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目的探讨3.0T磁共振弥散加权成像(diffusion-weighted imaging,DWI)对肾盂癌的诊断价值及其表观弥散系数(apparent diffusion coefficient,ADC)值与病理分期分级的关系。方法回顾性分析33例肾盂癌患者的临床资料。所有患者均行常规磁共振扫描及DWI检查(b值=0和b值=800s/mm~2),将磁共振DWI诊断结果与病理结果进行对照,计算DWI诊断肾盂癌的敏感性、特异性、准确率、阳性预测值、阴性预测值。分析并记录病灶的DWI信号特点,对每个病灶选择3个感兴趣区(region of interest,ROI):小ROI、大ROI及最小ADC值。比较不同性别间、不同部位肾盂癌间、肾盂癌与正常肾实质间、3组ROI间、不同病理分级和不同临床分期间的ADC值的差异。采用免疫组织化学染色方法检测Ki-67在肾盂癌组织中的表达,分析Ki-67表达与ADC值的关系。结果当b值=800s/mm~2时,利用DWI诊断肾盂癌的敏感性为90.9%、特异性91.4%、准确率91.2%、阳性预测值90.9%、阴性预测值91.4%。ADC值在不同性别、不同部位肾盂癌间差异无统计学意义(P>0.05),在肾盂癌与正常肾实质间差异有统计学意义(P<0.05),在3组ROI间差异无统计学意义(P>0.05)。低级别(G_1~G_2级)肾盂癌的ADC值较高级别(G_3级)高,局限于肾盂(Ta~T_2期)的ADC值较有局部侵犯(T_3期)高,差异均有统计学意义(P<0.01,P<0.05)。Ki-67表达与肿瘤的病理分级、分期有关,ADC值与Ki-67的表达量呈负相关(r=-0.88,P<0.01)。结论 ROI的大小对于尿路上皮癌的鉴别意义可能不大;在不使用造影剂的情况下,DWI有利于术前评估肾盂癌的组织学分级及分期。
Objective To investigate the diagnostic value of 3.0T magnetic resonance diffusion-weighted imaging (DWI) in renal pelvic carcinoma and the relationship between apparent diffusion coefficient (ADC) and pathological staging. Methods The clinical data of 33 patients with renal pelvic cancer were retrospectively analyzed. All patients underwent routine magnetic resonance imaging and DWI examination (b = 0 and b = 800s / mm ~ 2). The diagnostic results of DWI were compared with the pathological results to calculate the sensitivity and specificity of DWI in the diagnosis of renal pelvic cancer , Accuracy, positive predictive value, negative predictive value. The features of DWI signals were analyzed and recorded. Three regions of interest (ROI) were selected for each lesion: small ROI, large ROI and minimum ADC value. Differences in ADC values between different sexes, between the renal pelvis and between the renal pelvic cancer and the normal renal parenchyma, between the 3 groups of ROIs, between different pathological grades and between different clinical stages were compared. The expression of Ki-67 in renal pelvic cancer tissues was detected by immunohistochemical staining, and the relationship between Ki-67 expression and ADC value was analyzed. Results When b value = 800s / mm ~ 2, the sensitivity, specificity and accuracy of DWI in the diagnosis of renal pelvic cancer were 90.9%, 91.4%, 91.2%, 90.9% and 91.4% respectively. There was no significant difference in ADC value between different sexes and different parts of renal pelvic cancer (P> 0.05), but there was a significant difference between renal pelvic carcinoma and normal renal parenchyma (P <0.05). There was no significant difference in ROI between the three groups Significance (P> 0.05). The ADC value of low grade (G_1-G_2) renal pelvis cancer was higher than that of high grade (G_3 grade), while the ADC value of Ta_T_2 phase was higher than that of local invasion (T_3), the differences were statistically significant (P <0.01, P <0.05). The expression of Ki-67 was correlated with the pathological grade and stage of tumor. The ADC value was negatively correlated with the expression of Ki-67 (r = -0.88, P <0.01). Conclusion The size of ROI may not be significant for the differentiation of urothelial carcinoma. DWI is helpful for preoperative evaluation of histological grading and staging of renal pelvic carcinoma without contrast agent.