表观扩散系数最小值和平均值与肾透明细胞癌病理分级的相关性研究  

The relationship between the minimum and mean apparent diffusion coefficient with pathological grade of clear cell renal cell carcinoma

作　　者：王亚婷[1] 陈伟[1] 张晰[1] 单文莉 柏根基[1] WANG Yating;CHEN Wei;ZHANG Xi;SHAN Wenli;BAI Genji(Department of Imaging,the Affiliated Huai'an First Hospital of Nanjing Medical University,Huai'an,Jiangsu Province 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院影像科,江苏淮安223300

出　　处：《实用放射学杂志》2019年第12期1974-1977,共4页Journal of Practical Radiology

摘　　要：目的探讨肾透明细胞癌(CCRCC)ADC最小值和ADC平均值与肿瘤病理分级的相关性及其诊断价值。方法回顾性分析60例经病理证实的CCRCC患者,所有患者行MRI平扫、DWI并测量病灶实质部分的ADC平均值、ADC最小值。结合病理资料,将Fuhrman分级Ⅰ级和Ⅱ级定义为低级别组、Ⅲ级和Ⅳ级定义为高级别组。对比常规MRI上的信号特点在不同病理分级CCRCC中的差异;对比ADC平均值、ADC最小值在CCRCC不同病理分级中的差异及其与病理的相关性。采用ROC曲线分析ADC最小值对不同病理分级CCRCC的鉴别诊断价值。结果肿瘤大小、囊变、坏死、出血在2个不同级别组之间有统计学意义(P<0.05)。低级别组ADC平均值与ADC最小值分别为(1.75±0.27)×10^-3mm^2/s、(1.61±0.26)×10^-3mm^2/s;高级别组ADC平均值与ADC最小值分别为(1.53±0.24)×10^-3mm^2/s、(1.28±0.34)×10^-3mm^2/s;在CCRCC中,低级别组ADC平均值与ADC最小值均高于高级别组,且差异有统计学意义(P<0.05);ADC最小值与肿瘤病理分级呈负相关(r=-0.483,P<0.05),ADC平均值与肿瘤病理分级之间无明显相关性(r=-0.402,P>0.05);低级别组与高级别组CCRCC的鉴别中,ADC最小值具有较高的诊断效能,AUC为0.812,其敏感度、特异度分别为87.5%、66.7%。结论CCRCC中ADC最小值与肿瘤病理分级高度相关,有助于术前评估CCRCC的恶性程度,有助于优化治疗方案的选择。Objective To investigate the value of the minimum and mean ADC values in determination of the pathological grade of clear cell renal cell carcinoma(CCRCC).Methods 60 patients with pathologically confirmed CCRCC were analyzed retrospectively.All patients underwent conventional MRI and DWI examinations.The minimum and mean ADC values in the solid region of interest of CCRCC were measured and compared.We regarded FuhrmanⅠ-Ⅲas low-grade group and FuhrmanⅢ-Ⅳas high grade group by pathological results.The differences of conventional MRI features were compared in the different groups.The correlationships between the minimum and mean ADC value and pathological grade were analyzed in CCRCC of different pathological grades.ROC curves were used to evaluate the diagnostic efficacy of the minimum ADC value in differentiating low from high grade CCRCC.Results Statistical significances were found between the two groups in tumor size,hemorrhage,necrosis and cystic component(P<0.05).The mean and minimum ADC values in the low grade group were(1.75±0.27)×10^-3mm^2/s and(1.61±0.26)×10^-3mm^2/s,while in the high grade group were(1.53±0.24)×10^-3mm^2/s and(1.28±0.34)×10^-3mm^2/s.The mean and minimum ADC values were significantly higher in low grade group compared with high grade group(PV0.05).The minimum ADC value was negatively correlated with pathological grade(r=-0.483,P<0.05),while the mean ADC value had no correlation with pathological grade(r=-0.402,P>0.05).ROC curves showed that the minimum ADC value had higher diagnostic performance in the identification between high and low grade CCRCC with the AUC of 0.812,with the sensitivity and the specificity of 87.5%and 66.7%,respectively.Conclusion The minimum ADC value is highly correlated with the pathological grade of CCRCC,which may be helpful to predict the degree of malignancy of CCRCC and to select the best therapy.

关 键 词：肾透明细胞癌 磁共振成像 扩散加权成像 表观扩散系数 病理分级 

分 类 号：R737.11[医药卫生—肿瘤] R445.2[医药卫生—临床医学]