肾透明细胞癌CT征象与Fuhrman病理分级的 对照研究

目的 探究肾透明细胞癌的CT征象预测其病理分级的价值。方法 回顾性分析安徽医科大学第一附属医院2012年1月~2017年6月共70例临床资料完整、经手术病理证实为肾透明细胞癌患者的影像学资料。依据手术Fuhrman病理结果，将肿瘤分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级。Ⅰ级与Ⅱ级合并为低级别组，共39例，Ⅲ级与Ⅳ级合并为高级别组，共31例。观察肿瘤的CT征象，包括直径、形态、平扫密度、是否存在完整假包膜以及增强扫描动脉期绝对强化值、排泄期强化衰减值等特点，与Fuhrman病理分级结果进行统计学分析。探讨肾透明细胞癌的CT征象对预测其病理分级的价值。结果 低级别组与高级别组肿瘤的平均直径分别为（5.03±1.27）cm、（6.92±1.56）cm，平扫密度不均匀肿瘤分别有29例、31例，有完整包膜肿瘤分别有34例、13例，增强扫描绝对强化值分别为（74.73±23.14）HU、（35.19±8.65）HU，强化衰减值分别为（56.89±16.84）HU、（20.69±15.95）HU，差异均有统计学意义（P＜0.05）。低级别组与高级别组形状不规则的肿瘤分别有11例、18例，差异无统计学意义（P＞0.05）。结论 肾透明细胞癌的直径、平扫密度的均匀性、有无完整包膜、增强扫描绝对强化程度及强化衰减程度等CT征象，有助于术前评价肾透明细胞癌的Fuhrman病理分级。

A Comparative Study of CT Signs and Fuhrman Pathological Grading in Clear Cell Renal Cell Carcinoma

Abstract:Objective To investigate the value of CT findings in predicting pathological grade of clear cell renal cell carcinoma. Methods A retrospective analysis of the first hospital of Anhui Medical University from January 2012 to June 2017 a total of 70 patients with complete clinical data,pathologically confirmed as clear cell renal cell carcinoma in patients with imaging data. According to the Fuhrman pathology results,the tumors were divided into grades I,II,III,and IV.Levels I and II were merged into low-level groups with a total of 39 cases,and levels III and IV were merged into high-level groups with a total of 31 cases.Observe the CT signs of the tumor,including diameter,morphology,plain scan density,presence or absence of intact pseudocapsules,enhanced arterial phase absolute enhancement values,and enhanced attenuation values during excretion,and statistical analysis with Fuhrman's pathological graded results.To explore the value of CT signs of renal clear cell carcinoma in predicting its pathological grade.Results The mean diameters of the tumors in the low-grade and high-grade groups were(5.03±1.27)cm and(6.92±1.56)cm,respectively.There were 29 cases and 31 cases of non-uniform density tumors,and there were 34 cases and 13 cases of complete tumors.The absolute enhancement values of enhanced scans were(74.73±23.14)HU and(35.19±8.65)HU,respectively.The enhanced attenuation values were (56.89±16.84)HU and(20.69±15.95)HU,respectively,and the differences were statistically significant(P<0.05).There were 11 cases and 18 cases of irregular tumors in the low-grade group and high-grade group,respectively,and the difference was not statistically significant(P>0.05).Conclusion The CT signs of clear cell renal cell carcinoma of the kidney,the evenness of the plain scan density,the presence or absence of intact capsules,the degree of absolute enhancement of enhanced scans,and the degree of enhanced attenuation contribute to the preoperative evaluation of the Fuhrman pathological grade of renal clear cell carcinoma.