IVIM-MRI在评估透明细胞肾细胞癌病理分级中的价值  

Value of intravoxel incoherent motion in evaluating the pathological grade of clear cell renal cell carcinoma

作　　者：康钦钦 边云 田冰 李晶 刘芳 郝强 陆建平 KANG Qin-qin;BIAN Yun;TIAN Bing(Department of Radiology,Changhai Hospital,the Navy Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院影像医学科,上海200433

出　　处：《放射学实践》2022年第2期202-208,共7页Radiologic Practice

摘　　要：目的:探讨体素内不相干运动扩散加权成像(IVIM-DWI)在评估透明细胞肾细胞癌(CCRCC)病理分级中的价值,分析其相关参数与微血管密度(MVD)的相关性。方法:对经病理证实的82例CCRCC患者(Ⅰ级14例,Ⅱ级47例,Ⅲ级15例,Ⅳ级6例)行IVIM-DWI检查,Ⅰ级+Ⅱ级归为低级别组(n=61),Ⅲ+Ⅳ级归为高级别组(n=21)。IVIM-DWI检查设定9个b值(0、20、50、100、200、400、600、800、1000 s/mm^(2))。通过DWI双指数模型获得不同病理分级CCRCC的单纯组织扩散系数(D)、假性扩散系数(D*)和灌注分数(f)值。采用CD34免疫组化进行MVD值的测量。采用Mann-Whitney U检验比较高、低级别肿瘤IVIM-DWI参数的差异,采用ROC曲线分析各参数值的诊断效能并确定诊断阈值。低级别和高级别CCRCC的IVIM-DWI各参数、MVD值及病理分级之间的相关性通过Spearman等级相关进行分析。结果:高、低级别CCRCC的D*值分别为(51.1±7.6)、(944.3±9.5)mm^(2)/s(P=0.007),D值分别为(1.2±0.3)、(1.3±0.3)mm^(2)/s(P=0.015),MVD值分别为(81.5±8.8)、(67.5±12.8),差异均有统计学意义(P<0.05)。D*、D及MVD值均与病理分级相关,D*值与病理分级呈正相关(r=0.346,P<0.05),D值呈负相关(r=-0.315,P<0.05),MVD值呈正相关性(r=0.617,P>0.05)。D、D*值对于鉴别高、低级别CCRC的ROC曲线下面积均为0.7。D、D*值的诊断阈值分别为1.2 mm^(2)/s、44.4 mm^(2)/s,敏感度分别为70.0%、60.7%,特异度分别为70%、90%。D*及D值均与MVD存在相关性,MVD与D*值呈正相关(r=0.585,P<0.05),与D值呈负相关(r=-0.337,P<0.05)。结论:IVIM-DWI可提供CCRCC病理分级的相关信息,可用于微血管密度的无创评估。Objective:To investigate the value of intravoxel incoherent motion-diffusion weighted imaging(IVIM-DWI)in evaluating the pathological grading of clear cell renal cell carcinoma(CCRCC),and the correlation between its parameters and microvessel density(MVD).Methods:A total of 82 patients who underwent IVIM-DWI examination with surgical pathology-proven CCRCC were included(14 cases of gradeⅠ,47 cases of gradeⅡ,15 cases of gradeⅢ,and 6 cases of gradeⅣ).GradeⅠandⅡwere classified as low-grade group(n=61),and gradeⅢandⅣwere classified as high-grade group(n=21).IVIM-DWI was performed with 9 b-values(0,20,50,100,200,400,600,800 and 1000s/mm^(2)).True diffusivity(D),pseudo-diffusion coefficient(D*)and perfusion fraction(f)of CCRCC with different pathological grades were calculated by the bi-exponential DWI.MVD was measured by CD34 immunohistochemistry staining.Mann-Whitney U test was used to compare the difference of IVIM-DWI parameters between high-grade group and low-grade group.Spearman rank correlation was used to assess the correlation between IVIM-DWI parameters,MVD and pathological grading of low-grade and high-grade CCRCC.The diagnostic efficacy of each parameter and the diagnostic threshold were analyzed using receiver operating characteristic(ROC)curve.Results:The D*values,D values and MVD values of high-and low-grade CCRCC were significant difference(51.1±7.6 vs 944.3±9.5,P=0.007),(1.2±0.3 vs 1.3±0.3,P=0.015),and(81.5±8.8 vs 67.5±12.8),respectively(P<0.05).D*,D and MVD had correlation with pathological grade of CCRCC.D*value was positively correlated with pathological grading(r=0.346,P<0.05),D value was negatively correlated(r=-0.315,P<0.05)and MVD was positively correlated(r=0.617,P>0.05).Both D*and D had correlation with MVD.MVD was positively correlated with D*value(r=0.585,P<0.05),but negatively correlated with D value(r=-0.337,P<0.05).The areas under the ROC curve of D and D*for identifying high-and low-grade were both 0.7.When the diagnostic thresholds of D and D*were 1.2 mm^(2)/s and

关 键 词：体素内不相干运动 扩散加权成像 微血管密度 透明细胞肾细胞癌 肾肿瘤 病理分级 磁共振成像 

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