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[目的]分析~(18)F-FDG PET/CT葡萄糖代谢活性参数最大标准摄取比值(maximum of standardized uptake value,SUVmax)对肾透明细胞癌分级、分期的预测价值。[方法 ]回顾性分析行~(18)F-FDG PET/CT检查的51例肾透明细胞癌患者(Fuhrman分级G_1级16例、G_2级23例、G_3级和G_4级12例;pT分期为1和2期29例,3和4期13例),所有患者经手术或穿刺病理证实为透明细胞癌,根据~(18)F-FDG PET/CT图像,测定葡萄糖代谢参数SUVmax和肿瘤直径。分析不同Fuhrman分级、pT分期病灶的SUVmax差异情况,以及肿瘤的SUVmax与其大小的相关性。[结果]G_1级、G_2级、G_3级与G_4级三组病灶SUVmax中位数分别为2.15(1.83~2.83)、3.60(2.40~6.30)、10.05(7.73~14.08),差异有统计学意义(χ~2=26.11,P<0.001)。以6.65为界值,SUVmax≥6.65时,鉴别高级别肾透明细胞癌(G_3、G_4)的灵敏度和特异性分别为91.7%、84.7%,曲线下面积为0.938(P<0.001)。pT分期早期(1、2期)与晚期(3、4期)组SUVmax中位数分别为2.30(1.80~2.80)、6.00(3.90~11.10),差异有统计学意义(Z=-3.98,P<0.001)。以3.10为界值,SUVmax≥3.10时,鉴别晚期肾透明细胞癌(pT3期、pT4期)的灵敏度和特异性分别是94.7%、87.0%,曲线下面积为0.860(P<0.001)。病灶的SUVmax(1.5~17.7)与肿瘤的直径(0.70~17.70cm)有一定程度的正相关(r=0.62,P<0.001)。[结论 ]肾透明细胞癌的SUVmax与肿瘤Fuhrman分级、pT分期有一定关系,利用SUVmax,~(18)F-FDG PET/CT可以预测肿瘤的分级和分期。
[Objective] To analyze the predictive value of the maximum of standardized uptake value (SUVmax) of 18 F-FDG PET / CT for grading and staging renal clear cell carcinoma. [Methods] Totally 51 patients with clear cell renal cell carcinoma were analyzed retrospectively. (Fuhrman grade G 1 grade 16, Grade G 2 grade 23, grade G 3 and grade G 12; pT staging was 29 cases in stage 1 and 2 and 13 cases in stage 3 and 4). All patients were proved to be clear cell carcinoma by surgery or biopsy. The parameters of glucose metabolism SUVmax and tumor diameter were determined according to ~ (18) F-FDG PET / CT images. The differences in SUVmax between different Fuhrman grading and pT staging were analyzed, and the correlation between tumor SUVmax and its size was analyzed. [Results] The median SUVmax of three groups of G_1, G_2, G_3 and G_4 were 2.15 (1.83-2.83), 3.60 (2.40-6.30) and 10.05 (7.73-14.08) respectively, the difference was statistically significant ( χ ~ 2 = 26.11, P <0.001). The sensitivity and specificity of distinguishing high grade renal clear cell carcinoma (G_3, G_4) were 91.7% and 84.7%, respectively. The area under the curve was 0.938 (P <0.001) with 6.65 as the cutoff value and SUVmax≥6.65. The median of SUVmax in early stage of pT (stage 1, 2) and advanced stage (stage 3, 4) were 2.30 (1.80-2.80) and 6.00 (3.90-11.10) respectively, with significant difference (Z = -3.98, P <0.001). With a cutoff of 3.10 and a SUVmax of ≥3.10, the sensitivity and specificity for differentiating advanced renal clear cell carcinoma (pT3 and pT4) were 94.7% and 87.0%, respectively, and the area under the curve was 0.860 (P <0.001). There was a positive correlation between the SUVmax (1.5 ~ 17.7) and tumor diameter (0.70 ~ 17.70cm) (r = 0.62, P <0.001). [Conclusion] The SUVmax of renal clear cell carcinoma is related to the tumor Fuhrman grade and pT stage. The tumor grade and stage can be predicted by SUVmax and ~ (18) F-FDG PET / CT.