肾透明细胞癌瘤内出血的磁敏感加权成像初步研究及与病理对照

Susceptibility Weighted Imaging of Clear Cell renal Cell Carcinoma for Evaluating Intratumoral Hemorrhage Compared with Pathology: A Preliminary Study

目的探讨磁敏感加权成像(SWI)在评价肾透明细胞癌(CCRCC)瘤内出血中的价值。方法回顾性分析经病理证实的34例CCRCC患者的CT、常规MRI及SWI图像,选取肿瘤最大横断面作为观察瘤内出血的感兴趣层面,分别用三种影像方法诊断瘤内出血及出血类型,并与大体病理进行对照。分别采用卡方检验比较SWI与CT、SWI与常规MRI成像方法诊断瘤内出血及出血类型的病例数差异。结果大体病理34例均可见出血灶。CT诊断6例有瘤内出血,其中4例出血类型与病理所见一致;常规MRI诊断23例有瘤内出血,其中11例出血类型与病理所见一致;SWI诊断34例均有瘤内出血,34例出血类型与病理所见完全一致。SWI诊断CCRCC瘤内出血率、大面积出血率及片状出血率均显著高于CT(χ2=47.000、10.372、21.402,P=0.000、0.001、0.000)与常规MRI(χ2=13.123、10.372、4.976,P=0.000、0.001、0.026)。结论较之CT与常规MRI,SWI能更准确地评价CCRCC瘤内出血及出血类型。

Objective To explore the value of susceptibility weighted imaging （SWI） in assessing intratumoral hemor- rhage of clear cell renal cell carcinoma （ CCRCC ）. Methods The CT, conventional MRI and SWI images of 34 cases with CCRCC confirmed pathologically were analyzed retrospectively, and the maximum transverse section of each tumor was selected as the interesting slice for observing intratumoral hemorrhage. The results of three imaging techniques diagnosing intratumoral hemorrhage and hemorrhagic types of CCRCC were compared with pathology. The results of SWI in diagnosing intratumoral hemorrhage and hemorrhagic types were compared with that of CT and conventional MRI using Chi square test respectively. Results Intratumoral hemorrhage were confirmed by gross pathology in 34 cases. 6 cases with intratumoral hemorrhage were diagnosed by CT, the hemorrhagic types of 4 （4 out of 6 ） cases were consistent with pathological diagno- sis ; 23 cases with intratumoral hemorrhage were diagnosed by conventional MRI, the hemorrhagic types of 11 （ 11 out of 23 ） cases were consistent with pathological diagnosis; 34 cases with intratumoral hemorrhage were diagnosed by SWI, the hemorrhagic types of 34 （ 34 out of 34 ） cases were consistent with pathological diagnosis. The diagnosing accuracy of SWI in intratumoral hemorrhage, extensive hemorrhage and patchy hemorrhage was significantly higher than that of CT （X2 = 47. 000,10.372,21. 402, P = 0.000,0. 001,0. 000, respectively ） and conventional MRI （ X2 = 13. 123,10. 372,4. 976, P = 0.000, 0. 001, 0. 026, respectively） respectively. Conclusion SWI can evaluate intratumoral hemorrhage and hemor- rhagic types of CCRCC more accurately than CT and conventional MRI.