摘要
目的:探讨体素内不相干运动扩散加权成像(IVIM-DWI)在评估透明细胞肾细胞癌(CCRCC)病理分级中的价值,分析其相关参数与微血管密度(MVD)的相关性。方法:对经病理证实的82例CCRCC患者(Ⅰ级14例,Ⅱ级47例,Ⅲ级15例,Ⅳ级6例)行IVIM-DWI检查,Ⅰ级+Ⅱ级归为低级别组(n=61),Ⅲ+Ⅳ级归为高级别组(n=21)。IVIM-DWI检查设定9个b值(0、20、50、100、200、400、600、800、1000 s/mm^(2))。通过DWI双指数模型获得不同病理分级CCRCC的单纯组织扩散系数(D)、假性扩散系数(D*)和灌注分数(f)值。采用CD34免疫组化进行MVD值的测量。采用Mann-Whitney U检验比较高、低级别肿瘤IVIM-DWI参数的差异,采用ROC曲线分析各参数值的诊断效能并确定诊断阈值。低级别和高级别CCRCC的IVIM-DWI各参数、MVD值及病理分级之间的相关性通过Spearman等级相关进行分析。结果:高、低级别CCRCC的D*值分别为(51.1±7.6)、(944.3±9.5)mm^(2)/s(P=0.007),D值分别为(1.2±0.3)、(1.3±0.3)mm^(2)/s(P=0.015),MVD值分别为(81.5±8.8)、(67.5±12.8),差异均有统计学意义(P<0.05)。D*、D及MVD值均与病理分级相关,D*值与病理分级呈正相关(r=0.346,P<0.05),D值呈负相关(r=-0.315,P<0.05),MVD值呈正相关性(r=0.617,P>0.05)。D、D*值对于鉴别高、低级别CCRC的ROC曲线下面积均为0.7。D、D*值的诊断阈值分别为1.2 mm^(2)/s、44.4 mm^(2)/s,敏感度分别为70.0%、60.7%,特异度分别为70%、90%。D*及D值均与MVD存在相关性,MVD与D*值呈正相关(r=0.585,P<0.05),与D值呈负相关(r=-0.337,P<0.05)。结论:IVIM-DWI可提供CCRCC病理分级的相关信息,可用于微血管密度的无创评估。
Objective:To investigate the value of intravoxel incoherent motion-diffusion weighted imaging(IVIM-DWI)in evaluating the pathological grading of clear cell renal cell carcinoma(CCRCC),and the correlation between its parameters and microvessel density(MVD).Methods:A total of 82 patients who underwent IVIM-DWI examination with surgical pathology-proven CCRCC were included(14 cases of gradeⅠ,47 cases of gradeⅡ,15 cases of gradeⅢ,and 6 cases of gradeⅣ).GradeⅠandⅡwere classified as low-grade group(n=61),and gradeⅢandⅣwere classified as high-grade group(n=21).IVIM-DWI was performed with 9 b-values(0,20,50,100,200,400,600,800 and 1000s/mm^(2)).True diffusivity(D),pseudo-diffusion coefficient(D*)and perfusion fraction(f)of CCRCC with different pathological grades were calculated by the bi-exponential DWI.MVD was measured by CD34 immunohistochemistry staining.Mann-Whitney U test was used to compare the difference of IVIM-DWI parameters between high-grade group and low-grade group.Spearman rank correlation was used to assess the correlation between IVIM-DWI parameters,MVD and pathological grading of low-grade and high-grade CCRCC.The diagnostic efficacy of each parameter and the diagnostic threshold were analyzed using receiver operating characteristic(ROC)curve.Results:The D*values,D values and MVD values of high-and low-grade CCRCC were significant difference(51.1±7.6 vs 944.3±9.5,P=0.007),(1.2±0.3 vs 1.3±0.3,P=0.015),and(81.5±8.8 vs 67.5±12.8),respectively(P<0.05).D*,D and MVD had correlation with pathological grade of CCRCC.D*value was positively correlated with pathological grading(r=0.346,P<0.05),D value was negatively correlated(r=-0.315,P<0.05)and MVD was positively correlated(r=0.617,P>0.05).Both D*and D had correlation with MVD.MVD was positively correlated with D*value(r=0.585,P<0.05),but negatively correlated with D value(r=-0.337,P<0.05).The areas under the ROC curve of D and D*for identifying high-and low-grade were both 0.7.When the diagnostic thresholds of D and D*were 1.2 mm^(2)/s and 44.4mm^(2)/s,respectively,the sensitivity was 70.0%and 60.7%,respectively,and the specificity was 70%and 90%,respectively.Conclusions:IVIM-DWI can provide relevant information of pathological grade of CCRCC,and can be used for noninvasive assessment of MVD.
作者
康钦钦
边云
田冰
李晶
刘芳
郝强
陆建平
KANG Qin-qin;BIAN Yun;TIAN Bing(Department of Radiology,Changhai Hospital,the Navy Military Medical University,Shanghai 200433,China)
出处
《放射学实践》
CSCD
北大核心
2022年第2期202-208,共7页
Radiologic Practice
关键词
体素内不相干运动
扩散加权成像
微血管密度
透明细胞肾细胞癌
肾肿瘤
病理分级
磁共振成像
Intravoxel incoherent motion
Diffusion weighted imaging
Microvessel density
Clear cell renal cell carcinoma
Kidney tumor
Pathological grade
Magnetic resonance imaging
