Diffusion-weighted MRI in renal cell carcinoma: A surrogate marker for predicting nuclear grade and histological subtype
Diffusion-weighted MRI in renal cell carcinoma: A surrogate marker for predicting nuclear grade and histological subtype
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DOI：
10.1258/ar.2011.110415
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发表时间：
2012-04-01
期刊：
影响因子：
1.3
通讯作者：
Das, Prasenjit
中科院分区：
文献类型：
--
作者：
Goyal, Ankur;Sharma, Raju;Das, Prasenjit
背景：尽管先前的研究者已经尝试评估其在局灶性肾脏病变表征中的应用，但弥散加权磁共振成像（DW MRI）在肾脏疾病中的应用仍是一个不断发展的领域，其在预测肾细胞癌（RCC）侵袭性方面的作用尚未确定。目的：评估表观扩散系数（ADC）值是否可以用于确定rcc的核分级和组织学亚型，并确定导致ADC值变化的肿瘤属性。材料和方法：机构伦理委员会放弃了本回顾性研究的知情同意要求。该研究队列包括33例接受MRI检查的患者（b值为0和500 s/mm(2)），发现36例病理证实的rcc。测定肾细胞癌实性部分、囊性/出血区和正常肾实质的ADC值。对每个病变进行组织学亚型、核分级和细胞计数测定。比较不同分级和亚型之间的ADC值，并研究其与细胞计数的相关性。绘制接收机工作特性曲线，建立截止ADC值。结果：低级别肿瘤23例（I、II级），高级别肿瘤13例（ill、IV级）。透明细胞型rcc 32例，非透明细胞型rcc 4例。随着分级的增加，ADC值呈下降趋势，高分级RCC的平均ADC显著低于低分级(1.3145 vs 1.6982 × 10(-3) mm(2)/s) （P = 0.005）。透明细胞RCC的平均ADC显著高于非透明细胞RCC (1.6245 vs 1.0412 × 10(-3) mm(2)/s) （P = 0.005）。ADC值高于1.7960 × 10(-3) mm(2)/s仅见于低分级患者，高于1.4904 × 10(-3) mm(2)/s仅见于透明细胞RCC患者。结论：ADC值为预测RCC的核分级和组织学亚型提供了一种无创手段。细胞结构和形态是导致rcc ADC值变化的其他肿瘤属性。
Background: Though previous investigators have attempted to evaluate its utility in characterization of focal renal lesions, diffusion-weighted MR imaging (DW MRI) in renal diseases is still an evolving field and its role in predicting the aggressiveness of renal cell carcinoma (RCC) is yet to be established.Purpose: To assess whether apparent diffusion coefficient (ADC) values can be used to determine the nuclear grade and histological subtype of RCCs and to identify the tumor attributes contributing to variation in ADC values.Material and Methods: The institutional ethics committee waived the requirement of informed consent for this retrospective study. The study cohort consisted of 33 patients who underwent MRI (with diffusion-weighted imaging at b values of 0 and 500 s/mm(2)) and were found to have 36 pathologically-proven RCCs. ADC values were determined for solid portions of RCC, cystic/hemorrhagic areas, and normal renal parenchyma. Histological subtype, nuclear grade, and cell count were determined for each lesion. ADC values were compared between different grades and subtypes and correlation with cell count was investigated. Receiver operating characteristic curves were drawn to establish cut-off ADC values.Results: There were 23 low grade (grades I and II) and 13 high grade tumors (grades ill and IV). There were 32 clear-cell and four non-clear-cell RCCs. A decreasing trend of ADC values was seen with increasing grade and mean ADC of high grade RCC was significantly lower than low grade (1.3145 vs 1.6982 x 10(-3) mm(2)/s) (P = 0.005). Mean ADC for clear-cell RCC was significantly higher than non-clear-cell RCC (1.6245 vs. 1.0412 x 10(-3) mm(2)/s) (P = 0.005). ADC values higher than 1.7960 x 10(-3) mm(2)/s were seen only with low grade and values greater than 1.4904 x 10(-3) mm(2)/s were seen only with clear-cell RCC.Conclusion: ADC values provide a non-invasive means to predict the nuclear grade and histological subtype of RCC. Cellularity and morphology are other tumor attributes contributing to the variation in ADC values of RCCs.