T1分期肾透明细胞癌磁共振弥散加权成像的ADC值与Fuhrman病理分级的相关性研究

发布时间：2018-04-24 17:08

本文选题：磁共振成像 + 弥散加权成像　；参考：《苏州大学》2014年硕士论文

【摘要】：1目的应用磁共振弥散加权成像研究T1期肾透明细胞癌，探讨ADC值与Fuhrman病理分级之间的相关性，期望能对临床选择治疗方案及判断病人的预后有所帮助。 2材料与方法回顾性分析我院经病理证实的60例T1期肾透明细胞癌患者常规MRI平扫、DWI及增强检查的磁共振影像资料。同时，由两位高年资影像科医生在Siemens Syngo工作站共同对肿瘤的最大径进行测量（取横断位、冠状位图像所示肿瘤的最大径），同时对肾透明细胞癌DWI（ADC图）图像进行分析，测量肿瘤实性部分的ADC值。由两位高年资病理科医生共同对其采用Fuhrman病理分级法进行分级，共分为Ⅰ-Ⅳ级，其中Ⅰ-Ⅱ级为低级别组肾透明细胞癌，Ⅲ-Ⅳ级为高级别组肾透明细胞癌。应用SPSS17.0统计软件进行统计学分析。Fuhrman分级为Ⅰ-Ⅳ级T1期肾透明细胞癌之间ADC值的比较采用单因素方差分析；高、低病理级别组之间ADC值的比较采用独立样本t检验，并应用ROC曲线判断ADC值最佳阈值、敏感性及特异性；肿瘤ADC值与其Fuhrman病理级别之间相关性分析采用Spearman秩相关分析。相同分级不同T1分期期肾透明细胞癌与ADC值之间比较采用独立样本t检验；肿瘤最大径与ADC值之间相关关系采用Pearson相关分析。P0.05可认为差异有统计学意义。 3结果所有60例T1期肾透明细胞癌中，Fuhrman病理级别为Ⅰ、Ⅱ、Ⅲ、Ⅳ级的肿瘤实性部分的ADC值分别依次为（0.912±0.027）×10-3mm2/s、（0.851±0.128）×10-3mm2/s、（0.705±0.116）×10-3mm2/s、（0.600±0.274）×10-3mm2/s。其中，Ⅰ级与Ⅱ级、Ⅲ级与Ⅳ级之间差异无统计学意义（p=0.11、0.09）；Ⅰ级与Ⅲ级、Ⅰ级与Ⅳ级、Ⅱ级与Ⅲ级，Ⅱ级与Ⅳ级之间差异均有统计学意义（p≤0.00）。 T1期肾透明细胞癌低级别组ADC值为（0.872±0.123）×10-3mm2/s，高级别组ADC值为（0.675±0.110）×10-3mm2/s，，低级别组ADC值明显大于高级别组，差异具有统计学意义（p=0.00）。取ADC值为0.713×10-3mm2/s，ROC曲线下面积为0.886，此时，鉴别高低级别组T1期CCRCC的敏感度及特异度分别为92.9%和72.2%。T1期肾透明细胞癌Fuhrman分级与ADC值呈显著负相关（r=-0.64，p=0.00）。由于Fuhrman病理分级为Ⅳ级的T1a期肾透明细胞癌只有一例，故未将Ⅳ级的CCRCC纳入统计范围。Ⅰ、Ⅱ、Ⅲ级的肾T1a期与T1b期CCRCC的ADC值间无统计学差异（p值分别依次为0.49、0.72和0.88）。肿瘤最大径与ADC值之间相关系数为-0.17（r=-0.17，p=0.21），两者之间的相关性不显著。 4结论 4.1、T1期肾透明细胞癌Fuhrman病理分级与ADC值之间呈显著负相关，即Fuhrman病理分级级别越高，ADC值越低。 4.2、ADC值可以用来预测T1期肾透明细胞癌分级，取ADC值为0.713×10-3mm2/s，ROC曲线下面积为0.886，此时鉴别T1期肾透明细胞癌高低级别组的敏感度及特异度分别为92.9%，72.2%，从而为临床上选择肿瘤的治疗方案及判断预后提供帮助。 4.3、相同Fuhrman分级，不同T1分期CCRCC的ADC值没有明显差别。不同T1分期对相同Fuhrman病理分级肾透明细胞癌的ADC值无显著影响。
[Abstract]:1 purposes
The use of MR diffusion weighted imaging in the study of T1 renal clear cell carcinoma and the correlation between the ADC value and the Fuhrman pathological grading are expected to be helpful to the clinical selection and prognosis of the patients.
2 materials and methods
A retrospective analysis was made of 60 cases of T1 renal clear cell carcinoma confirmed by pathology in our hospital with conventional MRI scan, DWI and MRI. At the same time, the maximum diameter of the tumor was measured by two senior imaging doctors at the Siemens Syngo workstation (the maximum diameter of the transverse and coronal images), and the maximum diameter of the tumor. The DWI (ADC map) image of renal clear cell carcinoma was analyzed and the ADC value of the solid part of the tumor was measured. The two senior year medical science doctors were divided into grade I and IV by the Fuhrman pathological grading method together. The grade I - II was a low grade renal clear cell carcinoma, and the grade III - IV was a high grade renal clear cell carcinoma. SPSS17.0 Statistical software for statistical analysis of.Fuhrman classification of the ADC value of stage I - IV T1 stage renal clear cell carcinoma by single factor analysis of variance; high, low pathological grade group ADC value comparison between independent sample t test, and ROC curve to determine the best threshold of ADC value, sensitivity and specificity; tumor ADC value and Fuhrman disease Spearman rank correlation analysis was used for the correlation analysis between the levels of the rational level. An independent sample t test was used between the same classification and different T1 stages of the renal clear cell carcinoma and the ADC value; the correlation between the maximum diameter of the tumor and the ADC value was based on the Pearson correlation analysis.P0.05, which could be considered statistically significant.
