摘要
目的探讨多层螺旋CT(MSCT)征象及强化参数预测T1期肾透明细胞癌(ccRCC)的Fuhrman组织病理学分级。方法回顾性分析2014年1月至2021年3月于江苏大学附属昆山医院经术后组织病理学检查确诊为T1期ccRCC的66例患者的临床资料和影像学资料,其中男性40例、女性26例,年龄(58.3±14.9)岁。所有患者依据Fuhrman组织病理学分级,分为低级别组(Ⅰ~Ⅱ级)和高级别组(Ⅲ~Ⅳ级),分析2组患者的MSCT平扫和增强图像,比较2组患者的MSCT征象及其强化参数的差异,分析观察指标的预测效能。符合正态分布的计量资料的组间比较采用t检验;计数资料的组间比较采用卡方检验或Fisher确切概率法;采用Kappa检验比较2名医师测量结果的一致性;以Fuhrman组织病理学分级为"金标准",绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC);采用二元多因素Logistic回归分析评估影响ccRCC Fuhrman组织病理学分级的独立危险因素。结果 2组患者的MSCT表现在肿瘤形态、内部结构(囊变、坏死)、分叶征、假包膜、包膜侵犯、肿瘤强化均匀度的差异均有统计学意义(Fisher确切概率法,χ^(2)=8.800、7.830,均P<0.05)。低级别组患者皮髓质期病灶的CT值、CT差值、增强比值、增强指数均高于高级别组[(169.03±36.50)HUvs.(132.90±16.28)HU、(133.92±37.31)HUvs.(95.40±19.84)HU、4.09±1.61vs.2.79±1.09、1.45±1.13vs.0.91±0.81],且差异均有统计学意义(t=2.180~5.082,均P<0.05),4项指标的AUC分别为0.849(95%CI:0.744~0.953,P<0.001)、0.848(95%CI:0.748~0.948,P<0.001)、0.741(95%CI:0.621~0.861,P< 0.001)、0.757(95%CI:0.637~0.878,P<0.001),最佳临界值分别为152.5 HU、120.5 HU、3.356、0.953,约登指数分别为0.739、0.655、0.439、0.478。多因素Logistic回归分析结果表明,假包膜是Fuhrman组织病理学分级的独立预测因素(OR=0.082,95%CI:0.007~0.908,P<0.05)。结论 ccRCC患者平扫和增强MSCT图像的表现多样,结合皮髓质期肿瘤病灶CT值、CT差值、增强比值和增强指数,有助于预测Fuhrman组织病理学分级。其中,假包膜可以作为独立预测因素。
Objective To investigate the prediction of Fuhrman histopathological grade of T1 clear cell renal cell carcinoma(ccRCC)by multi-slice computed tomography(MSCT)signs and enhancement parameters.Methods The clinical and imaging data of 66 patients with T1 stage ccRCC diagnosed by postoperative histopathology in Kunshan Hospital Affiliated to Jiangsu University from January 2014 to March 2021,including 40 males and 26 females,aged(58.3±14.9)years,were analyzed retrospectively.All patients were divided into low-(Ⅰ-Ⅱ)and high-grade group(Ⅲ-Ⅳ)in accordance with the Fuhrman histopathological classification.The plain and enhanced images of MSCT of the patients in the two groups were analyzed,and the differences in MSCT signs and enhancement parameters between the two groups were compared.The predictive effectiveness of the observation indicators was analyzed.T-test was used to compare the measurement data with normal distribution;Chi square test or Fisher's exact test was used to compare the counting data between groups;Kappa test was used to compare the consistency of measurement results between two physicians.The"gold standard"was Fuhrman histopathological grading.The receiver operating characteristic curve was drawn,and area under curve(AUC)was calculated.Independent risk factors were evaluated by binary Logistic regression analysis.Results The MSCT findings of the two groups were statistically significant in terms of tumor morphology,internal structure(cystic degeneration and necrosis),lobulation sign,pseudocapsule,capsule invasion,and tumor enhancement homogeneity(Fisher's exact test,χ^(2)=8.800,7.830;all P<0.05).The CT value,CT difference,enhancement ratio,and enhancement index of tumor focus in the low-grade group were higher than those in the high-grade group((169.03±36.50)HU vs.(132.90±16.28)HU,(133.92±37.31)HU vs.(95.40±19.84)HU,4.09±1.61 vs.2.79±1.09,1.45±1.13 vs.0.91±0.81,respectively),and the difference was statistically significant(t=2.180-5.082,all P<0.05).The AUC of the four MSCT enhancements parameters were 0.849(95%CI:0.744–0.953,P<0.001),0.848(95%CI:0.748-0.948,P<0.001),0.741(95%CI:0.621–0.861,P<0.001),and 0.757(95%CI:0.637-0.878,P<0.001),the optimal critical values were 152.5 HU,120.5 HU,3.356,and 0.953,respectively.The Yoden indexes were 0.739,0.655,0.439 and 0.478.Multivariate Logistic regression analysis results show that pseudocapsule was an independent predictor of Fuhrman histopathological grading(OR=0.082,95%CI:0.007-0.908,P<0.05).Conclusions The manifestations of plain and enhanced MSCT images of ccRCC are diverse.Combined with the CT value,CT difference,enhancement ratio,and enhancement index of tumor lesions in the corticomedullary phase are helpful in the prediction of Fuhrman histopathological grading.Pseudocapsules can be used as an independent predictor.
作者
陈薏帆
朱俊辉
朱玉春
周伟
Chen Yifan;Zhu Junhui;Zhu Yuchun;Zhou Wei(Department of Nuclear Medicine,Kunshan Hospital Affiliated to Jiangsu University,Kunshan 215300,China;Medical College of Jiangsu University,Zhenjiang 212013,China)
出处
《国际放射医学核医学杂志》
2023年第1期18-25,共8页
International Journal of Radiation Medicine and Nuclear Medicine
基金
江苏大学临床医学科技发展基金(JLY2021050)
昆山市重点专科培育项目(昆卫〔2020〕3号)。
