| Part I .Value of CT in the differentiation between clear cell renal cell carcinomas and minimal fat renal angiomyolipoma whose diameter less than or equal to 4cmObjective: By analyzing the CT imaging findings of renal clear cell carcinoma and minimal fat renal angiomyolipoma whose long-diameter less than or equal to 4cm and confirmed by operation and pathology, the similarities and differences between the two were summarized,the differential diagnosis of renal clear cell carcinoma and minimal fat renal angiomyolipoma were evaluated,in order to improve the accuracy of the preoperative diagnosis of benign and malignant renal tumors.Materials and Methods: 120 cases of renal clear cell carcinoma cases and 106 cases of minimal fat renal angiomyolipoma cases were retrospectively analyzed by enhanced CT scan and confirmed by pathology. The differences of the morphological features (lesion morphology, cystic change, necrosis, bleeding, calcification, pseudocapsule sign, cup sign,black star sign, cleft sign and other signs), plain scan and enhanced scan were analyzedResults: In this study,the renal clear cell carcinoma (CCRCC) group was male,male:female 3.1: 1, the age of onset was 28 to 81 years,mean age was 54.62 ± 12.05 years old,40 years old accounted for 85.83%; minimal fat renal angiomyolipoma (MFAML) group was mostly female, male: female 0.51: 1, the age of onset 15 to 80 years old, the average age was 45.82 ± 12.58 years,60 years of age accounted for 88.68% of cases. The average length of lesion in the CCRCC group was 2.72 ± 0.83cm,and the average length of the lesion in the MFAML group was 2.19 ± 0.93cm. There was no significant difference in the diameter of the lesion between the two groups (P = 0.101). In the CCRCC group, there were 29 cases with protrusion ratio> 1/2 (the main body of the lesion outside the renal contour), 94 cases of the lesion protrusion ratio ?1/2 (the main part of the lesion in the kidney), the protrusion ratio of the MFAML group of the 86 cases, the lesion than the21/24 of the 24 cases, the difference between the two groups was statistically significant (P<0.001). CCRCC group and the renal cortex on both sides of the angle of acute angle and no correlation with the renal cortex were 88.52%, side of the obtuse angle side of the acute angle and angle of angle were obtuse angle accounted for 11.48%; MFAML group lesions and renal cortex angle on both sides are acute angle and There was no significant difference between the acute angle and the angle of oblique angle (78.18%), and the difference was statistically significant (P <0.001 ).There were 2 cases of hemorrhage in the CCRCC group, 21 cases of cystic necrosis were found in the lesion, 7 cases of calcification were included in the lesion; 4 cases of the MFAML group showed cystic necrosis zone, no bleeding and calcification, cystic necrosis (P = 0.001) and calcification (P = 0.015) were statistically significant between the two groups (P> 0.05). There was no significant difference between the two groups (P> 0.05). The average CT value of CCRCC group was 29.55 ± 6.71HU, which was significantly lower than that of MFAML group (45.28 ±7.25HU). However, the average enhancement rate of cortical, cortical and parenchyma in CCRCC group (116.69 ± 56.16HU,188.17 ± 80.52HU,101.67 ± 39.45HU) were higher than those in the MFAML group (75.53 ± 37.84HU,108.56 ± 49.59HU,73.66 ± 28.52HU).In the CCRCC group, 11 cases were uniformly enhanced, 111 cases showed inhomogeneous enhancement, 80 cases of MFAML group showed uniform enhancement,30 cases showed uneven enhancement, the difference between the two groups was statistically significant (P <0.001). The results of ROC curve showed that the sensitivity and specificity of CCRCC and MFAML were higher than those of CCRCC and MFAML,and the area under the ROC curve was 0.801, the sensitivity was 70.6% and the specificity was 83.6%. In the CCRCC group, tumor blood vessels were observed in the tumor of the CCRCC group. The tumor blood vessels were observed in 38 cases. The blood vessels were observed in 5 cases of MFAML group, and the blood vessels were observed to be gentle, and 11 lesions were observed (P = 0.023) and blood vessel (P <0.001) were statistically significant between the two groups. (CT enhanced scan, the strengthening of the lesion within the see more than no significant enhancement of the region, as bright as the tumor, (P <0.05). The difference between the two groups was statistically significant (P<0.05). The difference between the two groups was statistically significant (P <0.05).Multivariate logistic regression analysis was performed in the univariate analysis of the two groups of statistically significant CT images. The results showed that the lesion ratio was significantly higher than that of the lesion and renal cortex, cystic necrosis,enhancement, Signs are the most valuable CT image features for identifying MFAML and CCRCC.Conclusion: 1. Multi-slice spiral CT enhanced scan for the identification of renal clear cell carcinoma and minimal fat renal angiomyolipoma has important value. 