摘要
目的 探讨CT纹理特征术前预测肾透明细胞癌（ccRCC）患者Fuhrman分级的价值.方法 回顾性分析2011年1月至2016年12月苏州大学附属第三医院经手术病理证实且Fuhrman分级明确的206例ccRCC患者.Fuhrman分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为38、107、50和11例.患者术前均行常规腹部CT平扫＋增强扫描.提取2个直方图特征（峰度和偏度）和6个灰度共生矩阵特征（对比度、相关度、能量、熵、均质性和方差）,获取各纹理特征值.FuhrmanⅠ～Ⅳ级间的纹理特征值经过log转换后采用单因素方差分析方法进行比较,两两比较采用Newman-Keuls检验;Fuhrman低（Ⅰ＋Ⅱ级）、高级间（Ⅲ＋Ⅳ级）的纹理特征值比较采用两独立样本t检验;纹理特征值与病理Fuhrman分级的相关性分析采用Spearman秩检验;采用ROC评价纹理特征预测Fuhrman高低级别ccRCC的效能.结果 不同Fuhrman分级患者间,能量和偏度的差异无统计学意义（P均〉0.05）,其他6个特征（对比度、相关度、熵、均质性、方差和峰度）的差异均有统计学意义（P均〈0.05）;Ⅲ与Ⅳ级ccRCC患者间,5个纹理特征（相关度、熵、均质性、方差和峰度）的差异无统计学意义（P均〉0.05）.相关度、能量、熵、方差和偏度与Fuhrman分级的｜r｜值均〈0.3,临床价值有限;对比度、均质性和峰度与Fuhrman分级相关性分析的r值分别为-0.54、0.39和0.32（P均〈0.05）.与低级别ccRCC相比,高级别ccRCC的对比度和方差均减小,峰度、相关度和均质性增大,差异均有统计学意义（P均〈0.05）;偏度、能量和熵的差异无统计学意义（P均〉0.05）.对比度、相关性、均质性、峰度和方差鉴别诊断高、低级别ccRCC的ROC下面积分别为0.806、0.641、0.687、0.668和0.659,其中对比度的鉴别诊断效能最高.结论 CT纹理特征可术前预测ccRCC的Fuhrman分级,其中对比度是最具临床应用潜力的影像标记物.
Objective To detect the values of CT texture features in the preoperative prediction of Fuhrman grade of clear cell renal cell carcinoma （eeRCC）. Methods The CT data of 206 patients with ccRCC admitted to the Third Affiliated Hospital of Soochow University from January 2011 to December 2016 were retrospectively analyzed, and the ecRCC cases were graded using Fuhrman grading system, including 38 cases of Grade Ⅰ , 107 cases of Grade Ⅱ , 50 cases of Grade Ⅲ and Ⅱ cases of Grade Ⅳ. All subjects undergone plain and enhancement CT scans. There were two methods used for the extraction of texture features, including histogram （2 features： Kurtosis and Skewness） and gray-level co-occurrence matrix （6 features： Contrast, Correlation, Energy, Entropy, Homogeneity and Variance）. Each texture feature during Grade Ⅰ to Ⅳ was compared using a one-way analysis of variance following the log-ratio transformation, and a Newman-Keuls test was performed for all pairwise comparisons. An independent sample t test was used to find the differences of each texture feature between low （Grade Ⅰ ＋ Ⅱ） and high grade （Grade Ⅲ ＋Ⅳ） ccRCC. A Spearman Rank test was performed to quantify the correlation of each texture feature with Fuhrman grade in ccRCC. Receiver operating characteristic curve （ROC） was employed to compare the diagnostic performance of the texture features to differentiate the low grade from high grade ccRCC. Results Six texture features, including Contrast, Correlation, Entropy, Homogeneity, Variance and Kurtosis, were different during Grade Ⅰ to Ⅳ （all P〈0.05） with the exception of the two features of Energy and Skewness （all P〉0.05）. Furthermore, five textures, such as Correlation, Entropy, Homogeneity, Variance and Kurtosis, were not significantly different between Grade Ⅲ and Ⅳ ccRCC. There was no clinical application value for the features of Correlation, Energy, Entropy, Variance and Skewness with the absolute coefficients of〈0.3, in contrast, the
作者
丁玖乐
邢兆宇
陈真
俞胜男
孙军
陈杰
邱建国
邢伟
Ding Jiule;Xing Zhaoyu;Chen Zhen;Yu Shengnan;Sun Jun;Chen Jie;Qiu Jianguo;Xing Wei(Department of Radiology,Third Affiliated Hospital of Soochow University,Changzhou 213003,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2018年第8期614-618,共5页
Chinese Journal of Radiology
基金
国家自然科学基金面上项目（81771798）
江苏省医学青年人才项目（QNRC2016299）
江苏省卫生计生委面上项目（H20170031
