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| MDCT evaluation of the Fuhrman grade of clear cell renal cell carcinoma |
| LIU Ying-ying1, ZHANG Xue-ning1, HOU Wen-jing2 |
1. The Second Hospital of Tianjin Medical University, Tianjin 300211, China;
2. Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300100, China |
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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.
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Received: 10 November 2016
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