2. Lesion protrusion ratio> 1/2, the lesion and renal cortex was bilateral obtuse or side of the acute angle side of the obtuse angle intersect, no cystic necrosis, observed cleavage and (or) cup mark, uniform enhancement, cortical period of the value of <137.9HU is the minimal fat renal angiomyolipoma with diagnostic value of the CT features. 3. lesions protruding ratio?1/2, the lesion and renal cortex was bilateral acute angle or with the renal cortex does not intersect, observed capsule necrosis, low density, enhanced uneven, cortical enhancement value>137.9HU and other signs highly suggestive of renal clear cell carcinoma.Part ?: Differential diagnosis on CT of renal carcinoma associated with Xp11.2translocation / TFE3 gene fusions and clear cell renal cell carcinomaObjective: To analyze the CT imaging findings of renal carcinoma associated with Xp11.2 translocation/TFE3 gene fusions and typical renal clear cell carcinoma confirmed by pathology, and to summarize the CT images of renal carcinoma associated withXp11.2 translocation/TFE3 gene fusions and to deepen the understanding of the rare subtype of renal cell carcinoma.Materials and Methods: Thirty-three cases of renal carcinoma associated withXp11.2 translocation/TFE3 gene fusiorns and Thirty-fivecases of renal clear cell carcinoma were retrospectively analyzed by CT scan. The CT morphology characteristics,plain CT and enhanced CT value of the differences were analyzed.Results: In this study, 19 cases of renal cell carcinoma associated with Xp11.2 translocation / TFE3 gene fusion in 19 cases, female patients in 14 cases, aged 16 to 88 years, mean age 49.64 ± 16.59 years old,the peak age of onset of 51 to 60 years old,63.64%of the patients had no obvious symptoms when the physical examination found; kidney clear cell carcinoma (CCRCC) group, 21 males and 12 females, aged 30 to 88 years, mean age 58.89 ± 12.13 years,the peak age of 61 ?70 Aged,48.48% of patients without obvious symptoms of physical examination found that some patients with hematuria (12.12%),abdominal mass (25%) and other symptoms. The mean diameter of the XP11.2 translocation kidney cancer group was 2.00 ?15.21cm,the average diameter was 5.39 ?2.85cm, the diameter of the CCRCC group was 1.08 - 11.20cm, the average maximum diameter was 4.60 ± 2.75cm. (P = 0.907), bleeding (P = 0.299), cystic necrosis (P = 0.342)between the two groups was not statistically significant, and calcification (P = 0.022)between the two groups Statistically significant. The mean CT value of Xpl1.2 translocation renal cell carcinoma group was 41.78 ± 7.03HU,which was higher than that of CCRCC group (29.47 ± 6.42HU),while the enhancement rate of early cortex and cortical period (49.65 ± 24.76HU, 76.35 ± 42.06 HU) were lower than those in CCRCC group (136.46 ± 43.51 HU,204.19 ? 62.92HU). The difference of Xp11.2 translocation renal cell carcinoma and renal clear cell carcinoma between the two groups was statistically significant CT value, cortical enhancement value between the two groups was not statistically significant. In the Xpll.2 translocation renal cell carcinoma group, 10 cases (30.3%) had mild or moderate enhancement, 23 cases (69.7%) showed significant nonuniform enhancement. The enhancement method could be nodular (island-like), which was enhanced and the edge was unevenly strengthened. The tumor was observed in 3 cases.The tumor was more tortuous, 9 cases Can be observed tumor blood vessels; CCRCC group, 84.83% of the lesions were significantly uneven enhancement, of which 2 cases were nodular (island-like) or partition-like enhancement, 6 lesions can be observed within the tumor blood vessels, 8 Surgery can be observed in tumor blood vessels. There was no significant difference between the two groups (P = 0.147), intravascular blood vessels (P =0.478) and blood vessels (P = 0.782), and there was no significant difference between the two groups (P <0.01) 3 cases of retroperitoneal lymph nodes, 4 patients with distant metastasis (liver, peritoneum, omentum, bone); CCRCC group, 1 case of renal Venous and inferior vena cava visible tumor thrombus, 1 case of renal vein invasion, 3 cases of retroperitoneal see enlarged lymph nodes, 1 case of hilar see enlarged lymph nodes, 2 patients with liver metastases; Xp11.2 translocation of the kidney Cancer group had 3 cases of preoperative misdiagnosed as benign tumor, CCRCC group were diagnosed with renal cancer before surgery.Conclusion: Renal carcinoma associated with Xp 11.2translocation/TFE3 gene fusions occurred in young and middle-aged people, found that gender differences were not obvious .In the CT image to see calcified renal occupying lesions, the strengthening of the way different from the typical kidney Cell carcinoma, taking into account the possibility of renal carcinoma associated with Xp11.2translocation/TFE3 gene fusions. |
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