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

Part one.The application value of R.E.N.A.L.nephrometry score based on CT for the Fuhrman grade of clear cell renal carcinomaThe purpose of this study was to evaluate the efficacy and feasibility of the R.E.N.A.L.Nephrometry Score based on CT to predict cc RCC(clear-cell renal carcinoma).Methods CT data of 143 renal cell clear cell carcinoma patients confirmed by pathology and Fuhrman grading were collected.All the lesions were divided into low-grade(Fuhrman I-II)and high-grade(Fuhrman III-IV)groups,and R.E.N.A.L nephrometry score was performed for them.The relationship between the pathological grade of renal masses and R.E.N.A.L.Nephrometry Score was evaluated.Results A total of 98 low-grade and 45 high-grade cc RRCs were assessed.There was no significant difference in gender and age between high-grade and low-grade groups(P>0.05).There was also no significant difference in the incidence of necrosis and calcification in the lesions(P>0.05).In addition to the A(P=0.104),the other components of RENAL nephrometry score were significantly associated with the Fuhrman grade(P<0.05).Multivariable Logistic regression analysis showed that 3 points of R,2points of E,and 3 points of L were independent indicators for predicting high-grade lesions.In the ROC curve analysis,The multi-parameter regression model and total score have larger AUC(Area Under the ROC Curve),and when the total score is greater than 8points,the specificity and sensitivity of predicting high-grade tumors were 83.67% ?71.11%.Conclusion Higher R,E and L scores were more likely to beassociated with high grade pathological outcomes.R ? E and L scores were significant prognostic factors forhigh-grade cc RCC.And In addition,Multi-parameter regression model and total scores are more effective than single scores in the diagnosis of pathological grade in cc RCC.Part two.Differential diagnosis of CT between minimal fat renal angiomyolipoma and clear cell renal cell carcinoma with wash-out patternComparing the CT features between minimal fat renal angiomyolipoma(mf AML)and clear cell renal cell carcinoma(cc RCC)with wash-out pattern,and investigate the value of wash-in and wash-out rates in differential diagnosis of them.Methods We collected the CT images of 30 patients with cc RCC and 20 patients with mf AML,and all the lesions were confirmed pathologically have wash-out characteristic.Then,analyzing the shape ? unenhenced density and heterogenous or homogeneous enhencement of the two renal tumors,and the mass density? wash-in and wash-out rates of the lesion were measured too.Results The differences of shape and enhencement performence between the two groups were statistically significant(P < 0.05),mf AML shows non-round shape with homogeneous enhencement.The unenhenced density of mf AML was generally higher,the difference was statistically significant(P <0.05).But the wash-in and wash-out rates in the cc RCC group was higher than that in the mf AML,the difference was statistically significant(P<0.05).And the sensitive and specificity of differentiation of the two carcinomas with wash-out pattern was 83.3%?85.0% when the cut-off value of wash-in was 115 HU.The sensitive and specificity of differentiation of the two carcinomas with wash-out pattern was 73.3%?95.0% when the cut-off value of wash-out was 68 HU.Conclusion CT images with non-round shape with homogeneous enhencement were more likely to be mf AML;higher unenhenced density and wash-in rates ?115HU may be used to differentiate mf AML with minimal fat from cc RCC with washout pattern.