T1期肾透明细胞癌CT强化特征参数与Fuhrman病理分级的相关性研究

Correlation between CT enhancement parameters and Fuhrman grade in Tt clear cell renal cell carcinoma

目的探讨T1期（≤7cm）肾透明细胞癌CT强化特征与其Fuhrman病理分级的关系。方法回顾性分析我院2011年9月至2017年11月收治的102例术后病理证实为T．期肾透明细胞癌患者的临床资料。男71例，女31例；年龄（59．1±12．7）岁（26～79岁）；体重指数（24．0±2．8）kg／m^2（14．3～31．6kg／m^2）。肿瘤位于左肾55例，有肾47例。根据肿瘤Fuhrman分级分为低级别组（Fuhrman1～2级）和高级别组（Fuhrman3～4级）。低级别组67例，男46例，女21例；年龄（59．0±13．2）岁；体重指数（24．0±2．9）kg／m^2；高级别组35例，男25例，女10例；年龄（58．8±11．8）岁；体重指数（24．2±2．7）kg／m^2。测量并计算肿瘤最大径、肿瘤各期绝对强化值（TEVX）和相对强化值（REVX，X=1为动脉期，X=2为静脉期）。记录患者检查用碘总量。比较组间肿瘤最大径、肿瘤TEVl、TEV2、REVl、REV2及用碘总量的差异。使用肿瘤TEVl、TEV2、REVl、REV2绘制受试者工作特征（ROC）曲线，对肿瘤分级进行预测。结果低级别组与高级别组肿瘤TEVl[（146．1±29．1）HU与（100．2±32．1）HU、TEV2[（98．2±22．9）Hu与（75．6±25．7）HU]、REV1（1．12±0．24与0．70±0．16）、REV2（0．67±0．17与0．54±0．18）的差异均有统计学意义（P〈0．05）。低级别组和高级别组肿瘤最大径分别为（41．8±15．4）mm和（45．3±17．0）mm，用碘总量分别为（33．3±5．0）g和（34．2±4．4）g，两组差异均无统计学意义（P〉0．05）。TEV1、TEV2、REV1、REV2的ROC曲线下面积分别为0．856、0．755、0．901、0．728，其中REV1判别效能最高，最佳临界值为0．93。结论通过测量及计算T1期肾透明细胞癌各期强化参数值有助于在术前预测肿瘤的Fuhrman分级，REV1≤0．93的肿瘤更倾向于高级别（Fuhrman 3～4级）肿瘤。

Objective To evaluate the correlation of CT enhancement parameters with Fuhrman grade in T1 （ ≤7 cm） clear cell renal careinoma（ccRCC）. Methods From September 2011 to November 2017,102 post-operation cases in our hospital proven to be T1 ccRCC were retrospectively analyzed. There were 71 males and 31 females, with a mean age of （59.1 ± 12.7）years （26 -79 years） , mean body mass index（BMI） of （24.0 ± 2.8） kg/m2 （ 14.3 - 31.6 kg/m2 ）. Tmnors of 55 patients were in left kidneys, 47 in right kidneys. Fuhrman grade 1 and 2 were defined as low-grade group, meanwhile high-grade group included grade 3 and 4. There were 46 males and 21 females in low-grade group, with a mean age of （59.0 ± 13.2）years, mean BMI of （24.0 ± 2.9）kg/m2. In high-grade group, there were 25 males and 10 μmales, with amean age of （58.8 ± 11. 8）years, mean BMI of （24.2 ±2.7）kg/m2. The maximum diameter and tumor enhancement value （TEVX） , relative enhancement value （ REVX ） were measured and calculated. In arterial phase, X = 1 ; in venous phase X = 2. The total consumption amount of iodine was recorded. Comparisons of maximum diameter, TEV1, TEV2, REV1, REV2 and the total consumption of iodine between the two different groups were performed. The ROC curves of TEV1, TEV2, REV1, and REV2 were drawn to predict the grade of tumors.. Results The TEV1 [ （ 146.1 ± 29.1 ） HU vs. （ 100.2 ± 32.1）HU], TEV2[（98.2±22.9）HUvs. （75.6±25.7）HU], REVl （1.12 ± 0. 24 vs. 0.70±0.16）, REV2（0.67 ± 0. 17 vs. 0. 54 ±0. 18 ） between low-grade group and high-grade group had statistical difference （ P 〈 0.05 ）. There was no significant difference in the maximum diameter[ （ 41.8±15.4 ）mm vs. （45.3 ±17.0） mm]and the total consumption of iodine [ （ 33.3 ± 5.0） g vs. （ 34.2 ± 4.4） g ] between the two groups （P 〉 0.05 ）. The area under ROC curve of TEV1 ,TEV2, REV1 and REV2 were 0. 856, 0. 755, 0. 901 and 0.728 ,respectively. REV1 had the highest distinguish efficiency and the best critical value was 0.93. Conclusions The enhancement parameters of T1 ccRCC could contribute to predicting the Fuhrman grade. When the REV1 ≤0.93, the tumor tended to be high-grade tumor（ Fuhrman grade 3 -4）.