双能量CT预测透明细胞肾细胞癌病理分级及缺氧相关蛋白碳酸酐酶9表达的研究  

Study on the Value of Dual-Energy CT for Predicting Pathological Grading and Hypoxia Related Protein Carbonic Anhydrase 9 Expression of Clear Cell Renal Cell Carcinoma

作　　者：顾希来 刘欢欢[1] 李金凝 储彩婷[1] 管雯斌[2] 汪登斌[1] GU Xilai;LIU Huanhuan;LI Jinning;CHU Caiting;GUAN Wenbi;WANG Dengbin(Department of Radiology,Xinhua Hospital,Shanghai Jiao Tong University Schoolof Medicine;Department of Pathology,Xinhua Hospital,Shanghai Jiao Tong UniversitySchoolof Medicine)

机构地区：[1]上海交通大学医学院附属新华医院放射科 [2]上海交通大学医学院附属新华医院病理科

出　　处：《中国医学计算机成像杂志》2024年第5期576-582,共7页Chinese Computed Medical Imaging

摘　　要：目的:探索双能量CT (DECT)参数对透明细胞肾细胞癌(ccRCC)病理分级及缺氧相关蛋白碳酸酐酶9 (CA9)表达的预测价值,旨在筛选不良预后的高风险人群,以辅助临床制订治疗方案。方法:前瞻性纳入2023年5月至2023年11月在我院行肾肿瘤术前DECT检查的患者共42例,其中术后证实为ccRCC 38例。基于ccRCC患者术前DECT图像及后处理图像,对肿瘤边缘血供最丰富的部位和肿瘤整体进行测量,获得肿瘤边缘碘浓度值(IC)、相对于主动脉标准化碘浓度比值(NICA)、相对于正常肾皮质标准化碘浓度比值(NICC)、肿瘤整体IC及灌注指数(PI)。纳入术后预后相关病理指标,包括病理分级(WHO/ISUP)及缺氧病理指标CA9平均免疫组化光密度值(AOD)。采用独立样本t检验比较低级别组与高级别ccRCC组间DECT参数的差异,绘制受试者工作特征(ROC)曲线评价DECT参数对预测ccRCC预后相关病理指标的价值。结果:CA9 AOD在低级别肿瘤及高级别肿瘤间具有统计学差异(t=2.584,P=0.014),ROC曲线下面积(AUC)为0.774。T1a期肿瘤中(直径≤4 cm),低级别及高级别组PI具有统计学差异(t=-4.514,P<0.001),AUC为1.00,PI与CA9 AOD之间具有负相关性(r=-0.427,P=0.002)。结论:基于DECT后处理参数PI可区分肿瘤分级和有效预测T1a期ccRCC的缺氧情况,预测T1a期ccRCC的预后,为临床制订ccRCC治疗方案提供参考。Purpose:To explore the predictive value of dual energy CT(DECT)parameters for pathological grading and hypoxia related protein carbonic anhydrase 9(CA9)expression of clear cell renal cellcarcinoma(ccRCC),in order to screen high-risk populations with poor prognosis and assist clinical treatment planning.Method:A total of 42 patients who underwent preoperative DECT for renal tumors at our Hospital from May 2023 to November 2023 were prospectively recruited,in which 38 cases were confirmed as ccRCC after surgery.Based on preoperative DECT images and post-processing images of patients,measurements were taken on the areas with the richest blood supply at the tumor edge and the overall tumor to obtain the tumor edge iodine concentration(IC),normalized iodine concentration based on aorta(NICA),normalized iodine concentration based on cortex(NICC),the whole tumor IC and perfusion index(PI).Prognostic pathological indicators were collected,including postoperative pathological grading(WHO/ISUP)and average optical density(AOD)of CA9.The Student's t-test was used to compare the differences of iodine parameters between the low-grade and high-grade group and the receiver operating characteristic(ROC)curve was used to evaluate the value of DECT parameters in predicting prognostic pathological indicators of ccRCC.Results:There was statistical difference in CA9 AOD between low-grade and highgrade group(t-2.584,P=0.014).The area under curve(AUC)was 0.774.In Tla stage group,PI showed with statistical differences(t--4.514,P<0.001)between low-grade and high-grade tumors,with an AUC of 1.00.There was negative correlation between PI and CA9AOD(r=-0.427,P-0.002).Conclusions:Based on DECT measurement of PI,pathological grading and CA9 expression in Tla stage(diameter≤4 cm)ccRCC can be effectively predicted to forecast the prognosis of Tla ccRCC,providing new evidences for clinical ccRCC treatment.

关 键 词：透明细胞肾细胞癌 双能量CT 碘密度图 缺氧 

分 类 号：R737.11[医药卫生—肿瘤] R730.44[医药卫生—临床医学]