肾透明细胞癌64排多层螺旋CT直接征象与病理学分级的对比研究
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摘要
目的:探讨肾透明细胞癌(clear cell renal cell carcinoma,CCRCC)64排多层螺旋CT直接征象与病理学分级之间的相关性,并进行对比分析。方法:收集2015年2月—2018年5月期间安徽省黄山市人民医院经手术切除后病理学检查证实为CCRCC的34例患者,分析其术前64排多层螺旋CT平扫及多期增强扫描图像。CCRCC的直接征象包括肿瘤形态、大小、密度、强化方式、强化程度及是否有假包膜等,并与术后病理学分级进行对比。根据世界卫生组织(World Health Organization,WHO)/国际泌尿病理学会(International Society of Urological Pathology,ISUP)病理学分级标准,将CCRCC分为Ⅰ～Ⅳ级,其中Ⅰ～Ⅱ级定义为低级别组(n=28),Ⅲ～Ⅳ级定义为高级别组(n=6),采集相关数据,进行分析。结果:与低级别组CCRCC相比,高级别组CCRCC病灶形状更不规则(高级别组中不规则形肿块3例,占50.0%;低级别组中不规则肿块2例,占7.1%);平扫时肿瘤密度更高(高级别组中5例呈稍高密度,占83.3%;低级别组中仅3例呈稍高密度,占10.7%);增强扫描皮髓交界期肿瘤强化程度较弱[高级别组强化值与同侧正常肾皮质强化值平均差为(-16.1±12.3)HU,低级别组强化值与同侧正常肾皮质强化值平均差为(7.0±7.5)HU];实质期强化衰减程度较低[高级别组肿瘤平均强化衰减值为(-7.7±5.4)HU,低级别组肿瘤平均强化衰减值为(-17.3±7.3)HU]。两组间差异有统计学意义(P<0.05)。结论:CCRCC的64排多层螺旋CT直接征象中,肿瘤形态、平扫密度、皮髓交界期肿瘤强化程度及实质期肿瘤强化减退程度等对判断其WHO/ISUP病理学分级具有一定价值,能为术前确定CCRCC治疗方案提供帮助。
Objective: To compare the direct signs of clear cell renal cell carcinoma(CCRCC) on 64-row spiral CT with pathological grading. Methods: A total of 34 CCRCC cases confirmed by surgical pathology in Huangshan People's Hospital during Feb. 2015 and May. 2018 were selected. The plain scan and multiphase contrast-enhanced scan images of 64-row spiral CT before surgery were analyzed and compared with the pathological grading. The CT direct signs of CCRCC included tumor shape, size, density, enhancement degree, enhancement modality, and presence of false envelope, etc. In accordance with the pathological grading criteria of World Health Organization(WHO)/International Society of Urological Pathology(ISUP), CCRCC was classified into grades Ⅰ to Ⅳ, of which Ⅰ-Ⅱ was defined as low-grade(n=28), Ⅲ-Ⅳ as high-grade(n=6). The data were collected and analyzed. Results: Compared with low-grade CCRCC, high-grade CCRCC lesions had more irregular shape(3 cases with irregular shape in high-grade group, accounting for 50.0%, and 2 cases with irregular shape in low-grade group, accounting for 7.1%), higher density during plain scan(5 cases with slightly high density in high-grade group, accounting for 83.3%, and only 3 cases with slightly high density in low-grade group, accounting for 10.7%), lower enhancement degree during corticomedullary phase [the difference in enhancement degree between high-grade CCRCC and ipsilateral renal cortex was(-16.1±12.3) HU, and that between lowgrade CCRCC and ipsilateral renal cortex was(7.0±7.5) HU], and lower enhanced attenuation during parenchymal phase [the average attenuation value was(-7.7±5.4) HU in low-grade group, and(-17.3±7.3) HU in high-grade group]. The differences were statistically significant(P<0.05). Conclusion: The CT direct signs of CCRCC could provide a basis for WHO/ISUP pathological grading and help to formulate a preoperative plan.
