T1期肾透明细胞癌的ADC值、rADC值与Fuhrman病理分级的相关性

目的 探讨T1期肾透明细胞肾癌(CCRCC)3.0T MR的表观扩散系数(ADC)值、相对表观扩散系数(rADC)值与Fuhrman病理分级之间的相关性.方法 回顾性分析2009-2017年徐州医科大学附属医院经手术病理确诊的86例T1期肾透明细胞癌患者的3.0T MR ADC值及Fuhrman病理分级资料,依据Fuhrman核分级法,将其分为低级别组(Ⅰ～Ⅱ级)和高级别组(Ⅲ～Ⅳ级),分别测量病灶及对侧正常肾实质的ADC值,并计算rADC值.比较4个不同病理级别、高低病理级别组间的ADC值、rADC值;并绘制ROC曲线,评价ADC值和rADC值的诊断效能;分析病灶ADC值、rADC值与病理分级的相关性.结果 (1)四个病理分级之间平均ADC值和rADC值差异均有统计学意义(P<0.05);(2)高、低级别组平均ADC值分别为(1.317±0.110)×10-3 mm2/s,(1.886±0.447)×10-3 mm2/s,差异有统计学意义(P<0.05),ROC曲线下面积为0.861,最佳诊断阈值为1.465×10-3 mm2/s,敏感性和特异性为74.4％、95.3％.高、低级别组平均rADC值分别为(0.419±0.085)、(0.643±0.109),差异有统计学意义(P<0.05),ROC曲线下面积为0.954,最佳诊断阈值为0.535,敏感性和特异性为86.0％、95.3％.肿瘤的ADC值、rADC值与病理分级之间呈高度负相关(r=-0.821、-0.864,P<0.05).结论 T1期肾透明细胞肾癌的ADC值、rADC值与病理分级高度相关,能够预估肿瘤的恶性程度,且rADC值的评估价值大于ADC值,可为临床制定手术方案及判断预后提供有效参考.

Correlation between ADC,rADC and Fuhrman pathological grades in pTl clear cell renal cell carcinoma

Objective To investigate the correlation of apparent diffusion coefficient (ADC), relative ADC (rADC) on 3.0T Magnetic Resonance (MR) with Fuhrman pathological grades in pT1 clear cell renal cell carcinoma (CCRCC). Methods Conventional MR images, ADC values on 3.0T MR and Fuhrman pathological grading in 86 pa-tients of pT1 CCRCC from 2009 to 2017 were retrospectively analyzed. According to Fuhrman grading system, GradeⅠandⅡwere defined as low-grade group, and gradeⅢandⅣwere defined as high-grade group. The ADC values of lesions and contralateral normal renal parenchyma were measured, and then the rADC values were calculated. The val-ues of ADC and rADC were compared among four different pathological grades, and between low-grade group and high-grade group. ROC curve was performed to evaluate the diagnostic efficacy of ADC values and rADC values. The correlation between pathological grades and ADC values, rADC values was analyzed. Results (1) There were signifi-cant differences in ADC values, rADC values among the four pathological grades (P<0.05). (2) The ADC values, rADC values were (1.317 ± 0.110) × 10-3 mm2/s, (0.419 ± 0.085) in the high-grade group, as compared with (1.886 ± 0.447) × 10-3 mm2/s, (0.643 ± 0.109) in low-grade group (P<0.05). Area under ROC, best diagnostic threshold, sensitivity, specificity were 0.861, 1.465×10-3 mm2/s, 74.4％, 95.3％for ADC values, and 0.954, 0.535, 86.0％, 95.3％for rADC val-ues, respectively. There was a negative correlation between pathological grades and ADC values, rADC values (r=-0.821,-0.864,P<0.05). Conclusion The ADC values, rADC values of pT1 CCRCC have close correlation with pathological grades. They can be used to predict the degree of tumor malignancy preoperatively, and the evaluation value of rADC values is greater than ADC values, which can provide reference for clinical operation and prognosis.