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

作　　者：赵建 王美凤 方圆 段峰[4] 白旭 许伟 张晓晶[1] 周少鹏 李林[5] 马鑫[6] 张旭[6] 叶慧义[1] 王海屹[1] Jian Zhao;Meifeng Wang;Yuan Fang;Feng Duan;Xu Bai;Wei Xu;Xiaojing Zhang;Shaopeng Zhou;Lin Li;Xin Ma;Xu Zhang;Huiyi Ye;Haiyi Wang(Department of Radiology,First Medical Center,PLA General Hospital,Beijing 100853,China;Department of Radiology,Six Medical Center,PLA General Hospital,Beijing 100037,China;Department of Radiology,PLA Air Force Medical Center,Beijing 100142,China;Department of Interventional Radiology,First Medical Center,PLA General Hospital,Beijing 100853,China;Department of Innovative Medical Research,PLA General Hospital,Beijing 100853,China;Department of Urology,PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心放射诊断科,北京100853 [2]解放军总医院第六医学中心放射诊断科,北京100037 [3]空军特色医学中心放射诊断科,北京100142 [4]解放军总医院第一医学中心介入放射科,北京100853 [5]解放军总医院医学创新研究部医院管理研究所,北京100853 [6]解放军总医院泌尿外科医学部,北京100853

出　　处：《中华放射学杂志》2023年第3期274-281,共8页Chinese Journal of Radiology

基　　金：国家自然科学基金(81971580,82271951);北京市自然科学基金(7222167)。

摘　　要：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�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),

关 键 词：磁共振成像 癌 肾细胞 侧支循环 腔静脉 下 

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