多b值DWI在肾透明细胞癌Fuhrman核级诊断中的应用研究

doi:10.3969/j.issn.1007-3969.2015.03.008

中国癌症杂志 ›› 2015, Vol. 25 ›› Issue (3): 205-210.doi: 10.3969/j.issn.1007-3969.2015.03.008

多b值DWI在肾透明细胞癌Fuhrman核级诊断中的应用研究

沈丽娟^1,2，周良平²，彭卫军²，杨晓群³，岳磊²

1. 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，上海 200240 ；
2. 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，上海 200032 ；
3. 复旦大学附属肿瘤医院病理科，复旦大学上海医学院肿瘤学系，上海 200032

出版日期:2015-03-30 发布日期:2015-05-18
通信作者: 周良平　E-mail:zhoulp2003@aliyun.com

Application of DWI with various b values in diagnosis of clear cell renal cell carcinoma Fuhrman grades

SHEN Lijuan^1,2, ZHOU Liangping², PENG Weijun², YANG Xiaoqun³, YUE Lei²

1.Department of Radiology, the Fifth People’s Hospital of Shanghai, Fudan University, Department of Gynecology and Obstetrics, Shanghai Medical College, Fudan University, Shanghai 200240, China; 2.Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3.Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Published:2015-03-30 Online:2015-05-18
Contact: ZHOU Liangping E-mail: zhoulp2003@aliyun.com

摘要/Abstract

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_{0-600-1 200}、ADC_{0-400-800-1 200}及ADC_total)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_{0-400-800-1 200}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(P<0.05)。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_{0-400-800-1 200}最大，但是各AUC差异无统计学意义(P＞0.05)。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_{0-600-1 200}、ADC_{0-400-800-1 200}、ADC_total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。

关键词: 肾细胞癌, Fuhrman核级, 磁共振成像, 弥散加权成像, 鉴别诊断

Abstract: Background and purpose: Renal cell carcinoma is the most common type of adult renal cancer, and the Fuhrman grading system is the most widely accepted independent indicator for the prognosis of kidney tumors. This study aimed to explore the correlation between the conventional diffusion weighted imaging (DWI) with various b values and Fuhrman grade of clear cell renal cancer, and assess the diagnostic efficiency of ADC values at different b values in differentiating Fuhrman low- and high-grade tumor. Methods: Thirty-three patients with pathologically proved clear cell renal cell cancer (CCRCC) and qualified images were included for the research. The diagnostic effi-ciency of ADC values at different b values for differentiating Fuhrman low- (1 and 2) and high-grade (3 and 4) tumor were also assessed and compared by receiver operator characteristic curve (ROC), and the optimum sensitivity, specificity and accuracy were selected using Youden index. Results: The 33 patients consist one tumor of Fuhrman grade 1, 14 of grade 2, 16 of grade 3 and 2 of grade 4. A negative correlation was found between the ADC_0-800, ADC_0-400-800, ADC_{0-600-1 200}, ADC_{0-400-800-1 200} and ADC_total with Fuhrman grade (r: -0.553, -0.511, -0.603, -0.645, -0.610, respectively), among these the ADC_{0-400-800-1200} showed the strongest correlation. The AUCs ［area under the (receiver operator characteristic curve) ROC curve］ of those parameters for differentiating the low- and high-grade tumor were 0.789, 0.757, 0.813, 0.844 and 0.835, among which the ADC_{0-400-800-1 200} reveal the best result, but the difference was not statistically significant (P>0.05). The sensitivity of the ADC values were 86.7%, 73.3%, 60.0%, 86.7% and 86.7%; The specificity were 66.7%, 77.8, 72.2%, 77.8% and 72.2%. Conclusion: ADC_0-800, ADC_0-400-800, ADC_{0-600-1 200}, ADC_{0-400-800-1 200} and ADC_total revealed significant correlation with the Fuhrman grade of clear cell renal cancer, and providing high diagnostic efficiency in differentiating Fuhrman low- and high-grade tumor.

Key words: Renal cell carcinoma, Fuhrman grade, Magnetic resonance imaging, Diffusion weighted imaging, Differential diagnosis

沈丽娟,周良平,彭卫军,等. 多b值DWI在肾透明细胞癌Fuhrman核级诊断中的应用研究[J]. 中国癌症杂志, 2015, 25(3): 205-210.

SHEN Lijuan, ZHOU Liangping, PENG Weijun, et al. Application of DWI with various b values in diagnosis of clear cell renal cell carcinoma Fuhrman grades[J]. China Oncology, 2015, 25(3): 205-210.

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多b值DWI在肾透明细胞癌Fuhrman核级诊断中的应用研究

Application of DWI with various b values in diagnosis of clear cell renal cell carcinoma Fuhrman grades

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