多b值DWI在肾透明细胞癌Fuhrman核级诊断中的应用研究

发布时间：2018-05-29 08:14

本文选题：肾细胞癌 + Fuhrman核级　；参考：《中国癌症杂志》2015年03期

【摘要】：背景与目的:肾细胞癌是成人最常见的肾脏恶性肿瘤,而Fuhrman核级系统是得到广泛认可的肾细胞癌预后判断的独立指标之一。本文旨在探讨多b值磁共振弥散加权成像(diffusion weighted imaging,DWI)与肾透明细胞癌clear cell renal cell carcinoma,CCRCC)Fuhrman核级的相关性,评价各指标在鉴别Fuhrman核级高级别与低级别肿瘤中的诊断效能。方法:选取经病理证实为CCRCC的患者33例,后处理选择不同b值组合测量肿瘤ADC值,分析其与Fuhrman核级相关性。应用受试者操作特征性曲线评价不同b值组合所得ADC值在鉴别Fuhrman核级低级别(1、2级)及高级别(3、4级)CCRCC中的诊断效能。通过约登指数得出各参数的灵敏度和特异度。结果:在33例CCRCC患者中,Fuhrman核级1级1例、2级14例、3级16例、4级2例,不同b值所得肿瘤ADC值(ADC_(0-800)ADC_(0-400-800)ADC_(0-600-1200)、ADC_(0-400-800-1200)及ADC_(tatal))与肿瘤Fuhrman核级均为负相关,相关系数分别为-0.553、-0.511、-0.603、-0.645、-0.610,其中ADC_(0-400-800-1200)的相关系数绝对值最高。Fuhrman高级别组CCRCC的ADC值均明显低于低级别组,差异有统计学意义(P0.05)。各ADC值的受试者工作特征性曲线(receiver operator characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)分别为0.789、0.757、0.813、0.844、0.835,以ADC_(0-400-800-1200)最大,但是各AUC差异无统计学意义(P0.05)。各ADC值鉴别CCRCC高、低级别的灵敏度分别为86.7%、73.3%、60.0%、86.7%和86.7%;特异度分别为66.7%、77.8、72.2%、77.8%和72.2%。结论:ADC_(0-800)、ADC_(0-400-800)、ADC_(0-600-1200)、ADC_(0-400-800-1200)、ADC_(tatal)与肿瘤Fuhrman核级均具有显著相关性,并在鉴别Fuhrman核级高级别与低级别肿瘤中具有较高的诊断效能。
[Abstract]:Background & objective: renal cell carcinoma (RCC) is one of the most common renal malignancies in adults, and Fuhrman nuclear grade system is one of the independent prognostic markers of RCC. The purpose of this paper is to investigate the correlation between diffusion-weighted imaging (DWI) and the nuclear grade of clear cell renal cell carcinoma CCRCCC Fuhrman, and to evaluate the diagnostic effectiveness of each index in differentiating high grade and low grade Fuhrman tumors. Methods: 33 patients with pathologically proved CCRCC were selected to measure the ADC value of tumor with different b value combinations. The correlation between ADC and nuclear grade of Fuhrman was analyzed. The diagnostic efficacy of ADC values obtained from different b value combinations was evaluated by using the operating characteristic curves of the subjects in the differential diagnosis of Fuhrman nuclear grade 1 / 2) and high grade 3 / 4 CCRCCs. The sensitivity and specificity of each parameter were obtained by means of Yorden index. Results: among 33 patients with CCRCC, 1 case with Fuhrman nuclear grade 1, 14 cases with grade 2 and 16 cases with grade 3 and 2 cases with grade 4. The tumor ADC values obtained from different b values were negatively correlated with the Fuhrman nuclear grade of the tumor. The correlation coefficients were -0.553U -0.511U -0.603U -0.645U -0.610, among which, the ADC values of CCRCC in the highest. Fuhrman high grade group were significantly lower than those in the lower grade group (P 0.05, P 0.05), and the correlation coefficients of the two groups were significantly lower than those of the lower grade group (P < 0.05), and the absolute correlation coefficient of the correlation coefficient was higher than that of the lower grade group (P < 0.05). The area under the curve of receiver operator characteristic curved-ROC curve of each ADC value was 0.789 / 0.757 / 0.8130.840.84 / 40.35, respectively, and the maximum was ADCC _ (0-400-800-1200), but there was no significant difference between AUC and ADCA (P _ (0.05) P _ (0.05), but there was no significant difference between them (P > 0.05). The sensitivity of each ADC was 86.7% and 86.7%, and the specificity was 66.7% and 72.2%, respectively, and the specificity was 77.8% and 72.2%, respectively. Conclusion there is a significant correlation between the Fuhrman nuclear grade of the Fuhrman and the number of ADCADCT (0-400-800). It has high diagnostic efficacy in differentiating the high grade and the low grade of Fuhrman from the low grade tumors, and there is a significant correlation between the number of ADCT and the number of ADC-D, and the relationship between the number of ADCS and the number of ADCS, and the correlation between the number of ADCS and the nuclear grade of Fuhrman.
【作者单位】：复旦大学附属上海市第五人民医院放射科;复旦大学上海医学院妇产科学系;复旦大学附属肿瘤医院放射诊断科;复旦大学上海医学院肿瘤学系;复旦大学附属肿瘤医院病理科;
【分类号】：R737.11

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