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中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 47 -52. doi: 10.3877/cma.j.issn.1674-3253.2018.01.013

所属专题： 专题评论； 文献；

临床研究

磁共振弥散加权成像信号强度评价透明细胞肾癌组织分化程度的价值
彭令荣1, 孔庆聪1, 刘卫敏1, 陈健宁2, 邹艳1, 江婷1,†()   
  1. 1. 510630　广州，中山大学附属第三医院放射科
    2. 510630　广州，中山大学附属第三医院病理科
  • 收稿日期:2017-06-10 出版日期:2018-02-01
  • 通信作者: 江婷
  • 基金资助:
    广东省科技计划重大专项课题(2014B02022500)

Value of diffusion weighted imaging signal intensity in exploring histopathological differentiation of clear cell renal cell carcinoma

Lingrong Peng1, Qingcong Kong1, Weimin Liu1, Jianning Chen2, Yan Zou1, Ting Jiang1,†()   

  1. 1. Department of Radiology, the Third Affiliated Hospital of SUN Yat-sen University, Guangzhou 510630, China
    2. Department of Padiology, the Third Affiliated Hospital of SUN Yat-sen University, Guangzhou 510630, China
  • Received:2017-06-10 Published:2018-02-01
  • Corresponding author: Ting Jiang
  • About author:
    Corresponding author: Jiang Ting, Email:
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引用本文：

彭令荣, 孔庆聪, 刘卫敏, 陈健宁, 邹艳, 江婷. 磁共振弥散加权成像信号强度评价透明细胞肾癌组织分化程度的价值[J]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(01): 47-52.

Lingrong Peng, Qingcong Kong, Weimin Liu, Jianning Chen, Yan Zou, Ting Jiang. Value of diffusion weighted imaging signal intensity in exploring histopathological differentiation of clear cell renal cell carcinoma[J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(01): 47-52.

目的

分析磁共振弥散加权成像（DWI）目测信号强度、量化信号强度（SI）值与透明细胞肾癌（CCRCC）的组织分化程度的关系，探讨DWI信号强度评价CCRCC的组织分化程度的价值。

方法

回顾性收集经病理证实的CCRCC患者91例，并根据Fuhrman病理分级Ⅰ～Ⅳ级标准，分为高分化组（Ⅰ级和Ⅱ级，37例）、中分化组（Ⅲ级，32例）、低分化组（Ⅳ级，22例），所有患者均行中腹部MR平扫、增强和DWI检查（1.5 T，b=800 sec/mm2)，分别目测CCRCC的DWI信号强度、测量SI值，采用Kruskal-Wallis秩和检验比较CCRCC的DWI目测信号强度与组织分化程度差异；采用单因素方差比较CCRCC的SI值与组织分化程度的差异；采用Spearman等级相关检验分析CCRCC的组织分化程度与目测信号强度、SI值的相关性；并采用受试者工作特征ROC曲线评价CCRCC的SI值诊断高分化CCRCC、低分化CCRCC的效能。

结果

91例CCRCC的DWI目测信号强度中，43.9%呈明显高信号，30.8%呈中等高信号，25.3%呈等/略高信号。明显高信号组与等/略高信号组的CCRCC的组织分化程度差异有统计学意义（P<0.05）。中等高信号组与等/略高信号组、中等高信号组与明显高信号组的CCRCC组织分化程度差异均无统计学意义（P>0.05）。CCRCC的DWI目测信号强度与组织分化程度呈中等的负相关（rs=-0.552，P<0.05）。高分化CCRCC的SI值明显低于中、低分化CCRCC，中分化CCRCC的SI亦低于低分化CCRCC（P<0.05）。CCRCC的SI值与组织分化程度呈显著的负相关（r=-0.711，P<0.05）。受试者工作特征ROC曲线分析显示DWI的SI值诊断高分化CCRCC的最佳临界点值为273.7，相应的敏感度与特异度分别67.6%、98.2%；诊断低分化CCRCC的最佳临界点值为378.9，相应的敏感度与特异度分别91.3%、59.1%。

结论

随DWI目测信号强度、SI值升高，CCRCC的组织分化程度降低。DWI目测信号强度及SI值预测CCRCC组织分化程度有一定的临床价值。

关键词: 磁共振, 弥散, 透明细胞肾癌, 信号强度, 分化
Objective

To evaluate the relationship between diffusion weighted imaging visual signal intensity and quantitative signal intensity of cell renal cell carcinoma (CCRCC) and histopathological differentiation of CCRCC.

