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体素内不相干运动扩散加权I成像对肾癌分型的诊断价值

  • 摘要: 目的:探讨体素内不相干运动扩散加权成像(IVIM-DWI)对肾癌组织分型的应用价值,评价灌注相关参数(D*和f)与病灶强化百分率及微血管密度的相关性。方法:回顾分析2013年5月至2015年3月经病理证实的52例(57个病灶)肾癌患者资料,所有患者术前均经常规磁共振和IVIM-DWI检查,其中34例(36个病灶)肾癌术后经免疫组化CD34染色评估微血管密度。采用单因素方差分析、Pearson相关分析和ROC曲线进行统计分析。结果:透明细胞肾癌的ADC值和D值高于乳头状肾癌和嫌色细胞肾癌(P<0.01),乳头状肾癌和嫌色细胞肾癌的ADC值和D值差异无统计学意义(P=0.536);透明细胞肾癌和嫌色细胞肾癌的D*值差异无统计学意义;3种肾癌亚型间f值差异均有统计学意义(P<0.05)。ADC、D、D*和f值鉴别透明和非透明细胞肾癌的ROC曲线下面积分别为0.84、0.85、0.65和0.80。D*值和f值与皮髓质期和肾实质期病灶强化百分率正相关(r值分别为0.45,0.30;0.56,0.55);D*值和f值均与肾癌的MVD值正相关(r值分别为0.362和0.501)。结论:IVIM-DWI有助于肾癌亚型的鉴别诊断,灌注相关参数D*和f与病灶强化百分率及微血管密度具有一定的相关性。

     

    Abstract: Objective:To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) in the classification of renal cell carcinoma (RCC), and to evaluate the correlation between the perfusionrelated parameters (D* and f) and the percentage of enhanced lesion and microvascular density (MVD). Methods:The data of 57 pathologically confirmed cases of renal cell carcinoma (RCC) in 52 patients between May 2013 and March 2015 were retrospectively analyzed. All patients underwent conventional MRI and IVIM-DWI scanning. 36 cases of RCC in 34 patients underwent immunohistochemistry CD34 staining to evaluate MVD. Oneway ANOVA, Pearson correlation analysis and receiver operating characteristic (ROC) curve were used for statistical analysis. Results:The ADC and D values of clear cell renal cell carcinoma (ccRCC) were higher than those of papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC, P<0.01), but there was no significant statistical difference between the ADC and D values of pRCC and chRCC〖BP(〗 (P=0.536). There was no significant statistical difference between the D* values of ccRCC and chRCC〖BP(〗 (P>0.05)〖BP)〗. The f values of 3 subtypes of RCC were statistically different (all P<0.05). The areas under the ROC curve (AUC) of ADC, D, D* and f values in the differentiation between ccRCC and nonccRCC were 0.84, 0.85, 0.65, and 0.80 respectively. The D* and f values were positively correlated with the percentage of enhanced lesions in corticomedullary phase and parenchymal phase (r=0.45, 0.30; 0.56, 0.55, respectively). The D* and f values were both positively correlated with the MVD value of renal cell carcinoma (r=0.362 and 0.501 respectively). Conclusions:IVIM-DWI is valuable in helping to differentiate among RCC subtypes. Perfusionrelated parameters D* and f have certain correlation with the percentage of lesion enhancement and MVD.

     

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