增强MRI定量参数预测肾癌合并下腔静脉癌栓患者侧支循环建立的价值

Value of quantitative parameters of enhanced MRI in predicting collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus

目的探讨基于增强MRI的定量参数预测肾癌合并下腔静脉癌栓患者下腔静脉侧支循环建立的价值。方法回顾性连续收集2006年5月至2021年1月在解放军总医院第一医学中心接受肾癌并下腔静脉癌栓根治性切除术并行下腔静脉造影的患者67例。以下腔静脉造影结果为金标准分为侧支循环建立良好组(41例)和侧支循环建立不良组(26例)。于术前增强MRI图像上测量定量参数,包括肿瘤最大径、双侧腰静脉最大径、癌栓长度、癌栓长径与短径。采用独立样本t检验或Mann-WhitneyU检验进行组间比较。运用二元逻辑回归分析获得侧支循环建立相关的独立危险因素,并建立模型。对MRI定量参数和逻辑回归模型进行受试者操作特征曲线分析,曲线下面积(AUC)比较采用DeLong检验。结果侧支循环建立良好组与侧支循环建立不良组间右侧腰静脉最大径、左侧腰静脉最大径、癌栓长度、癌栓长径、癌栓短径差异有统计学意义(P<0.05),肿瘤最大径差异无统计学意义(t=0.30,P=0.766)。右侧腰静脉最大径、左侧腰静脉最大径、癌栓长度、癌栓长径、癌栓短径预测侧支循环建立良好的AUC(95%CI)分别为0.917(0.824~0.971)、0.869(0.764~0.939)、0.756(0.636~0.853)、0.886(0.785~0.951)、0.906(0.809~0.963)。右侧腰静脉最大径和癌栓短径的AUC大于癌栓长度的AUC,差异有统计学意义(Z=2.25、2.04,P=0.025、0.041),其余参数的AUC间差异均无统计学意义(P>0.05)。右侧腰静脉最大径(OR为24.210,95%CI 2.845~205.998)、左侧腰静脉最大径(OR为20.973,95%CI 2.359~186.490)和癌栓长径(OR为23.006,95%CI 2.952~179.309)是与下腔静脉侧支循环建立相关的独立危险因素。逻辑回归模型的AUC(95%CI)为0.969(0.931~1.000)。结论基于增强MRI的癌栓和腰静脉径线定量参数对肾癌合并下腔静脉癌栓患者下腔静脉侧支循环建立具有良好的预测效能,其中双侧腰静脉最大径和癌栓长径是独立危险因素。

Objective To explore the value of quantitative parameters of enhanced MRI in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus.Methods Sixty-seven patients with renal cell carcinoma and inferior vena cava tumor thrombus who underwent radical resection and inferior vena cava venography in First Medical Center,PLA General Hospital from May 2006 to January 2021 were included retrospectively.According to the results of inferior vena cava venography,the patients were divided into two groups:the well-established collateral circulation group(n=41)and the poor-established collateral circulation group(n=26).Quantitative parameters were measured on preoperative enhanced MRI images,including tumor size,the maximum diameter of bilateral lumbar veins,the length of tumor thrombus,and the long and short diameters of tumor thrombus.Student′s t test or Mann-Whitney U test was used for comparison between the two groups.The independent risk factors related to the establishment of collateral circulation were obtained by binary logistic regression analysis and the model was established.The receiver operating characteristic curve was employed to evaluate MRI quantitative parameters and the logistic model,and the area under the curve(AUC)was compared by the DeLong test.Results Between the well-established collateral circulation group and the poor-established collateral circulation group,the maximum diameter of the right lumbar vein,the maximum diameter of the left lumbar vein,the length of the tumor thrombus,the long diameter of the tumor thrombus,and the short diameter of the tumor thrombus were different significantly(P<0.05).There was no significant difference in the tumor size between the two groups(t=0.30,P=0.766).The AUC of the maximum diameters of the right lumbar veins and left lumbar veins,length of tumor thrombus,long and short diameters of tumor thrombus in predicting the collateral circulation were 0.917(95%CI 0.824-0.971),0.869(95%CI 0.764-0.939),0.756(95%CI 0.636-0.853),0.886(95%CI 0.785-0.951),and 0.906(95%CI 0.809-0.963).The AUC of the maximum diameter of the right lumbar vein and the short diameter of the tumor thrombus were larger than those of the length of the tumor thrombus,and the differences were statistically significant(Z=2.25,2.04,P=0.025,0.041),but the AUC between other parameters had no significant difference(P>0.05).The maximum diameter of the right lumbar vein(OR 24.210,95%CI 2.845-205.998),the maximum diameter of the left lumbar vein(OR 20.973,95%CI 2.359-186.490),and the length of the tumor thrombus(OR 23.006,95%CI 2.952-179.309)were independent risk factors for predicting the establishment of inferior vena cava collateral circulation.The AUC of logistic model was 0.969(95%CI 0.931-1.000).Conclusion Quantitative parameters of tumor thrombus and lumbar vein based on enhanced MRI have a good ability in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus.The maximum diameter of bilateral lumbar veins and the length of the tumor thrombus were independent risk factors for inferior vena cava collateral circulation.