Objective: To compare the direct signs of clear cell renal cell carcinoma(CCRCC) on 64-row spiral CT with pathological grading. Methods: A total of 34 CCRCC cases confirmed by surgical pathology in Huangshan People's Hospital during Feb. 2015 and May. 2018 were selected. The plain scan and multiphase contrast-enhanced scan images of 64-row spiral CT before surgery were analyzed and compared with the pathological grading. The CT direct signs of CCRCC included tumor shape, size, density, enhancement degree, enhancement modality, and presence of false envelope, etc. In accordance with the pathological grading criteria of World Health Organization(WHO)/International Society of Urological Pathology(ISUP), CCRCC was classified into grades Ⅰ to Ⅳ, of which Ⅰ-Ⅱ was defined as low-grade(n=28), Ⅲ-Ⅳ as high-grade(n=6). The data were collected and analyzed. Results: Compared with low-grade CCRCC, high-grade CCRCC lesions had more irregular shape(3 cases with irregular shape in high-grade group, accounting for 50.0%, and 2 cases with irregular shape in low-grade group, accounting for 7.1%), higher density during plain scan(5 cases with slightly high density in high-grade group, accounting for 83.3%, and only 3 cases with slightly high density in low-grade group, accounting for 10.7%), lower enhancement degree during corticomedullary phase [the difference in enhancement degree between high-grade CCRCC and ipsilateral renal cortex was(-16.1±12.3) HU, and that between lowgrade CCRCC and ipsilateral renal cortex was(7.0±7.5) HU], and lower enhanced attenuation during parenchymal phase [the average attenuation value was(-7.7±5.4) HU in low-grade group, and(-17.3±7.3) HU in high-grade group]. The differences were statistically significant(P<0.05). Conclusion: The CT direct signs of CCRCC could provide a basis for WHO/ISUP pathological grading and help to formulate a preoperative plan.
引文
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[3]ZHU Y H,WANG X,ZHANG J,et al.Low enhancement on multiphase contrast-enhanced CT images:an independent predictor of the presence of high tumor grade of clear cell renal cell carcinoma[J].AJR Am J Roentgenol,2014,203(3):W295-W300.
[4]饶秋,夏秋媛,周晓军,等.2016版WHO肾脏肿瘤新分类解读[J].中华病理学杂志,2016,45(7):435-441.
[5]赵金坤,叶兆祥,陈旭升,等.不同病理分级肾透明细胞癌与CT表现的相关性分析[J].临床放射学杂志,2015,34(8):1233-1237.
[6]吴木军,张凡.肾透明细胞癌的CT表现与病理分期、分级的关系研究[J].交通医学,2016,30(6):636-638.
[7]YAMASHITA Y,TAKAHASHI M,WATANABE O,et al.Small renal cell carcinoma:pathologic and radiologic correlation[J].Radiology,1992,184(2):493-498.
[8]马振申,赵强,孙秀彬,等.宝石能谱CT能谱参数与透明细胞肾癌分化程度的相关性分析[J].医学影像学杂志,2013,23(10):1592-1596.
[9]赵娜,程琦.CT能谱成像评价肾透明细胞癌核分级[J].中国医学影像学杂志,2014,22(9):681-685.
[10]MCDONALD D M,BALUK P.Significance of blood vessel leakiness in cancer[J].Cancer Res,2002,62(18):5381-5385.
[11]JOO H J,OH D K,KIM Y S,et al.Increased expression of caveolin-1 and microvessel density correlates with metastasis and poor prognosis in clear cell renal cell carcinoma[J].BJUInt,2004,93(3):291-296.
[12]ZHANG X,YAMASHITA M,UETSUKI H,et al.Angiogenesis in renal cell carcinoma:evaluation of microvessel density,vascular endothelial growth factor and matrix metalloproteinases[J].Int J Urol,2002,9(9):509-514.
[13]YILDIZ E,AYAN S,GOZE F,et al.Relation of microvessel density with microvascular invasion,metastasis and prognosis in renal cell carcinoma[J].BJU Int,2008,101(6):758-764.
[14]QI L,DU J,ZHANG Z,et al.Low differentiated microvascular density and low expression of platelet-derived growth factorBB(PDGF-BB)predict distant metastasis and poor prognosis in clear cell renal cell carcinoma[J].BJU Int,2013,112(4):E415-E423.
[15]Chen C,Kang Q,Xu B,et al.Differentiation of low-and highgrade clear cell renal cell carcinoma:tumor size versus CTperfusion parameters[J].Clin Imaging,2017,46:14-19.
[16]李刚,宋华林,王超,张淑敏,等.小肾癌的病理特点及其临床意义[J].中华泌尿外科杂志,2015,36(5):325-328.