Methods

This retrospective analysis included 91 patients with CCRCC confirmed by pathology. All patients were grouped according to the Fuhrman pathological grading system, from Ⅰto Ⅵ. Four grades were merged into three classifications consisting of 37 well-differentiated CCRCCs (Ⅰ and Ⅱ), 32 moderately-differentiated CCRCCs (Ⅲ) and 22 poorly-differentiated CCRCCs (Ⅳ). Magnetic resonance examinations of MR plain scan, LALA dynamic enhanced scan and DWI (1.5T, b value: 800 sec/mm2) were performed. The each visually signal intensity of CCRCC was evaluated and quantitative signal intensity of CCRCC was measured. The Kruskal-Wallis test was used to compare DWI visual signal intensity between the three different histopathological groups. ANOVA was used to compare SI values between the three different histopathological groups. Spearman correlation analysis was used to analyze the correlation between histopathological differentiation of CCRCC and DWI visual signal intensity and SI values. ROC analysis was performed to evaluate the diagnostic efficiency of SI values.

Results

43.9% of CCRCC appeared as obviously hyperintense, 30.8% of CCRCC appeared as moderate hyperintense, and 25.3% of CCRCC appeared as isointense/slight hyperintense to the surrounding renal parenchyma. There was a significant difference between obviously hyperintense and isointense/slight hyperintense in histopathological differentiation (P<0.05). There was no significant difference between isointense/slight hyperintense and moderate hyperintense, and between moderate hyperintense and obviously hyperintense in histopathological differentiation (P>0.05).There was a moderate negative correlation between visually signal intensity and histopathological differentiation of CCRCC (rs=-0.552; P<0.01). There was a significant difference in DWI signal intensity value among well- differentiated、moderately-differentiated and poorly-differentiated CCRCC (P<0.05). The SI value of moderately differentiated CCRCC was lower than that of poorly-differentiated CCRCC and there was significant difference between the SI value of moderately-differentiated and poorly-differentiated CCRCC. There was a significant negative correlation between SI value and histopathological differentiation of CCRCC (r=-0.711; P<0.01). The ROC curve showed the optimal cutoff point of SI value was 273.7 in diagnosing well-differentiated CCRCC. Taking 273.7 as the threshold value, sensitivity and specificity of differential diagnosis was 67.6% and 98.2%, respectively. The ROC curve showed the optimal cutoff point of SI value was 378.9 in diagnosing poorly-differentiated CCRCC. Taking 378.9 as the threshold value, sensitivity and specificity of differential diagnosis was 91.3% and 59.1%, respectively.

Conclusion

CCRCC tended to show a higher visual signal intensity and quantitative signal intensity on DWI with decreasing histopathologicaldifferentiation (P<0.05). DWI had some practical value in predicting histopathogical differentiation of CCRCC using signal intensity and quantitative signal intensity.

