T1b期肾透明细胞癌ADC值与病理分级相关性的研究  

Correlation between apparent diffusion coefficient value and pathological grading in pTlb clear cell renal cell carcinoma

作　　者：孙军[1] 邢伟[1] 陈杰[1] 邢士军[1] 张丽君[1] 张艳文[1] 陈铜兵[2] 曹赟杰[3] 

机构地区：[1]苏州大学附属第三医院放射科,常州213003 [2]苏州大学附属第三医院病理科,常州213003 [3]苏州大学附属第三医院泌尿外科,常州213003

出　　处：《中华放射学杂志》2012年第8期682-686,共5页Chinese Journal of Radiology

基　　金：常州市卫生局重大科技资助项目（ZD201110）

摘　　要：目的探讨T1b期肾透明细胞癌（CCRCC）病理分级与3．0TMRADC值的相关性。方法回顾性分析2011年2月至11月经手术病理证实的30例T1b期CCRCC患者的常规3．0TMR图像、ADC值及Fuhrman病理分级资料，将Fuhrman分级I和Ⅱ级定为低级别组、Ⅲ和Ⅳ级定为高级别组。4个不同病理分级之间的ADC值比较采用单因素方差分析；两个不同级别组之间的ADC值比较采用独立样本t检验，并行ROC曲线分析；ADC值与病理分级的相关性研究采用Spearman秩相关分析。结果（1）Fuhrman分级I级10例、Ⅱ级8例、Ⅲ级7例、Ⅳ级5例，平均ADC值分别为（0．94±0．11）×10^-3、（0．82±0．13）×10^-3、（0．68±0．09）×10^-3和（0．59±0．03）×10^-3mm2／s，差异有统计学意义（F=16．422，P：0．000）。（2）低级别组平均ADC值[（0．89±0．13）×10^-3mm^2／s]高于高级别组[（0．64±0．08）×10^-3mm^2／s]，差异有统计学意义（t=5．738，P=0．000）。ROC曲线下面积为0．940，最佳鉴别阈值为0．73×10^-3mm^2／s，诊断低级别组的敏感度与特异度分别为88．9％和83．3％。肿瘤ADC值与Fuhrman分级之间呈高度负相关（r=-0．807，P〈0．05）。结论T1b期CCRCC的ADC值与病理分级有高度相关性，能术前预测肿瘤的恶性程度，有助于手术方案的制定。Objective To evaluate the correlation of ADC values on 3.0 T MR with the pathological grades in pTlb clear cell renal cell carcinoma（CCRCC）. Methods Conventional MR images, ADC values and Fuhrman pathological grading of pT1 b CCRCC were performed in 30 patients. Grade I and I] were defined as low-grade group; grade Ⅲ and Ⅳwere defined as high-grade group. The differences of ADC values among four different pathologic grades were compared with a one-way analysis of variance. The comparison of ADC values of two different grade groups was performed with t test, and the ROC curve was performed to evaluate the diagnostic efficacy of ADC value. Correlation between pathological gradings and ADC values was assessed with Spearman rank correlation analysis. Results （1）The mean ADC value of grading I （10 patients）, Ⅱ （8 patients）, 11I （7 patients）, IV （5 patients） was （0.94 ± 0. 11） ×10^-3 mm^2/s, （0. 82 ~ 0. 13 ） ×10^-3 mm^2/s, （0. 68 ±0. 09 ） ×10^-3 mm^2/s, （ 0. 59 ± 0. 03 ） × 10^-3 mm^2/s, respectively. Significant differences of ADC values among the four grades were present （ F = 16. 422, P = 0. 000）. （2）The mean ADC value of the low-grade group was significantly higher than that of the high-grade group（ t = 5. 738, P = 0. 000）. Sensitivity and specificity of diagnosing the low-grade group was 88.9% and 83.3% respectively. There was a negative correlation between pathological grading and ADC value （ r = -0.807,P 〈 0.05） . Conclusions The ADC values of pTlb CCRCC have close correlation with pathological gradings. They can be used to predict the degree of tumor malignancy preoperatively and guide surgical planning.

关 键 词：磁共振成像 肾肿瘤 病理分级 

分 类 号：R737.11[医药卫生—肿瘤]