本文選題：磁共振成像 + 彌散加權(quán)成像��； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：1目的 應(yīng)用磁共振彌散加權(quán)成像研究T1期腎透明細(xì)胞癌，探討ADC值與Fuhrman病理分級(jí)之間的相關(guān)性，期望能對(duì)臨床選擇治療方案及判斷病人的預(yù)后有所幫助。 2材料與方法 回顧性分析我院經(jīng)病理證實(shí)的60例T1期腎透明細(xì)胞癌患者常規(guī)MRI平掃、DWI及增強(qiáng)檢查的磁共振影像資料。同時(shí)，由兩位高年資影像科醫(yī)生在Siemens Syngo工作站共同對(duì)腫瘤的最大徑進(jìn)行測(cè)量（取橫斷位、冠狀位圖像所示腫瘤的最大徑），同時(shí)對(duì)腎透明細(xì)胞癌DWI（ADC圖）圖像進(jìn)行分析，測(cè)量腫瘤實(shí)性部分的ADC值。由兩位高年資病理科醫(yī)生共同對(duì)其采用Fuhrman病理分級(jí)法進(jìn)行分級(jí)，共分為Ⅰ-Ⅳ級(jí)，其中Ⅰ-Ⅱ級(jí)為低級(jí)別組腎透明細(xì)胞癌，Ⅲ-Ⅳ級(jí)為高級(jí)別組腎透明細(xì)胞癌。應(yīng)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。Fuhrman分級(jí)為Ⅰ-Ⅳ級(jí)T1期腎透明細(xì)胞癌之間ADC值的比較采用單因素方差分析；高、低病理級(jí)別組之間ADC值的比較采用獨(dú)立樣本t檢驗(yàn)，并應(yīng)用ROC曲線判斷ADC值最佳閾值、敏感性及特異性；腫瘤ADC值與其Fuhrman病理級(jí)別之間相關(guān)性分析采用Spearman秩相關(guān)分析。相同分級(jí)不同T1分期期腎透明細(xì)胞癌與ADC值之間比較采用獨(dú)立樣本t檢驗(yàn)；腫瘤最大徑與ADC值之間相關(guān)關(guān)系采用Pearson相關(guān)分析。P0.05可認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。 3結(jié)果 所有60例T1期腎透明細(xì)胞癌中，F(xiàn)uhrman病理級(jí)別為Ⅰ、Ⅱ、Ⅲ、Ⅳ級(jí)的腫瘤實(shí)性部分的ADC值分別依次為（0.912±0.027）×10-3mm2/s、（0.851±0.128）×10-3mm2/s、（0.705±0.116）×10-3mm2/s、（0.600±0.274）×10-3mm2/s。其中，Ⅰ級(jí)與Ⅱ級(jí)、Ⅲ級(jí)與Ⅳ級(jí)之間差異無統(tǒng)計(jì)學(xué)意義（p=0.11、0.09）；Ⅰ級(jí)與Ⅲ級(jí)、Ⅰ級(jí)與Ⅳ級(jí)、Ⅱ級(jí)與Ⅲ級(jí)，Ⅱ級(jí)與Ⅳ級(jí)之間差異均有統(tǒng)計(jì)學(xué)意義（p≤0.00）。 T1期腎透明細(xì)胞癌低級(jí)別組ADC值為（0.872±0.123）×10-3mm2/s，高級(jí)別組ADC值為（0.675±0.110）×10-3mm2/s，，低級(jí)別組ADC值明顯大于高級(jí)別組，差異具有統(tǒng)計(jì)學(xué)意義（p=0.00）。取ADC值為0.713×10-3mm2/s，ROC曲線下面積為0.886，此時(shí)，鑒別高低級(jí)別組T1期CCRCC的敏感度及特異度分別為92.9%和72.2%。T1期腎透明細(xì)胞癌Fuhrman分級(jí)與ADC值呈顯著負(fù)相關(guān)（r=-0.64，p=0.00）。 由于Fuhrman病理分級(jí)為Ⅳ級(jí)的T1a期腎透明細(xì)胞癌只有一例，故未將Ⅳ級(jí)的CCRCC納入統(tǒng)計(jì)范圍。Ⅰ、Ⅱ、Ⅲ級(jí)的腎T1a期與T1b期CCRCC的ADC值間無統(tǒng)計(jì)學(xué)差異（p值分別依次為0.49、0.72和0.88）。腫瘤最大徑與ADC值之間相關(guān)系數(shù)為-0.17（r=-0.17，p=0.21），兩者之間的相關(guān)性不顯著。 4結(jié)論 4.1、T1期腎透明細(xì)胞癌Fuhrman病理分級(jí)與ADC值之間呈顯著負(fù)相關(guān)，即Fuhrman病理分級(jí)級(jí)別越高，ADC值越低。 4.2、ADC值可以用來預(yù)測(cè)T1期腎透明細(xì)胞癌分級(jí)，取ADC值為0.713×10-3mm2/s，ROC曲線下面積為0.886，此時(shí)鑒別T1期腎透明細(xì)胞癌高低級(jí)別組的敏感度及特異度分別為92.9%，72.2%，從而為臨床上選擇腫瘤的治療方案及判斷預(yù)后提供幫助。 4.3、相同F(xiàn)uhrman分級(jí)，不同T1分期CCRCC的ADC值沒有明顯差別。不同T1分期對(duì)相同F(xiàn)uhrman病理分級(jí)腎透明細(xì)胞癌的ADC值無顯著影響。
[Abstract]:1 purposes
The use of MR diffusion weighted imaging in the study of T1 renal clear cell carcinoma and the correlation between the ADC value and the Fuhrman pathological grading are expected to be helpful to the clinical selection and prognosis of the patients.
