磁敏感成像与肾透明细胞癌病理分级的相关性研究

Correlation between susceptibility weighted imaging and pathological grade of clear cell renal cell carcinom

目的评价磁敏感成像技术(SWI)划分透明细胞肾癌(CRCC)病理级别的可行性并比较SWI和坏死划分CRCC级别的能力。材料与方法回顾性分析35例病理证实的CRCC患者。所有患者均行常规MRI和SWI检查。肿瘤内磁敏感信号强度(ITSS)分为出血和微血管。评价高低级别CRCC ITSS和瘤内坏死的差异。比较ITSS和坏死鉴别高低级别CRCC的价值。结果 35例患者中有31例在SWI上显示ITSS。4例瘤内未见ITSS的患者均为低级别CRCC。低级别CRCC的ITSS平均分数(1.24±0.72)明显低于高级别CRCC(2.70±0.48)(P<0.01)。10例低级别CRCC未见明显坏死。高低级别CRCC之间瘤内坏死的发生有明显差异(P<0.05)。ITSS区分高低级别CRCC的敏感性、特异性、阳性和阴性预测值分别为70.0%、100%、100%和89.3%;坏死为100%、40.0%、40.0%和100%。结论 SWI可评价瘤内ITSS并在术前区分CRCC的病理级别。

Objective： To evaluate the feasibility of SWI in grading clear cell renal cell carcinoma （CRCC） and compare the ability of SWI and necrosis for grading CRCCs. Materials and Methods：Retrospective reviews of 35 patients with pathologically-proven CRCCs were performed. All patients underwent both conventional MRI and SWI examinations. The morphologies of the intratumoral susceptibility signal intensities （ITSS） were classiifed into hemorrhage and microvessels. The differences of ITSSs and intratumoral necrosis between low-and high-grade CRCCs were assessed. The diagnostic values of ITSSs and necrosis in differentiating low-from high-grade CRCCs were compared. Results：ITSSs were seen in 31 of 35 patients. No ITSSs were seen in 4 patients with low-grade CRCCs. Mean scores of ITSSs were significantly lower in low-grade CRCCs （1.24±0.72） than that in the high-grade CRCCs （2.70±0.48） （P〈0.01）. No signiifcant necrosis was seen in 10 patients with low-grade CRCCs. There was a significant difference of the presence of intratumoral necrosis between low-and high-grade CRCCs （P〈0.05）. Sensitivity, speciifcity, positive （PPV） and negative predictive values （NPV） were for ITSSs：70.0%, 100%, 100%, and 89.3%, respectively;for necrosis：100%, 40.0%, 40.0%and 100%. Conclusions：SWI can evaluate ITSSs and can be an alternative to grade CRCCs preoperatively.