摘要
目的探讨磁共振扩散加权成像(DWI)及扩散张量成像(DTI)在肾透明细胞癌(ccRCC)与乏脂性肾血管平滑肌脂肪瘤(MFAML)鉴别诊断中的价值。方法回顾性搜集行腹部MRI检查、经手术病理证实为ccRCC及MFAML的患者共55例(ccRCC 42例,MFAML 13例)。两组患者均行1.5T(GE 1.5T Signa HDXT,美国)MRI常规T1WI、T2WI扫描、LAVA增强扫描、DWI(b=0,600 s/mm^2)、DTI序列扫描(b=0,600 s/mm^2,在6个方向)。由两位放射科医师采用双盲法进行图像分析和测量。在ADW4.6工作站上应用Functool后处理软件进行后处理,使用DWI序列生成ADC图,使用DTI序列生成ADC图和FA图,分别在相应的ADC图和FA图中的ccRCC及MFAML病灶实质部分放置ROI,测量各ROI的ADC值及FA值,对两次测量结果的平均值进行统计分析。应用组内相关系数(ICC)检验两观察者所测数据一致性。使用独立样本t检验比较DWI的ADC值(ADCDWI)及DTI的ADC值(ADCDTI)在ccRCC与MFAML之间的差异,使用Mann-Whitney U检验比较FA值在ccRCC与MFAML之间的差异。应用ROC曲线分析DWI的ADCDWI值及DTI参数中ADCDTI值、FA值对鉴别ccRCC与MFAML的诊断效能,并且分析ADCDWI、ADCDTI及FA值三者联合诊断对鉴别ccRCC与MFAML的效能。结果两位观察者测量各参数的一致性良好。ccRCC的ADCDWI值显著高于MFAML[(1.93±0.44)×10^-3mm^2/s与(1.40±0.29)×10^-3mm^2/s,P<0.001],ccRCC的ADCDTI值显著高于MFAML[(2.06±0.45)×10^-3mm^2/s与(1.63±0.33)×10^-3mm^2/s,P=0.002],但ccRCC的FA值显著低于MFAML[(0.20±0.07)与(0.31±0.20),P=0.020]。ADCDWI值对鉴别ccRCC与MFAML的曲线下面积为0.845,阈值为1.63×10^-3mm^2/s时,其诊断ccRCC排除MFAML的敏感性和特异性分别为71.4%、84.6%;ADCDTI值对鉴别两者的曲线下面积为0.788,阈值为1.77×10^-3mm^2/s时,其诊断ccRCC排除MFAML的敏感性和特异性分别为76.2%、76.9%;FA值对鉴别两者的曲线下面积为0.722,阈值为0.27时,其诊断ccRCC排除MFAML的敏感性和特异性分别为88.1%、53.8%。应用
Objective To evaluate and compare diffusion weighted imaging(DWI)and diffusion tensor imaging(DTI)in differentiating clear cell renal cell carcinoma(ccRCC)and minimal fat angiomyolipoma(MFAML).Methods Fifty-five histopathology proven ccRCC and MFAML patients(42 cases of ccRCC and 13 cases of MFAML),were retrospectively enrolled in this study.All the patients were performed abdominal MRI exams on 1.5 T scanner(GE 1.5 T Signa HDXT,America)from April 2012 to January 2018 in a protocol containing the routine T1WI,T2WI,LAVA,DWI(b=0,600 s/mm2)and DTI(b=0,600 s/mm2,in 6 directions).MR images were reviewed and analyzed by two radiologists in a double-blind manner with the value of ADC from DWI,the value of ADC and FA from DTI measured using the Functool on GE ADW 4.6 workstation.For every ROI,the ADC values and FA values were measured.ROIs were drawn twice in tumor parenchyma that was greater than 1/3 of the tumor avoiding of hemorrhagic and necrotic part,then the average value was calculated for analysis.The data from two observers was analyzed with intra-class correlation coefficients(ICC)to assess inter-observer agreement,if the values were concordant,the average data from them was calculated for further statistical analysis.The differences of ADC values of DWI(ADCDWI)and the ADC values of DTI(ADCDTI)between ccRCC and MFAML were compared by independent t-test.The Mann-Whitney U test was used to compare the differences of the FA values of DTI between ccRCC and MFAML.The ROC curves of all parameters were used to analyze and compare the diagnostic value of DWI and DTI in differentiating ccRCC and MFAML.Results The inter-observer agreements were good(ICC>0.75).The ADCDWI value of ccRCC was statistically higher than that of MFAML[(1.93±0.44)×10^-3mm^2/s vs.(1.40±0.29)×10^-3mm^2/s,P<0.001],and The ADCDTI value of ccRCC was statistically higher than that of MFAML[(2.06±0.45)×10^-3mm^2/s vs.(1.63±0.33)×10^-3mm^2/s,P=0.002].But the FA value of ccRCC was statistically lower than that of MFAML[(0.20±0.07)vs.(0.31±0.20)
作者
徐明哲
刘爱连
孙美玉
宋清伟
XU Mingzhe;LIU Ailian;SUN Meiyu(Department of Radiology,the Affiliated No.1 Hospital of Dalian Midical University,Dalian,Liaoning Province 116011,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第1期96-102,共7页
Journal of Clinical Radiology
