能谱CT成像与Ki-67联合评价肾透明细胞癌核分级

CT gemstone spectral imaging and Ki-67 joint evaluation of pathologic grading in clear cell renal cell carcinoma

目的探讨宝石CT能谱成像参数与Ki-67表达的相关性,以联合评价肾透明细胞癌的核分级。方法回顾性分析44例术前采用宝石CT能谱扫描模式扫描,术后经病理证实为肾透明细胞癌的能谱成像特征,所有肿瘤组织病理标本切片行Ki-67免疫组织化学染色。病例分高、低分化组,比较两组的能谱特征参数及Ki-67表达指数。结果高分化组Ki-67表达指数低于低分化组(P<0.01),Ki-67表达指数与皮、髓质期各能谱参数均呈负相关。肾透明细胞癌高分化组皮髓质期70 keV CT值比值、碘浓度比值及能谱曲线斜率均高于低分化组(P<0.05,P<0.01)。两组肾透明细胞癌皮、髓质期水浓度比值比较,差异无统计学意义。受试者工作特征曲线(ROC)分析显示髓质期70 keV单能量CT值比值对肾透明细胞癌核分级的判定诊断价值最高,曲线下面积最大(0.870),敏感性和特异性分别为82.8%、80%。结论Ki-67表达与肾透明细胞癌能谱CT征像有相关性,两者联合评价对肾透明细胞癌核分级的判定有重要诊断价值。

Objective Discussing the index （LI） , to assess the pathologic correlation between CT spectroscopy imaging parameters and Ki-67 labeling grading of clear cell renal cell carcinoma. Methods 44 cases with CCRCC were analyzed by using retrospective way, all the patients underwent gemstone spectral imaging scans before operation and all tumor tissue pathologic specimens were confirmed by Ki-67 immunohistochemical staining after operation. The patients were divided into high differentiation group and low differentiation group. Spectral characteristic parameters and the expression of Ki-67 between two groups were compared. Results The Ki-67 LI of high differentiation group was lower than the low differentiation group（ P 〈 0. 01 ）, and CT spectroscopy imaging parameters in two phases had a significantly negative correlation with Ki-67 LI. The CT value ratio of CCRCC under 70 keV, the iodine concentration ratio and the spectrum curve slope of high differentiation group were higher than the low differentiation group in cortex phase （P 〈 0.05 ）. The CT value ratio under 70 keV, the iodine concentration ratio and the spectrum curve slope of high differentiation group were higher than the low differentiation group in medulla phase （P 〈 0. 01 ）. However, the water concentration ratio had no difference at each phase between the two groups. The 70 keV single energy ratio in the medulla phase provided the best combination of sensitivity （82.8%） and specificity （80%） in deciding the nuclear grading of CCRCC, and the area under the ROC curve was 0. 870. Conclusion The expression of Ki-67 has a certain correlation with spectral characteristic parameters, and the evaluating methods combined gemstone spectral imaging with Ki-67 have important diagnostic value for deciding tumor＇s pathologic grading.