.132,P=0.716). The maximum diameter of the tumor in high-grade group was significantly higher than that in low-grade group( t=-2.363,P=0.022). The maximum diameter of lesions with complete hyper-enhancement rim or pseudocapsule was significantly lower than the lesions with incomplete or without hyper-enhancement rim or pseudocapsule(both P<0.05). Conclusion The lower Fuhrman nuclear grades is, the stronger enhancement in enhanceing early stage and the quicker attenuation of the CCRCC will be. The higher Fuhrman nuclear grades and the larger tumordiameter is, the worse integrity of the hyper-enhancement rim and pseudocapsule will be.Part two: To Investigate CT Diagnosis and Differential Diagnosis between Clear Cell Renal Cell Carcinoma and Renal Angiomyolipoma with Minimal FatObjective To analyze the CT differential diagnosis of clear cell renal cell carcinoma(CCRCC) and renal angiomyolipoma with minimal fat(AMLmf),to improve the accuracy of diagnosis of renal tumors. Methods CT feature of 55 patients with CCRCC and 12 AMLmf which were pathologically confirmed were analyzed. For each lesion, unenhanced CT value, the maximum CT value in corticomedullary phase, the CT value of the same location in parenchymal phase and excretion phase, attenuation value(△P1, △P2, △P3), contrast rate(△R1、△R2、△R3), maximum diameter, uniformity enhancement of tumor, the relationship between renal parenchyma and the major part of the tumor, interface with the cortex, calcification and necrosis rate, and the data were statistical analysis. Results The maximum diameter of CCRCC was significantly higher than AMLmf,the unenhanced CT value of AMLmf was significantly higher than CCRCC(t=3.457,P=0.001;t=-2.738,P=0.008);the value in parenchymal phase of CCRCC was significantly higher than AMLmf(t=2.246,P=0.033),but the value in corticomedullary phase and excretion phase showed no statistically significant difference between CCRCC and AMLmf(both P>0.05).the value of △P1, △P2, △P3 showed no statistically significant difference between CCRCC and AMLmf(all P>0.05);the △P1 of low-grade group in CCRCC was significantly higher than AMLmf, but the △P2、△P3 in low-grade group of CCRCC and △P1, △P2, △P3 in high-grade group of CCRCC showed no statistically significant difference with AMLmf(all P>0.05). The △R1、△R2、△R3 of CCRCC was significantly higher than AMLmf(t=2.468,P=0.016;t=4.798,P<0.001;t=2.541,P=0.013).The rate of the major part of the AMLmf exceeding the outline of renal was significantly higher than CCRCC(χ2=5.448,P=0.020),whether the major part of the tumor exceeding the outline and interface with the cortex or not showed no statistically significant difference between CCRCC and AMLmf(both P>0.05),but the rate of interface with the cortex in low-grade group was significantly higher than that high-grade group of CCRCC. The interface with the cortex showed no statistically significant difference between CCRCC and AMLmf( χ2=0.208, P=0.649).The hemogeneous enhancement rate was 100%(55/55)in corticomedullary phase of CCRCC,but in AMLmf was 16.7%(2/12);the hoemogeneous enhancement rate in parenchymal phase and excretion phase of CCRCC was significantly lower than AMLmf(χ2=15.180,P<0.001;χ2=24.725,P<0.001).The necrosis and calcification rate of CCRCC was significantly higher than AMLmf. Conclusion the unenhanced CT value of CCRCC was lower than AMLmf,CCRCC was hemogeneous enhancement in Tri-phase Enhancement, AMLmf was hemogeneous enhancement in early phase, but in late enhancement phase tending to homogeneous,the contrast rate of CCRCC was higher than AMLmf. The major part of the AMLmf exceeding the outline of renal was more common than CCRCC,the the major part of the tumor exceeding the outline and interface with the cortex were no correlation with the diameter of tumor,but it was correlate to Fuhrman grades. In the end, the necrosis and calcification in CCRCC were more common than AMLmf, in addition, the morbidity of AMLmf and CCRCC has obviousiy tendency of gender.