MDCT对肾透明细胞癌Fuhrman分级诊断价值的研究

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摘要目的：探讨肾透明细胞癌（ccRCC）MDCT影像学表现与Fuhrman分级之间的关系。方法：回顾性分析113例经手术病理证实的ccRCC的MDCT影像资料。两名放射科医生双盲记录患者的影像学特征，包括肿瘤大小、囊性或实性、钙化、不均匀性、坏死比、生长方式等，并与Fuhrman分级结果进行统计学分析。结果：14/15例囊性ccRCC为低级别（Fuhrman Ⅰ~Ⅱ级）；在相对较多的实性ccRCC中，20/27例浸润型ccRCC为高级别（Fuhrman Ⅲ~Ⅳ级）。单因素分析显示肿瘤越大（临界值为4 cm），Fuhrman分级越高（χ2=11.441，P<0.001）；高级别以实性为主ccRCC中钙化和坏死比≥0.6较低级别实性ccRCC多见（χ2=29.007，P<0.001；χ2=18.454，P=0.030）。多因素分析提示肿瘤大小、浸润性生长、坏死比≥0.6是实性为主ccRCC Fuhrman Ⅲ~Ⅳ级的独立预测因素（OR：0.122，P=0.002；OR：13.234，P=0.002；OR：12.891，P=0.031）。结论：MDCT对预测ccRCC Fuhrman分级有较大的应用价值。囊性ccRCC倾向于低级别。以实性为主ccRCC中，肿瘤越大、浸润性生长、坏死比（≥0.6）越高，均预示较高的Fuhrman分级。

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	刘莹莹1
	张雪宁1
	侯文静2

关键词 ：肾肿瘤, 体层摄影术, 螺旋计算机

Abstract：Objective: To investigate the relationship between MDCT findings and Fuhrman grade of clear cell renal cell carcinoma(ccRCC). Materials and Methods: A retrospective analysis of MDCT manifestations of 113 patients with pathologically confirmed ccRCC, including 8 cases of Fuhrman grade Ⅰ, 60 cases of Fuhrman grade Ⅱ, 30 cases of Fuhrman grade Ⅲ and 15 cases of Fuhrman grade Ⅳ. The tumor characteristics, including tumor size, cystic versus solid, calcification, heterogeneity of lesions, percentage of non-enhancing necrotic ratio and growth pattern were noted independently by two radiologists, and statistical analysis was performed. Results: Fourteen of fifteen(93.3%) cystic ccRCC were low grade(Fuhrman grades Ⅰ~Ⅱ). In predominantly solid ccRCC, twenty of twenty-seven(74%) infiltrative ccRCC were high grade(Fuhrman grades Ⅲ~Ⅳ). Univariate analysis showed that larger tumor size(critical value 4 cm) had higher grade(χ2=11.441, P<0.001); calcification and necrotic ratio ≥0.6 were significantly more common in high grade ccRCC than in low grade ccRCC(χ2=29.007, P<0.001; χ2=18.454, P=0.030). Multivariate analysis showed tumor size, infiltrative growth and necrotic ratio ≥0.6 were Fuhrman grades Ⅲ~Ⅳ of three independent predictors(OR: 0.122, P=0.002; OR: 13.234, P=0.002; OR: 12.891, P=0.031). Conclusion: Multi-detector CT shows great application value in distinguishing Fuhrman grading system of ccRCC. Cystic ccRCC tends to have low grade. Infiltrative growth, larger tumor size and necrotic ratio ≥0.6 may increase the likelihood of high grade predominantly solid ccRCC.

Key words： Kidney neoplasms Tomography, spiral computed

收稿日期: 2016-11-10

PACS:	Ｒ737.11
	Ｒ814.42

通讯作者: 张雪宁，天津医科大学第二医院放射科，300211。E-mail：luckyxn@126.com

作者简介: 刘莹莹（1985-），女，天津人，满族，住院医师。E-mail：liuyingying9019@163.com

引用本文:

刘莹莹1，张雪宁1，侯文静2. MDCT对肾透明细胞癌Fuhrman分级诊断价值的研究[J]. 中国临床医学影像杂志, 2017, 28(7): 507-511.
LIU Ying-ying1, ZHANG Xue-ning1, HOU Wen-jing2. MDCT evaluation of the Fuhrman grade of clear cell renal cell carcinoma. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(7): 507-511.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I7/507

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