3 Results
In all 60 cases of T1 renal clear cell carcinoma, the pathological grade of Fuhrman was I, II, II, III and IV, the ADC values were (0.912 + 0.027) x 10-3mm2/s, (0.851 + 0.128) x 10-3mm2/s, (0.705 + 0.116) x 10-3mm2/s, (0.600 + 0.274) x 10-3mm2/ S., and there was no statistical difference between grade I and grade II, and the difference between grade III and IV (p=0). .11,0.09); there were significant differences between grade I and III, grade I and IV, grade II and III, grade II and IV (P < 0.00).
The ADC value of the low grade renal cell carcinoma group T1 was (0.872 + 0.123) x 10-3mm2/s, and the ADC value of the advanced group was (0.675 + 0.110) x 10-3mm2/s. The ADC value of the low grade group was significantly greater than that of the advanced group. The difference was statistically significant (p=0.00). The value of ADC was 0.713 x 10-3mm2/s and the area under the ROC curve was 0.886. At this time, the sensitivity of the T1 stage CCRCC was identified. The degree and specificity of 92.9% and 72.2%.T1 stage clear cell renal cell carcinoma were significantly negatively correlated with Fuhrman score (ADC, r=-0.64, p=0.00).
Due to the only one case of T1a stage renal clear cell carcinoma with grade IV of Fuhrman pathological grade, the grade IV CCRCC was not included in the statistical range. There was no statistical difference between the T1a phase of grade II and stage III of the kidney and the ADC value of CCRCC in T1b phase (P values were respectively 0.49,0.72 and 0.88). The correlation coefficient between the maximum diameter of the tumor and the ADC value was -0.17 (r=-0.17,). The correlation between them is not significant.
4 Conclusion
There was a significant negative correlation between the pathological grading of Fuhrman and the ADC value of 4.1, T1 stage clear cell carcinoma, that is, the higher the Fuhrman pathological grading level, the lower the ADC value.
4.2, ADC value can be used to predict stage T1 stage of renal clear cell carcinoma. The value of ADC is 0.713 x 10-3mm2/s, and the area under ROC curve is 0.886. At this time, the sensitivity and specificity of identifying the high and low level group of T1 stage renal clear cell carcinoma are respectively 72.2%, which is helpful for the clinical selection of tumor treatment and prognosis.
4.3, the same Fuhrman classification, the ADC values of CCRCC in different T1 stages were not significantly different. Different T1 stages had no significant effect on the ADC value of the same Fuhrman pathological classification of renal clear cell carcinoma.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11;R445.2

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