2 materials and methods
A retrospective analysis was made of 60 cases of T1 renal clear cell carcinoma confirmed by pathology in our hospital with conventional MRI scan, DWI and MRI. At the same time, the maximum diameter of the tumor was measured by two senior imaging doctors at the Siemens Syngo workstation (the maximum diameter of the transverse and coronal images), and the maximum diameter of the tumor. The DWI (ADC map) image of renal clear cell carcinoma was analyzed and the ADC value of the solid part of the tumor was measured. The two senior year medical science doctors were divided into grade I and IV by the Fuhrman pathological grading method together. The grade I - II was a low grade renal clear cell carcinoma, and the grade III - IV was a high grade renal clear cell carcinoma. SPSS17.0 Statistical software for statistical analysis of.Fuhrman classification of the ADC value of stage I - IV T1 stage renal clear cell carcinoma by single factor analysis of variance; high, low pathological grade group ADC value comparison between independent sample t test, and ROC curve to determine the best threshold of ADC value, sensitivity and specificity; tumor ADC value and Fuhrman disease Spearman rank correlation analysis was used for the correlation analysis between the levels of the rational level. An independent sample t test was used between the same classification and different T1 stages of the renal clear cell carcinoma and the ADC value; the correlation between the maximum diameter of the tumor and the ADC value was based on the Pearson correlation analysis.P0.05, which could be considered statistically significant.
3 Results
In all 60 cases of T1 renal clear cell carcinoma, the pathological grade of Fuhrman was I, II, II, III and IV, the ADC values were (0.912 + 0.027) x 10-3mm2/s, (0.851 + 0.128) x 10-3mm2/s, (0.705 + 0.116) x 10-3mm2/s, (0.600 + 0.274) x 10-3mm2/ S., and there was no statistical difference between grade I and grade II, and the difference between grade III and IV (p=0). .11,0.09); there were significant differences between grade I and III, grade I and IV, grade II and III, grade II and IV (P < 0.00).
The ADC value of the low grade renal cell carcinoma group T1 was (0.872 + 0.123) x 10-3mm2/s, and the ADC value of the advanced group was (0.675 + 0.110) x 10-3mm2/s. The ADC value of the low grade group was significantly greater than that of the advanced group. The difference was statistically significant (p=0.00). The value of ADC was 0.713 x 10-3mm2/s and the area under the ROC curve was 0.886. At this time, the sensitivity of the T1 stage CCRCC was identified. The degree and specificity of 92.9% and 72.2%.T1 stage clear cell renal cell carcinoma were significantly negatively correlated with Fuhrman score (ADC, r=-0.64, p=0.00).
Due to the only one case of T1a stage renal clear cell carcinoma with grade IV of Fuhrman pathological grade, the grade IV CCRCC was not included in the statistical range. There was no statistical difference between the T1a phase of grade II and stage III of the kidney and the ADC value of CCRCC in T1b phase (P values were respectively 0.49,0.72 and 0.88). The correlation coefficient between the maximum diameter of the tumor and the ADC value was -0.17 (r=-0.17,). The correlation between them is not significant.
4 Conclusion
There was a significant negative correlation between the pathological grading of Fuhrman and the ADC value of 4.1, T1 stage clear cell carcinoma, that is, the higher the Fuhrman pathological grading level, the lower the ADC value.
4.2, ADC value can be used to predict stage T1 stage of renal clear cell carcinoma. The value of ADC is 0.713 x 10-3mm2/s, and the area under ROC curve is 0.886. At this time, the sensitivity and specificity of identifying the high and low level group of T1 stage renal clear cell carcinoma are respectively 72.2%, which is helpful for the clinical selection of tumor treatment and prognosis.
4.3, the same Fuhrman classification, the ADC values of CCRCC in different T1 stages were not significantly different. Different T1 stages had no significant effect on the ADC value of the same Fuhrman pathological classification of renal clear cell carcinoma.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.11;R445.2

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