多排CT血管成像对肾癌并rAVM的临床应用分析(1)
【摘要】 目的 探討利用多排CT成像技术对肾癌伴有先天性微小肾动静脉畸形(rAVM)患者的诊断价值， 为肾癌根治术的实施提供可靠依据。方法 82例需实施肾癌根治术的患者行双侧肾64排CT肾血管成像检查并采用rAVM诊断的金标准数字减影血管造影(DSA)进行证实， DSA证实肾癌伴有rAVM作为观察组， 肾癌不伴有rAVM作为对照组。对两组CT成像图像质量分级进行比较；计算CT成像检查的灵敏度、特异度、阳性似然比、阴性似然比、诊断指数、Youden指数， 比较两种检查方式对82例患者肾微血管病变发现率；两组患者的手术情况及术后情况比较。结果 经过DSA检查将肾癌伴有rAVM患者34例作为观察组， 肾癌不伴有rAVM患者48例作为对照组， 两组图像质量分级比较差异无统计学意义(P>0.05)。DSA微血管畸形、肾静脉癌栓、腔静脉癌栓的发现率分别为41.46%、17.07%、10.98%， 均高于CT成像的37.80%、12.20%、6.10%， 但比较差异无统计学意义(P>0.05)。采用CT成像检查肾癌伴有rAVM的灵敏度为79.41%、特异度为91.67%、阳性似然比为9.529、阴性似然比为0.225、诊断指数为1.71>1.70、Youden指数为0.71。两组患者手术时间、术中出血量、术后下床活动时间、术后出院时间比较差异均无统计学意义(P>0.05)。结论 多排CT成像技术对肾癌伴有rAVM患者的血管解剖结构能够进行明确诊断， 在手术中有目的的游离肾脏、避免盲目分离造成血管损伤。
【关键词】 CT成像技术；肾癌；先天性微小肾动静脉畸形
DOI：10.14163/j.cnki.11-5547/r.2017.09.002
Analysis on clinical application of multiple row CT angiography in renal carcinoma complicated with rAVM FENG Kai， ZUO Yong. Department of Radiology， Hubei Province Laohekou City First Hospital， Laohekou 441800， China
【Abstract】 Objective To explore the diagnostic value of multiple row CT angiography in patients complicated with congenital small renal arteriovenous malformation (rAVM)， to provide reliable basis for the implement of radical nephrectomy. Methods A total of 82 patients with radical nephrectomy received bilateral renal 64 row CT renal vascular imaging examination and its results were confirmed by gold standard digital subtraction angiography (DSA) of rAVM diagnosis. Renal carcinoma patients complicated with rAVM confirmed by DSA were named as observation group， and renal carcinoma patients uncomplicated with rAVM were named as control group. Comparison was made on CT image quality classification in two groups to calculate degree of sensitivity， specificity， positive likelihood ratio， negative likelihood ratio， diagnosis index and Youden index. Discovery rate of renal microangipathy in 82 patients by two check methods， operation state and postoperative state in two groups were compared. Results 34 renal carcinoma patients complicated with rAVM confirmed by DSA were named as observation group， and 48 renal carcinoma patients uncomplicated with rAVM were named as control group， there was no statistically significant difference in image quality classification in two groups (P>0.05). Discovery rate of microvascular abnormalities， renal vein tumor emboli and vena cava tumor emboli by DSA respectively as 41.46%， 17.07% and 10.98%， which were all higher than 37.80%， 12.20% and 6.10% by CT image， but their differences had statistical significance (P>0.05). Renal carcinoma complicated with rAVM detected by CT image had degree of sensitivity as 79.41%， specificity as 91.67%， positive likelihood ratio as 9.529， negative likelihood ratio as 0.225， diagnosis index as 1.71>1.70 and Youden index as 0.71. There were no statistically significant difference in operation time， intraoperative bleeding volume， postoperative activity out of bed days and postoperative discharge time in two groups (P>0.05). Conclusion Multiple row CT angiography can make a clear diagnosis of vascular anatomy structure in patients with renal carcinoma complicated with rAVM， which is helpful for free kidney with purpose and avoid blind separation of vascular damage., 百拇医药(冯凯 左勇)
【关键词】 CT成像技术；肾癌；先天性微小肾动静脉畸形
DOI：10.14163/j.cnki.11-5547/r.2017.09.002
Analysis on clinical application of multiple row CT angiography in renal carcinoma complicated with rAVM FENG Kai， ZUO Yong. Department of Radiology， Hubei Province Laohekou City First Hospital， Laohekou 441800， China
【Abstract】 Objective To explore the diagnostic value of multiple row CT angiography in patients complicated with congenital small renal arteriovenous malformation (rAVM)， to provide reliable basis for the implement of radical nephrectomy. Methods A total of 82 patients with radical nephrectomy received bilateral renal 64 row CT renal vascular imaging examination and its results were confirmed by gold standard digital subtraction angiography (DSA) of rAVM diagnosis. Renal carcinoma patients complicated with rAVM confirmed by DSA were named as observation group， and renal carcinoma patients uncomplicated with rAVM were named as control group. Comparison was made on CT image quality classification in two groups to calculate degree of sensitivity， specificity， positive likelihood ratio， negative likelihood ratio， diagnosis index and Youden index. Discovery rate of renal microangipathy in 82 patients by two check methods， operation state and postoperative state in two groups were compared. Results 34 renal carcinoma patients complicated with rAVM confirmed by DSA were named as observation group， and 48 renal carcinoma patients uncomplicated with rAVM were named as control group， there was no statistically significant difference in image quality classification in two groups (P>0.05). Discovery rate of microvascular abnormalities， renal vein tumor emboli and vena cava tumor emboli by DSA respectively as 41.46%， 17.07% and 10.98%， which were all higher than 37.80%， 12.20% and 6.10% by CT image， but their differences had statistical significance (P>0.05). Renal carcinoma complicated with rAVM detected by CT image had degree of sensitivity as 79.41%， specificity as 91.67%， positive likelihood ratio as 9.529， negative likelihood ratio as 0.225， diagnosis index as 1.71>1.70 and Youden index as 0.71. There were no statistically significant difference in operation time， intraoperative bleeding volume， postoperative activity out of bed days and postoperative discharge time in two groups (P>0.05). Conclusion Multiple row CT angiography can make a clear diagnosis of vascular anatomy structure in patients with renal carcinoma complicated with rAVM， which is helpful for free kidney with purpose and avoid blind separation of vascular damage., 百拇医药(冯凯 左勇)