Application Study of Contrast-enhanced CT in Renal Cystic Lesions with the Bosniak Classification Version 2019
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摘要: 目的：本研究拟采用多期增强CT对肾囊性病变的2019版Bosniak分类细节进行评估。方法：共入组88例肾囊性病变，两名不同的观察者对Bosniak v.2019分类评判标准中的细节进行评测，并将最终分类结果与病理进行对照。结果：两名观察者对肾囊性病变的大小、病灶内均质程度、各期CT值、分隔数量及结节大小的评测一致性很好（ICC=0.97，ICC=0.96，ICC=0.98，ICC=0.97，ICC=0.96，ICC=0.97，ICC=0.90，ICC=0.96），对囊壁厚度的评测一致性良好（ICC=0.73），而对病变分隔厚度及不规则突起厚度的评测一致性中等（ICC=0.41，ICC=0.50）。与病理结果进行对照，我们发现对于肾囊性病变良恶性，其病灶大小、均质度、各期CT值、囊壁厚度、分隔厚度及分隔数量存在统计学意义，钙化大小则无明显统计学意义。结论：对Bosniak v.2019版CT分类细节的评估有利于判断肾囊性病变的良恶性，但不同观察者对于细节的评测存在一定程度的差异。Abstract: This study aimed to use multiphase-enhanced CT to evaluate the classification details of the Bosniak classification version 2019 of renal cystic lesions. A total of 88 cases of renal cystic lesions were enrolled. Two reviewers evaluated the details of the Bosniak v. 2019 classification and then compared the final classifications with pathological results. We found that the two reviewers had excellent consistency in evaluating the size, degree of homogeneity within the lesion, CT values of each scanning phase, number of septations, and nodule size of renal cystic lesions, while the consistency in evaluating the thickness of the cyst wall was good. The consistency in evaluating lesion septal thickness and irregular protrusion thickness was moderate. Compared to pathological results, we found that for benign and malignant renal cystic lesions, there were statistical significance in lesion size, homogeneity, CT values of each scanning phase, cyst wall thickness, septal thickness, and number of septations, while there was no significant statistical significance in calcification size. Therefore, the evaluation of the classification details of Bosniak classification v. 2019 CT is beneficial in determining the benign and malignant nature of renal cystic lesions, but there are differences in observer consistency.
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Key words:
- X-ray computed tomography /
- renal cystic disease /
- classification
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图 1 两名观察者应用Bosniak v.2019诊断肾囊性病变良恶性的ROC曲线图
Figure 1. ROCs of Bosniak v. 2019 in the diagnosis of benign and malignant renal cystic lesions by two reviewers
图 2 62岁女性，两名观察者对该囊性病变（白箭头）的分类分别为ⅡF和 Ⅲ 类，最终病理类型为透明细胞性肾细胞癌（WHO/ISUP 分级：2级）
Figure 2. Female, 62 years old, the two observers classified the cystic lesion (white arrow) as ⅡF and Ⅲ, respectively, with the final pathological type being clear cell renal cell carcinoma (WHO/ISUP grade: 2)
表 1 肾囊性病变CT细节特征的评测结果
Table 1. Evaluation results of CT details of renal cystic lesions
CT细节 观察者1 观察者2 ICC值 大小/mm 52.30±18.20 51.90±18.50 0.97 均质程度 1.56±0.69 1.60±0.72 0.96 CT值/HU 15.01±11.90 15.24±11.54 0.98 动脉期CT值/HU 16.16±13.61 17.92±13.71 0.97 静脉期CT值/HU 16.66±13.94 18.85±13.78 0.96 钙化大小/mm 2.60±2.51 2.48±2.14 0.97 囊壁厚度/mm 1.19±0.45 1.31±0.53 0.73 分隔数量/mm 2.20±2.33 2.70±2.35 0.90 分隔厚度/mm 1.47±0.87 1.60±0.86 0.41 结节/mm 4.23±4.30 3.9±2.84 0.96 不规则突起厚度/mm 1.67±0.58 1.25±0.50 0.50 
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表 2 两名观察者对肾囊性病变的Bosniak分类结果
Table 2. Bosniak classification results for renal cystic lesions by the two reviewers
Bosniak v.2019 肾囊性病变分类（总计（恶性病例）） Kappa值 观察者1 观察者2 Ⅰ 37（0） 32（0） 0.834 Ⅱ 34（5） 31（1） 0.781 ⅡF 6（5） 10（6） 0.727 Ⅲ 6（6） 9（8） 0.782 Ⅳ 5（5） 6（6） 0.903
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表 3 肾囊性病变良、恶性CT细节差异
Table 3. Differences in CT details between benign and malignant renal cystic diseases
CT细节 病变情况 P 良性 恶性 大小/mm 55.70±17.80 40.00±15.30 0.000 均质程度 1.46±0.61 2.05±0.86 0.001 CT值/HU 12.60±8.33 23.67±15.89 0.000 动脉期CT值/HU 14.00±8.90 30.43±18.44 0.005 静脉期CT值/HU 14.76±8.90 31.91±18.14 0.001 钙化大小/mm 2.68±2.40 1.83±0.75 0.408 囊壁厚度/mm 1.15±0.40 1.81±0.60 0.000 分隔数量/mm 1.74±1.71 4.78±2.24 0.000 分隔厚度/mm 1.28±0.69 2.28±0.83 0.000
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