基于MRI-DWI不同指数模型构建的列线图模型对肾透明细胞癌与肾错构瘤的鉴别诊断价值  

The Differential Diagnostic Value of Column Chart Models Constructed Based on Different Index Models of MRI-DWI for Clear Cell Renal Cell Carcinoma and Renal Hamartoma

作　　者：周青 赵祖来[2] 左鹏[3] 张莉 周刚[3] 童欣[2] ZHOU Qing;ZHAO Zulai;ZUO Peng;ZHANG Li;ZHOU Gang;TONG Xin(Huanggang Zhiying Medical Imaging Diagnosis Center,Huanggang 438000,Hubei,P.R.China;Radiology Department,Huanggang Hospital of Traditional Chinese Medicine,Huanggang 438000,Hubei,P.R.China;Radiology Department,Huanggang Central Hospital,Huanggang 438000,Hubei,P.R.China)

机构地区：[1]黄冈智影医学影像诊断中心,湖北黄冈438000 [2]黄冈市中医医院放射科,湖北黄冈438000 [3]黄冈市中心医院放射科,湖北黄冈438000

出　　处：《影像科学与光化学》2024年第3期257-263,共7页Imaging Science and Photochemistry

摘　　要：目的:基于磁共振-弥散加权成像(MRI-DWI)不同指数构建列线图模型,探讨其对肾透明细胞癌(ccRCC)与肾错构瘤的鉴别诊断价值。方法:回顾性选择医院经病理确诊的85例ccRCC或肾错构瘤患者作为建模组,其中肾错构瘤54例,ccRCC 31例;选择经病理确诊的105例ccRCC或肾错构瘤患者作为验证组,其中肾错构瘤59例,ccRCC 46例。基于建模组数据比较肾错构瘤与ccRCC组MRI-DWI不同指数模型参数,采用多因素Logistic回归分析筛选鉴别诊断ccRCC与肾错构瘤的影响因子,并建立列线图模型进行内部验证及外部验证。结果:ccRCC组MRI-DWI参数微循环灌注相关快速表观弥散系数(ADC)(Dt)、扩散异质性指数(α)值高于肾错构瘤组,表观弥散系数(ADC)值、单纯扩散相关慢速表观弥散系数值(Dp)、灌注分数(fp)、扩散分布指数(DDC)值低于肾错构瘤组(P<0.05)。经Logistic回归分析显示,Dt、α值是鉴别诊断ccRCC与肾错构瘤的危险因子(OR>1,P<0.05),ADC值、Dp、fp、DDC值是保护因子(OR<1,P<0.05)。根据以上参数建立的列线图模型在建模组与验证组C指数分别为0.941、0.903,校准曲线与理想曲线接近;ROC曲线显示,建模组与验证组的ROC曲线下面积(AUC)分别为0.962(95%CI为0.921~1.000)、0.903(95%CI为0.846~0.961),敏感度分别为0.907、0.898,特异度分别为0.935、0.804,约登指数分别为0.842、0.702。结论:基于MRI-DWI不同模型参数构建的列线图模型具有良好的区分度、准确性,对ccRCC与肾错构瘤具有较高的鉴别诊断价值。Objective:To construct a nomogram model based on different indexes of magnetic resonance imaging-diffusion weighted imaging(MRI-DWI)and to explore the differential diagnostic value of renal clear cell carcinoma(ccRCC)and renal hamartoma.Methods: A total of 85 patients with ccRCC or renal hamartoma confirmed by pathology in our hospital were retrospectively selected as the modeling group, including 54 cases of renal hamartoma and 31 cases of ccRCC. A total of 105 patients with ccRCC or renal hamartoma confirmed by pathology were selected as the validation group, including 59 cases of renal hamartoma and 46 cases of ccRCC. Using data from the modeling group, the parameters of different exponential models of MRI-DWI in renal hamartoma and ccRCC group were compared. Multivariate Logistic regression analysis was used to identify influencing factors for distinguishing ccRCC and renal hamartoma. The nomogram model was established according to the influencing factors and underwent both internal and external validation. Results: ccRCC group MRI-DWI parameters microcirculation perfusion related fast apparent diffusion coeffecient (ADC) value (Dt) and diffusion heterogeneity index (α) were higher in the renal hamartoma group, while the values of ADC, simple diffusion related slow apparent diffusion coeffecient (Dp), perfusion fraction (fp), and diffusion distribution index (DDC) were lower in the renal hamartoma group ( P <0.05). Logistic regression analysis showed that Dt and α value is a risk factor for differential diagnosis of ccRCC and renal hamartoma (OR>1, P <0.05), and ADC value, Dp, fp and DDC values were protective factors (OR<1, P <0.05). The C index of the nomogram model based on the above parameters in the modeling group and the verification group was 0.941 and 0.903, respectively, and the calibration curve was close to the ideal curve. The receiver operator characteristic (ROC) curve showed that the AUC under ROC of the modeling group and the verification group were 0.962(95%CI: 0.921-1.000) and 0.903 (95%CI

关 键 词：肾透明细胞癌 肾错构瘤 磁共振成像 弥散加权成像 不同指数模型 列线图 

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