磁共振扩散加权成像于肾脏恶性肿瘤的应用价值

The Role of Diffusion Weighted Imaging in Differentiation of Malignant Renal Tumors

目的:探讨磁共振扩散加权成像(DWI)于肾脏常见恶性肿瘤不同病理类型的鉴别及临床应用价值。方法:回顾性分析49例经我院手术病理证实的肾脏恶性肿瘤患者的术前DWI图像,测量肿瘤部位的表观扩散系数(ADC),并结合T1及T2加权图像及相关临床、病理资料进行统计学分析。结果:肾细胞癌的平均ADC值为(2.93±1.35)×10-3mm2/s,肾盂移行细胞癌的平均ADC值为(1.72±0.78)×10-3mm2/s,两者存在统计学差异(P<0.05)。然而两者T1及T2加权图像上的信号强度未见统计学差异(P>0.05)。进一步统计显示肾细胞癌中透明细胞癌ADC值明显低于非透明细胞癌的ADC值(P<0.05),两者ADC值分别为(1.67±0.45)×10-3mm2/s和(3.81±1.81)×10-3mm2/s。同时有淋巴结或远处转移的肾占位ADC值明显低于无转移的肾占位ADC值(P<0.05)。分别为有淋巴结转移的肾占位平均ADC值为(1.13±0.34)×10-3m m2/s、无转移者平均A DC值为(2.97±1.20)×10-3m m2/s;有远处转移的肾占位平均ADC值为(1.07±0.31)×10-3m m2/s,无转移者平均A DC值为(2.54±1.35)×10-3m m2/s。结论:磁共振扩散加权成像可用于肾脏恶性肿瘤的诊断及病理分型,并能对临床治疗及预后起到一定的指导作用。

Purpose： To evaluate the value of diffusion weighted imaging （DWI） in the differentiation of different malignant renal tumors. Methods： A total of 49 patients with malignant renal tumors were retrospectively reviewed. The apparent diffusion coefficient （ADC） of tumors was measured. The correlations between ADC and clinical or pathological data were analyzed statistically. Results： The mean ADC value was significantly higher in renal cell carcinoma （RCC） than that in transitional cell carcinoma （2.93＋ 1.35 × 10-3mm2/s vs 1.725：0.78 ×10-3mmZ/s, P〈0.05）, whereas there was no significant difference of the tumor intensities between T1 weighted imaging and T2 weighted imaging （P〉0.05）. While analyzing the histological subtype of RCC, there was a significant difference in ADC values between clear cell carcinoma （CCC） and non-clear cell carcinoma （Non-CCC） was present （1.675±0.45×103mm2/s vs 3.81±1.81× 103mm2/s, P〈0.05）. ADC values of renal malignant tumors was revealed with a significant difference between patients with lymph node metastasis （1.13 5±0.34 × 103mm2/s） and those without lymph node metastasis （2.975±1.20 × 10-3mm2/s）. Patients with distant metastatic lesions showed lower ADC values （1.07±0.31× 10-3mmZ/s） than those without distant metastatic lesions （2.545±1.35×10-3mm2/s）. Conclusion： DWI has clinical value in diagnosis and differential diagnosis of renal malignant tumors, so it could be applied in clinical practice for their management.