Key words: Magnetic resonance imaging, Diffusion magnetic resonance imaging, Clear cell renal cell carcinoma, Signal intensity, Histopathological
图3 低分化透明细胞肾癌的MR表现（Ⅳ级）
表1 CCRCC的组织分化程度与DWI的目测信号强度的关系
组别 DWI的目测信号强度（例） 合计
明显高信号 中等高信号 等/略高信号
高分化组 4 15 18 37
中分化组 20 9 3 32
低分化组 16 4 2 22
合计 40 28 23 91
χ2值 30.770
P值 <0.001
表2 CCRCC的组织分化程度与SI值测量结果关系（±s）
组别 例数 SI值
? 95%可信区间
高分化组 37 248±57 229～267
中分化组 32 344±48 327～361
低分化组 22 387±69 356～417
F值 ? 47.46
P值 ? <0.001
图4 高分化CCRCC中SI值的ROC曲线下面积
图5 低分化CCRCC中SI值的ROC曲线下面积
表3 SI值诊断CCRCC的组织分化程度的效能
组别 SI
临界点值 敏感度（%） 特异度（%） AUC
高分化组 273.7 67.6 98.2 0.912
低分化组 378.9 91.3 59.1 0.825
[1]
Chen J, Djing JL, Wu CP, et al. Preoperatively evaluating the correlation between pathological grades and oxygenation level-dependent MRI in clear renal cell carcinoma[J]. Acad Radiol, 2013, 20(2): 224-230.
[2]
Fukatsu A, Tsuzuki T, Sassa N, et al. Growth pattern, an important pathologic parameter for clear cell renal cell carcinoma[J]. Am J ClinPathol, 2013, 140(4): 500-505.
[3]
Steffens S, Roos RC, Janssen M, et al. Clinical behavior of chromophobe renal cell carcinoma is less aggressive than that of clear cell renal cell carcinoma, independent of Fuhrman grade or tumor size[J]. VirchowsArchiv, 2014, 465(4): 439-444.
[4]
Hotker AM, Mazaheri Y, Wibmer A, et al. Differentiation of clear renal cell carcinoma from other renal cortical tumors by use of a quantitative multiparametric MRI approach[J]. AJR Am J Roentgenol, 2017, 208(3): W85-W91.
[5]
王春喜, 芦志华. 保留肾单位手术的热点问题探讨[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2012, 6(6): 421-423.
[6]
Teng J, Gao Y, Chen M, et al. Prognostic value of clinical and pathological factors for surgically treated localized clear cell renal cell carcinoma[J]. Chin Med(Engl), 2014, 127(9): 1640-1644.
[7]
李茂章, 廖锦先, 周晓波, 等. 后腹腔镜下与开放性肾癌根治术治疗局限性肾癌的比较[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2014, 8(3): 175-177．
[8]
Goyal A, Sharma R, Bhalla, et al. Diffusion-weighted MRI in renal cell carcinoma: a surrogate marker for predicting nuclear grade and histological subtype[J]. ActaRadiol, 2012, 53(3): 349-358.
[9]
Vargas HA, Delaney HG, Delappe EM, et al. Multiphasic contrast-enhanced MRI: single-slice versus volumetric quantification of tumor enhancement for the assessment of renal clear cell carcinoma Fuhrman grade[J]. J Magn Reson Imaging, 2013, 37(5): 1160-1167.
Zhang H, Gan Q, Wu Y, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in differentiating human renal lesion (benignity or malignance): a meta-analysis[J]. AbdomRadiol, 2016, 41(10): 1997-2010.
[10]
丛欣莹, 陈雁, 张瑾, 等. 体素内不相干运动扩散加权成像在肾细胞癌诊断中的应用[J]. 中华肿瘤杂志, 2016, 38(6): 434-439.
[11]
王超, 王龙胜, 郑穗生, 等. 肾透明细胞癌Fuhrman核分级与CT征象的关系[J]. 中国医学影像技术, 2015, 31(9): 1292-1296.
[12]
Choi YA, Kim CK, Park SY, et al. Subtype differentiation of renal cell carcinoma using diffusion-weighted and blood oxygenation level-dependent MRI[J]. AJR Am J Roentqenol, 2014, 203(1): 78-84.
[13]
Lassel EA, Rao R, Schwenk C, et al. Diffusion-weighted imaging focal renal lesion: a meta-analysis[J]. EurRadiol, 2014, 24(1): 241-249.
[14]
Chandarana H, Rosenkrantz AB, Mussi TC, et al. Histogram analysis of whole-lesion enhancement in differentiating clear cell from papillary subtype of renal cell cancer[J]. Radiology, 2012, 265(3): 790-798.
[15]
丁玖乐, 邢伟, 陈杰, 等. 信噪比在肾透明细胞癌多b值DWI分析中的重要研究[J]. 中华医学杂志, 2014, 94(3): 171-173.
[16]
Shen L, Zhou L, Liu X, et al. Comparison of biexponential and monoexponential DWI in evaluation of Fuhrman grading of clear cell renal carcinoma[J]. Diagn Interv Radiol, 2017, 23(2): 100-105.
[17]
Mirka H, Korcakova E, Kastner J, et al. Diffusion-weighted imaging using 3.0T MRI as a possible biomarker of renal tumor[J]. Anticancer Res, 2015, 35(4): 2351-2357.
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