肾透明细胞癌Fuhrman核分级与CT征象的关系

Relation between CT feature and Fuhrman nuclear grades of clear cell renal cell carcinoma

目的探讨肾透明细胞癌（CCRCC）的CT征象与病理Fuhrman核分级之间的关系。方法回顾性分析55例经病理证实的肾CCRCC的CT表现,包括肿块皮髓期最大CT值、衰减值（△P1、△P2、△P3）、最大直径、肿瘤假包膜及强化环,并与病理核分级进行统计学分析。结果低级别组（Fuhrman核分级Ⅰ~Ⅱ级）病灶皮髓期最大CT值显著高于高级别组（Fuhrman核分级Ⅲ~Ⅳ级,t=3.214,P=0.002）;低级别组CCRCC的衰减值△P2（皮髓期与排泄期）明显高于高级别组（t=3.363,P=0.001）,而高、低级别组间△P1（皮髓期与实质期）、△P3（实质期与排泄期）的差异均无统计学意义（P均〉0.05）;Ⅰ级与Ⅱ级病灶的皮髓期最大CT值、△P1、△P2、△P3差异均无统计学意义（P均〉0.05）;高、低级别组的假包膜及强化环构成比差异均有统计学意义（χ^2=4.935,P=0.026;χ^2=6.727,P=0.009）;各核分级病灶间假包膜情况的差异均无统计学意义（χ^2=0.132,P=0.716）;高级别组肿瘤最大直径明显高于低级别组（t=-2.363,P=0.022）;假包膜、强化环不完整/无的病灶最大直径明显高于完整者（P均〈0.05）。结论肾CCRCC核分级越低,皮髓期强化越明显,衰退也越快;CCRCC核分级越高,肿瘤直径越大,假包膜、强化环的完整性也越差。

Objective To analyze the relation between CT features and Fuhrman nuclear grades of clear cell renal cell carcinoma（CCRCC）.Methods CT features of 55 patients with CCRCC pathologically confirmed were analyzed.For each lesion,the maximum CT value,attenuation value（△P1,△P2,△P3）,maximum diameter,tumor pseudocapsule and hyperenhancement rim in corticomedullary phase were compared and evaluated with Fuhrman nuclear grades.Results The maximum CT value of low-grade group（Ⅰ—Ⅱ grade）was significantly higher than that of the high-grade group（Ⅲ—Ⅳgrade）in corticomedullary phase（t=3.214,P=0.002）.The △P2（corticomedullary phase and excretory phase）of lowgrade group was significantly higher than that of the high-grade group（t=3.363,P=0.001）,but the value of△P1（corticomedullary phase and parenchymal phase）,△P3（parenchymal phase and excretory phase）showed no statistically significant difference between high-grade group and low-grade group（both P〉0.05）.The maximum CT value in corticomedullary phase,△P1,△P2 and △P3showed no statistically significant difference between Ⅰ grade and Ⅱ grade（all P〉0.05）.The constitution ratio of pseudocapsule and hyper-enhancement rim showed statistical difference between high-grade group and low-grade group（χ2=4.935,P=0.026;χ2=6.727,P=0.009）.There was no statistical difference among pseudocapusle characteristics of lesions with different nuclear grade（χ2=0.132,P=0.716）.The maximum diameter of the tumor in high-grade group was significantly higher than that in low-grade group（t=-2.363,P=0.022）.The maximum diameter of lesions with complete hyper-enhancement rim or pseudocapsule was significantly lower than the lesions with incomplete or without hyper-enhancement rim or pseudocapsule（both P〈0.05）.Conclusion The lower Fuhrman nuclear grades is,the stronger enhancement in corticomedullary phase and the quicker attenuation of the CCRCC will be.The higher Fuhrman nuclear grades and the larger tumor diameter is,the worse integrity of the hyper-enhancement rim and pseudocapsule will be.