MRI平扫及增强扫描对肾癌病理亚型的鉴别价值分析

Differential value of MRI plain scan combined with enhanced scan in pathological subtypes of renal cell carcinoma

目的分析MRI平扫及增强扫描对肾癌病理亚型的鉴别价值。方法回顾性分析2017年2月至2023年4月安阳市人民医院收治的114例肾癌患者的临床资料,所有患者均经病理检查证实为肾癌且治疗前均接受过磁共振成像(MRI)平扫及增强扫描。比较各病理亚型肾癌患者MRI平扫及增强扫描表现,并以病理结果为“金标准”,评价MRI平扫及增强扫描在肾癌病理亚型中的鉴别价值。结果pRCC和cRCC患者ADC值低于ccRCC患者(P<0.05);cRCC患者T1WI和T2WI平扫低、等信号占比高于ccRCC和pRCC患者(P<0.05),混杂信号占比低于ccRCC和pRCC患者(P<0.05)。pRCC和cRCC患者不均匀强化占比低于ccRCC患者(P<0.05),且cRCC患者不均匀强化占比低于pRCC患者(P<0.05);不同病理亚型强化程度分布差异有统计学意义(P<0.05),ccRCC以重度强化为主,pRCC以轻中度强化为主,cRCC均为轻度强化患者;pRCC和cRCC患者皮质期、实质期、延迟期信号强度变化均低于ccRCC患者(P<0.05),且pRCC患者以上各期信号强度变化均低于cRCC患者(P<0.05)。MRI平扫及增强扫描联合鉴别ccRCC的灵敏度、准确度均高于单项鉴别(P<0.05);MRI平扫及增强扫描联合鉴别pRCC的特异度、准确度均高于单项鉴别(P<0.05),灵敏度高于MRI平扫单项鉴别(P<0.05);MRI平扫及增强扫描联合鉴别cRCC准确度高于单项鉴别(P<0.05)。结论不同病理亚型肾癌患者的MRI平扫及增强扫描表现存在差异,且MRI平扫及增强扫描联合鉴别肾癌病理亚型的价值较高。

【Objective】To analyze the differential value of MRI plain scan combined with enhanced scan for pathological subtypes of renal cell carcinoma.【Methods】Clinical data of 114 renal cell carcinoma patients admitted to Anyang People's Hospital from February 2017 to April 2023 were retrospectively analyzed,and all patients were confirmed to have renal cell carcinoma through pathological examination and underwent magnetic resonance imaging(MRI)plain scan and enhanced scan before treatment.The MRI plain scan and enhanced scan of patients with various subtypes of renal cell carcinoma were compared.Using pathological results as the"gold standard",the differential value of MRI plain scan combined with enhanced scan in pathological subtypes of renal cell carcinoma were evaluated.【Results】The ADC of pRCC and cRCC patients were lower than those of ccRCC patients(P<0.05).The proportion of low and equal signals on T1WI and T2WI plain scans in cRCC patients were higher than those in ccRCC and pRCC patients(P<0.05),while the proportion of mixed signals was lower than that of ccRCC and pRCC patients(P<0.05).The proportion of uneven enhancement in pRCC and cRCC patients were lower than those in ccRCC patients(P<0.05),and the proportion of uneven enhancement in cRCC patients was lower than that in pRCC patients(P<0.05).The enhancement degree distribution of different pathological subtypes were statistically significant(P<0.05),and ccRCC mainly exhibited severe enhancement,and pRCC mainly exhibited moderate enhancement,and cRCC were all mild enhancement patients.The signal intensity changes in cortical,parenchymal and delayed phases of pRCC and cRCC patients were lower than those of ccRCC patients(P<0.05),while the signal intensity changes in all stages of pRCC patients were lower than those in cRCC patients(P<0.05).The sensitivity and accuracy of the combination of MRI plain scan and enhanced scan in ccRCC were higher than those of single identification(P<0.05).The specificity and accuracy of the combination of MRI plain scan and enhanced scan in pRCC were higher than those of single identification(P<0.05),while the sensitivity was higher than that of MRI plain scan alone(P<0.05).The accuracy of combining MRI plain scan and enhanced scan in cRCC was higher than that of single identification(P<0.05).【Conclusion】There are differences in MRI plain and enhanced scan of patients with renal cell carcinoma of different pathological subtypes,and the combination of MRI plain scan and enhanced scan has high value in distinguishing pathological subtypes of renal cell carcinoma.