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| 磁敏感加权成像与灌注加权成像在肾透明细胞癌分级诊断中的应用 |
| 马亮1,许晓雯1,王金红1,张敏1,张纬1,倪炯1,朱旭友2,易祥华2,王培军1* |
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(1. 同济大学附属同济医院医学影像科, 上海 200065;
2. 同济大学附属同济医院病理科, 上海 200065
*通信作者) |
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| 摘要: |
| 目的 明确磁敏感加权成像(SWI)肿瘤内磁敏感信号(ITSS)与灌注加权成像(PWI)转运常数(Ktrans)之间是否存在相关性,以及两者在肾透明细胞癌(ccRCC)分级诊断中的应用价值。方法 选取36例经手术病理证实为ccRCC并进行病理Fuhrman核分级(Ⅰ~Ⅳ)评估的患者,行2D多次屏气SWI和肾脏PWI扫描。评估测量ITSS等级与Ktrans的平均值,对Fuhrman Ⅰ、Ⅱ、Ⅲ3组间分别进行Kruskal-Wallis检验和方差分析,并分析ITSS等级和Ktrans平均值之间的相关性;同时应用受试者工作特征(ROC)曲线分析其分级诊断效能。结果 Fuhrman分级Ⅰ级8例、Ⅱ级16例、Ⅲ级12例,对应的ITSS等级分别为1.25±0.43、1.75±0.83和2.20±0.75,Ktrans值分别为(0.24±0.07)、(0.31±0.08)和(0.34±0.07) min-1,不同Fuhrman分级间ITSS等级和Ktrans值差异均有统计学意义(χ2=6.089,P<0.05;F=4.116,P<0.05)。ITSS与Ktrans总体呈中度正相关(r=0.536,P<0.01)。以ITSS和Ktrans的ROC曲线鉴别高、低级别(Fuhrman Ⅲ vsⅠ~Ⅱ) ccRCC的曲线下面积(AUC)、敏感性和特异性相对较高,分别为0.737、80.0%、37.5%和0.737、90.0%、68.8%。结论 ITSS和Ktrans可以为ccRCC术前分级诊断提供更加丰富的信息,从而有助于手术方案的制定及预后的判断。 |
| 关键词: 肾肿瘤 透明细胞癌 磁敏感加权成像 肿瘤内磁敏感信号 灌注加权成像 转运常数 病理分级 |
| DOI：10.16781/j.0258-879x.2016.02.0153 |
| 投稿时间：2015-04-26修订日期：2015-07-11 |
| 基金项目: |
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| Application of susceptibility weighted and perfusion weighted imaging techniques in diagnosis and grading of clear cell renal cell carcinomas |
| MA Liang1,XU Xiao-wen1,WANG Jin-hong1,ZHANG Min1,ZHANG Wei1,NI Jiong1,ZHU Xu-you2,YI Xiang-hua2,WANG Pei-jun1* |
(1. Department of Radiology, Tongji Hospital, Tongji University, Shanghai 200065, China;
2. Department of Pathology, Tongji Hospital, Tongji University, Shanghai 200065, China
*Corresponding author) |
| Abstract: |
| Objective To investigate whether the degree of intratumoral susceptibility signal intensity (ITSS) of susceptibility weighted imaging (SWI) correlates with the transfer constant (Ktrans) of perfusion weighted imaging (PWI), and to assess their values in diagnosis and grading of clear cell renal cell carcinoma(ccRCC). Methods Thirty-six patients with pathologically confirmed ccRCC and Fuhrman grades (Ⅰ-Ⅳ) underwent both 2D multi-breath-hold SWI and renal PWI examination. The degree of ITSS and the mean value of Ktrans were evaluated. Kruskal-Wallis test and one-way analysis of variance (ANOVA) were applied to compare the differences among the three groups (Fuhrman Ⅰ,Ⅱand Ⅲ). Spearman correlation coefficient was used to determine the correlation between degree of ITSS and mean value of Ktrans. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy. Results The degrees of ITSS of Fuhrman grade Ⅰ (8 patients), grade Ⅱ(16 patients) and grade Ⅲ(12 patients) were (1.25±0.43), (1.75±0.83) and (2.20±0.75), with the Ktrans values being (0.24±0.07)min-1, (0.31±0.08)min-1 and (0.34±0.07)min-1 , respectively; statistical significances were found for both degrees of ITSS and Ktrans values among the three Fuhrman groups (χ2=6.089, P<0.05; F=4.116, P<0.05). A positive correlation was found between the degree of ITSS and value of Ktrans (r=0.536, P<0.01). ITSS and value of KtransROC curve analysis was used to distinguish Fuhrman Ⅲ vs Ⅰ-Ⅱ ccRCC, the optimal area under curves (AUCs), sensitivity and specificity were 0.737, 80.0%, 37.5% and 0.737, 90.0%, 68.8%, respectively. Conclusion Both the degree of ITSS and mean value of Ktrans can provide more pre-operative information of ccRCC, helping to make surgical plans and to predict the prognosis. |
| Key words: kidney neoplasms clear cell carcinoma susceptibility weighted imaging intratumoral susceptibility signal intensity perfusion weighted imaging transfer constant pathological grading |
