异机融合^(18)F-FDG PET/MRI对肾透明细胞癌WHO/ISUP病理分级预测价值  

Predictive value of hybrid ^(18)F-FDG PET/MRI for WHO/ISUP pathological grading of clear cell renal cell carcinoma

作　　者：姜双士 刘烜利 周莹 冯洪燕 王科 涂宁 谢新立[3] 韩芳[2] 卜丽红 JIANG Shuangshi;LIU Xuanli;ZHOU Ying;FENG Hongyan;WANG Ke;TU Ning;XIE Xinli;HAN Fang;BU Lihong(PET Center,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;PET Center,Zhongshan Hospital of Dalian University,Dalian 116001,Liaoning,China;Dept.of Nuclear Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)

机构地区：[1]武汉大学人民医院PET中心,湖北武汉430060 [2]大连大学附属中山医院PET中心,辽宁大连116001 [3]郑州大学第一附属医院核医学科,河南郑州450052

出　　处：《武汉大学学报(医学版)》2025年第1期41-47,共7页Medical Journal of Wuhan University

基　　金：国家自然科学基金资助项目(编号:81871419)。

摘　　要：目的:探讨异机融合^(18)F-FDG PET/MRI对肾透明细胞癌(ccRCC)WHO/ISUP病理分级的预测价值。方法:回顾性分析2018年3月至2023年3月于武汉大学人民医院PET中心行异机融合^(18)F-FDG PET/MRI的57例经病理证实的ccRCC患者的临床及影像资料并分为低级别组(WHO/ISUP分级Ⅰ~Ⅱ级,33例)及高级别组(WHO/ISUP分级Ⅲ~Ⅳ级,24例)。使用χ^(2)检验、两独立样本t检验或Mann-Whitney U检验分析两组间各参数差异。并采用二元logistic回归分析联合ROC曲线评价异机融合^(18)F-FDG PET/MRI术前预测WHO/ISUP病理分级的诊断效能。结果:低级别与高级别组患者间病灶出血坏死、静脉癌栓、MTV、TLG及TLR的差异具有统计学意义(均P<0.05)。回归分析显示仅TLR是高级别ccRCC核分级的独立危险因素(P=0.009)。ROC曲线显示各参数及联合预测效能大小排序为:联合诊断>TLR>TLG>MTV>出血坏死>静脉癌栓,其中联合诊断肾透明细胞癌WHO/ISUP病理分级价值最高,AUC值为0.817(95%CI:0.692~0.907),灵敏度为75.0%,特异度81.8%。结论:异机融合^(18)F-FDG PET/MRI在预测ccRCCWHO/ISUP病理分级中具有重要价值,且TLR的预测价值最高。同时联合PET参数(MTV、TLG)以及MRI特征(出血坏死、静脉癌栓)可大大提高ccRCC患者病理肿瘤分级预测价值,改善患者生存预后。Objective:To investigate the predictive value of hybrid ^(18)F-FDG PET/MRI for WHO/ISUP pathological grading of clear cell renal clear cell carcinoma(ccRCC).Methods:The clinical and imaging data of 57 patients with pathologically confirmed ccRCC who underwent hybrid ^(18)F-FDG PET/MRI from March 2018 to March 2023 in our hospital were retrospectively analyzed and divided into a low-grade group(WHO/ISUP gradingⅠtoⅡ,33 cases)and a high-grade group(WHO/ISUP gradingⅢtoⅣ,24 cases).The differences of each parameter between the two groups were analyzed using theχ^(2) test,two independent samples t-test or Mann-Whitney U test.The diagnostic ef-ficacy of preoperative prediction of WHO/ISUP pathologic grade by hybrid ^(18)F-FDG PET/MRI was evaluated by binary logistic regression analysis combined with ROC curve.Results:The differences in lesion hemorrhagic necrosis,venous cancerous thrombus,MTV,TLG and TLR between patients in the low-grade and high-grade groups were statistically significant(all P<0.05).Regression analysis showed that only TLR was an independent risk factor for high-grade ccRCC nuclear grading(P=0.009).The ROC curve showed that the ranking of predictive efficacy was as follows:combined diagnosis>TLR>TLG>MTV>hemorrhagic necrosis>vein cancer embolus.Among them,the combined diagnosis of ccRCC using WHO/ISUP pathology grading had the highest value.The AUC value for this diagnosis was 0.817(95%CI:0.692–0.907),with a sensitivity of 75.0%and a specificity of 81.8%.Conclusion:Hybrid ^(18)F-FDG PET/MRI has significant value in predicting ccRCC WHO/ISUP pathologic grading,and TLR has the highest predictive value.Meanwhile,the combination of PET parameters(MTV,TLG)and MRI features(hemorrhagic necrosis,venous can-cer embolism)can greatly enhance the predictive value of pathological tumor grading in patients with ccRCC,and improve their survival and prognosis.

关 键 词：肾透明细胞癌 病理分级 氟脱氧葡萄糖F18 正电子发射断层显像 磁共振成像 

分 类 号：R445.5[医药卫生—影像医学与核医学]