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目的评价MRI弥散张量成像(DTI)在肾透明细胞癌(ccRCC)与肾盂移行细胞癌(TCC)鉴别诊断中的价值。方法回顾性分析行腹部MR检查、经病理证实为ccRCC及TCC的患者38例(ccRCC 29例,TCC 9例)。患者均行MR T1W脂肪抑制和T2W脂肪抑制序列扫描、LAVA增强扫描、DTI序列扫描(b=0、600s/mm~2)。由2名放射科医师采用AW 4.4工作站采用Functool后处理软件进行图像分析和测量。采用组内相关系数(ICC)检验2名察者所测数据的一致性。ccRCC和TCC ADC值及FA值的比较采用独立样本t检验。采用ROC曲线分析ADC值、FA值对ccRCC与TCC的鉴别诊断效能。结果 2名观察者测量各参数一致性良好(ICC值均>0.75)。ccRCC的ADC值[(2.03±0.49)×10~(-3) mm~2/s]高于TCC[(1.57±0.43)×10~(-3 )mm~2/s;P=0.015)],但ccRCC的FA值(0.24±0.10)低于TCC(0.42±0.22);P=0.002)。ADC值曲线下面积0.761(P<0.05),敏感度和特异度分别为79.3%、77.8%,阈值为1.59×10~(-3) mm~2/s。FA值曲线下面积为0.762(P<0.05),敏感度和特异度分别为66.7%、93.1%,阈值为0.326。结论 MR DTI可有效鉴别ccRCC和肾盂TCC,其中FA值对鉴别两者的特异度较高。
Objective To evaluate the value of MRI diffusion tensor imaging (DTI) in the differential diagnosis of renal clear cell carcinoma (ccRCC) and renal pelvis transitional cell carcinoma (TCC). Methods Retrospective analysis of abdominal MR examination, pathologically confirmed 38 patients with ccRCC and TCC (ccRCC 29 cases, TCC 9 cases). Patients underwent MR T1W fat suppression and T2W fat suppression sequence scan, LAVA enhanced scan, DTI sequence scan (b = 0,600 s / mm ~ 2). The AW 4.4 workstation was used by two radiologists for image analysis and measurement using Functool post-processing software. The consistency of the data measured by two observers was tested using the intraclass correlation coefficient (ICC). Comparison of ccRCC and TCC ADC values and FA values was performed using an independent sample t-test. ROC curve analysis of ADC value, FA value of the differential diagnosis of ccRCC and TCC efficacy. Results Two observers measured the consistency of the parameters (ICC values> 0.75). The ADC value of ccRCC was (2.03 ± 0.49) × 10 ~ (-3) mm ~ 2 / s higher than that of TCC [(1.57 ± 0.43) × 10 ~ (-3) mm ~ 2 / s; , But the FA values for ccRCC (0.24 ± 0.10) were lower than those for TCC (0.42 ± 0.22; P = 0.002). The area under the curve of ADC value was 0.761 (P <0.05), the sensitivity and specificity were 79.3% and 77.8% respectively, and the threshold was 1.59 × 10 -3 mm 2 / s. The area under the curve of FA value was 0.762 (P <0.05), the sensitivity and specificity were 66.7% and 93.1% respectively, and the threshold was 0.326. Conclusion MR DTI can effectively distinguish between ccRCC and renal pelvis TCC. The FA value is highly specific to both of them.