多模态MRI定量、定性分析对高、低级别肾透明细胞癌的诊断价值

Diagnostic value of multimodal MRI quantitative and qualitative analysis in high and low grade renal clear cell carcinoma

目的探讨3.0T MRI不同序列图像征象及参数对高、低级别肾透明细胞癌的诊断价值。方法回顾性分析2012年1月—2020年4月徐州医科大学附属医院经手术病理确诊的89例肾透明细胞癌患者的病理资料及术前MRI平扫、增强检查资料。依据Fuhrman核分级法,分为低级别组(Ⅰ、Ⅱ级)70例,高级别组(Ⅲ、Ⅳ级)19例。统计患者MRI图像征象中假包膜、囊变、出血、坏死、钙化及纤维条索、静脉癌栓、肾窦肾周浸润、淋巴结肿大、远处转移的发生率;记录病灶DWI信号强度、增强皮髓质期病灶的强化程度及强化方式差异;测量肿瘤的最大径、表观扩散系数(ADC)值;采用独立样本t检验、χ^(2)检验及受试者工作曲线对2组病灶的MRI图像征象做统计学分析。结果在MRI图像征象中,高、低级别组间的肿瘤最大径、坏死、静脉癌栓、肾窦肾周脂肪浸润、淋巴结肿大、远处转移、DWI信号强度、皮髓质期强化程度的差异均有统计学意义(P<0.05),对应的ROC曲线下面积分别为0.816、0.638、0.692、0.665、0.737、0.658、0.752、0.661。而2组间囊变、出血、钙化条索、假包膜、强化方式的差异无统计学意义(P>0.05)。低级别组ADC值明显高于高级别组(P<0.05),POC曲线下面积为0.830。不同诊断组合中,ADC值、肿瘤最大径、皮髓质期强化程度三者组合的ROC曲线下面积为0.902,敏感度为73.7%,特异度为92.2%。结论多模态MRI定性、定量分析可鉴别诊断高、低级别肾透明细胞癌,ADC值结合肿瘤最大径及皮髓质期强化程度对高级别肾透明细胞癌的诊断效能最高,可为临床提供参考。

Objective To explore the diagnostic value of 3.0T MRI sequence features and parameters for high and low grade clear cell renal cell carcinoma(ccRCC).Methods A total of 89 ccRCC patients who were pathologically diagnosed in the Affiliated Hospital of Xuzhou Medical University from January 2012 to April 2020 were enrolled and their pathological data,preoperative renal MRI and enhanced MRI were retrospectively analyzed.According to the Fuhrman nuclear grade system,the patients were divided into two groups:a low grade group(gradesⅠandⅡ,n=70)and a high grade group(gradesⅢandⅣ,n=19).Their incidences of pseudocapsule,cystic degeneration,necrosis,hemorrhage,calcification and fibrous cord,vein thrombosis,renal sinus and pefinephfic invasion,lymphadenopathy,and metastasis were statistically analyzed.The difference in DWI signal intensity of the lesion,the enhancement degree and method were recorded.The maximum diameter of tumor and the apparent diffusion coefficient value(ADC value)were also measured.Two-sample t-test,Ch-squared test and the receiver operating curve(ROC)were used to evaluate the MRI date between two groups.Results According to MRI images,there were statistically differences in the maximum tumor diameter,necrosis,vein thrombosis,renal sinus and pefinephfic invasion,lymphadenopathy,metastasis,DWI signal intensity,and medullary phase enhancement between the high and low grade groups(P<0.05).The corresponding areas under the curve(AUC)were:0.816,0.638,0.692,0.665,0.737,0.658,0.752,and 0.661.There were no statistical differences in cystic degeneration,hemorrhage,calcified cord,pseudocapsule,and enhancement mode between the two groups(P>0.05).The ADC value of the low grade group was significantly higher than the ADC value of the high grade group(P<0.05),and the AUC was 0.830.Among the different diagnostic combinations,the AUC of the combination of ADC value,tumor maximum diameter,and medullary phase enhancement was 0.902,with a sensitivity of 73.7%and a specificity of 92.2%.Conclusions Qualitative and quantitative analysis of multimodal MRI can differentiate and diagnose high and low grade ccRCC.The ADC value combined with the maximum diameter and enhancement degree are the most effective in the diagnosis of high grade ccRCC,which can provide reference for clinical practice.