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; 周良平; 彭卫军

doi:10.3969/j.issn.1007-3969.2015.03.008

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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

更新时间：2025-12-31

- 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
- 中国癌症杂志 2015年25卷第3期页码：205-210
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2015.03.008
  中图分类号：
- 网络出版：2015-05-18，
  
  纸质出版：2015-05-18
- 稿件说明：
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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.

沈丽娟, 周良平, 彭卫军. 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.
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. DOI： 10.3969/j.issn.1007-3969.2015.03.008.

沈丽娟, 周良平, 彭卫军. 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. DOI： 10.3969/j.issn.1007-3969.2015.03.008.

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(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

0-400-800-1 200

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。

Abstract

Background and purpose: Renal cell carcinoma is the most common type of a

dult 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 (P0.05). 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 i

n differentiating Fuhrman low- and high-grade tumor.

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