CT prediction of the Fuhrman grade of clear cell renal cell carcinoma (RCC): towards the development of computer-assisted diagnostic method.
CT prediction of the Fuhrman grade of clear cell renal cell carcinoma (RCC): towards the development of computer-assisted diagnostic method.
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透明细胞肾细胞癌 (RCC) Fuhrman 分级的 CT 预测：走向计算机辅助诊断方法的发展
DOI：
10.1007/s00261-015-0531-8
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发表时间：
2015-10
影响因子：
--
通讯作者：
Duddalwar, Vinay
中科院分区：
文献类型：
--
作者：
Huhdanpaa, Hannu;Hwang, Darryl;Cen, Steven;Quinn, Brian;Nayyar, Megha;Zhang, Xuejun;Chen, Frank;Desai, Bhushan;Liang, Gangning;Gill, Inderbir;Duddalwar, Vinay
目的在增强CT检查中，肾细胞癌具有明确的可量化特征，如肿瘤峰值增强、肿瘤异质性和对比洗脱率。虽然定性的视觉印象通常足以用于诊断，但如果开发和验证了定量指标，则可以增加从标准护理诊断成像中获得的信息。本研究的目的是评估定量增强指标在预测透明细胞RCC的Fuhrman分级中的应用。材料与方法采用65例透明细胞RCCs多期CT检查，44例Fuhrman分级为1、2级，21例为3、4级。肿瘤分割后，提取以下数据：基于体素的各阶段全病灶衰减直方图分析，利用均值、中位数、偏度、峰度、标准差和四分位间距进行增强和洗脱。结果1 ~ 2级与3 ~ 4级肾图衰减值的四分位数范围、绝对强化的标准差、残留强化的四分位数范围和标准差4项指标的测量结果差异均有统计学意义。1-2级肾显像衰减值的四分位数范围为292.86 HU， 3-4级为241.19 HU （p值为0.02）。1 ~ 2级绝对增强的标准差为41.26 HU， 3 ~ 4级绝对增强的标准差为34.66 HU （p值为0.03）。1-2级和3-4级残留肾造影增强的四分位数差分别为297.12 HU和235.57 HU (p值0.02)，1-2级和3-4级残留肾造影增强的四分位数差分别为42.45 HU和37.11 HU （p值0.04）。结论低级别肿瘤的绝对强化更不均匀，低级别肿瘤肾造影期的衰减和残余强化更不均匀。这是设计一种预测非侵入性模型来预测核仁分级的重要一步。
PurposeThere are distinct quantifiable features characterizing renal cell carcinomas on contrast-enhanced CT examinations, such as peak tumor enhancement, tumor heterogeneity, and percent contrast washout. While qualitative visual impressions often suffice for diagnosis, quantitative metrics if developed and validated can add to the information available from standard of care diagnostic imaging. The purpose of this study is to assess the use of quantitative enhancement metrics in predicting the Fuhrman grade of clear cell RCC.Materials and methods65 multiphase CT examinations with clear cell RCCs were utilized, 44 tumors with Fuhrman grades 1 or 2 and 21 tumors with grades 3 or 4. After tumor segmentation, the following data were extracted: histogram analysis of voxel-based whole lesion attenuation in each phase, enhancement and washout using mean, median, skewness, kurtosis, standard deviation, and interquartile range.ResultsStatistically significant difference was observed in 4 measured parameters between grades 1–2 and grades 3–4: interquartile range of nephrographic attenuation values, standard deviation of absolute enhancement, as well as interquartile range and standard deviation of residual nephrographic enhancement. Interquartile range of nephrographic attenuation values was 292.86 HU for grades 1–2 and 241.19 HU for grades 3–4 (pvalue 0.02). Standard deviation of absolute enhancement was 41.26 HU for grades 1–2 and 34.66 HU for grades 3–4 (pvalue 0.03). Interquartile range was 297.12 HU for residual nephrographic enhancement for grades 1–2 and 235.57 HU for grades 3–4 (pvalue 0.02), and standard deviation of the same was 42.45 HU for grades 1–2 and 37.11 for grades 3–4 (pvalue 0.04).ConclusionOur results indicate that absolute enhancement is more heterogeneous for lower grade tumors and that attenuation and residual enhancement in nephrographic phase is more heterogeneous for lower grade tumors. This represents an important step in devising a predictive non-invasive model to predict the nucleolar grade.
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