肾小肿块的鉴别诊断：扩散加权磁共振成像的表观扩散系数的作用
Differential diagnosis of the small renal masses: role of the apparent diffusion coefficient of the diffusion-weighted MRI.
作者信息
Mytsyk Yulian, Dutka Ihor, Yuriy Borys, Maksymovych Iryna, Caprnda Martin, Gazdikova Katarina, Rodrigo Luis, Kruzliak Peter, Illjuk Polina, Farooqi Ammad Ahmad
机构信息
Department of Urology, Lviv National Medical University, Pekarska Str. 69, Lviv, Ukraine.
Euroclinic Medical Center, Lviv, Ukraine.
出版信息
Int Urol Nephrol. 2018 Feb;50(2):197-204. doi: 10.1007/s11255-017-1761-1. Epub 2017 Dec 11.
INTRODUCTION
Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and more than 90% of neoplasms arising from the kidney. Uninformative percutaneous kidney biopsies vary from 10 to 23%. As a result, 7.5-33.6% of partial nephrectomies in patients with small renal masses (SRM) are performed on benign renal tumors. The aim of this study was to assess the feasibility of the apparent diffusion coefficient (ADC) of the diffusion-weighted imaging (DWI) of MRI, as RCC imaging biomarker for differentiation of SRM.
METHOD
Adult patients (n = 158) with 170 SRM were enrolled into this study. The control group were healthy volunteers with normal clinical and radiologic findings (n = 15). All participants underwent MRI with DWI sequence included.
RESULTS
Mean ADC values of solid RCC (1.65 ± 0.38 × 10 mm/s) were lower than healthy renal parenchyma (2.47 ± 0.12 × 10 mm/s, p < 0.05). There was no difference between mean ADC values of ccRCC, pRCC and chRCC (1.82 ± 0.22 × 10 vs 1.61 ± 0.07 × 10 vs 1.46 ± 0.09 × 10 mm/s, respectively, p = ns). An inverse relationship between mean ADC values and Fuhrman grade of nuclear atypia of solid ccRCCs was observed: grade I-1.92 ± 0.11 × 10 mm/s, grade II-1.84 ± 0.14 × 10 mm/s, grade III-1.79 ± 0.10 × 10 mm/s, grade IV-1.72 ± 0.06 × 10 mm/s. This was significant (p < 0.05) only between tumors of I and IV grades. Significant difference (p < 0.05) between mean ADC values of solid RCCs, benign renal tumors and renal cysts was observed (1.65 ± 0.38 × 10 vs 2.23 ± 0.18 × 10 vs 3.15 ± 0.51 × 10 mm/s, respectively). In addition, there was a significant difference (p < 0.05) in mean ADC values between benign cysts and cystic RCC (3.36 ± 0.35 × 10 vs 2.83 ± 0.21 × 10 mm/s, respectively).
CONCLUSION
ADC maps with b values of 0 and 800 s/mm can be used as an imaging biomarker, to differentiate benign SRM from malignant SRM. Using ADC value threshold of 1.75 × 10 mm/s allows to differentiate solid RCC from solid benign kidney tumors with 91% sensitivity and 89% specificity; ADC value threshold of 2.96 × 10 mm/s distinguishes cystic RCC from benign renal cysts with 90% sensitivity and 88% specificity. However, the possibility of differentiation between ccRCC histologic subtypes and grades, utilizing ADC values, is limited.
引言
肾细胞癌（RCC）约占成人恶性肿瘤的3%，占肾脏肿瘤的90%以上。未提供有效信息的经皮肾活检比例在10%至23%之间。因此，在小肾肿块（SRM）患者中，7.5% - 33.6%的部分肾切除术是针对良性肾肿瘤进行的。本研究的目的是评估磁共振成像（MRI）扩散加权成像（DWI）的表观扩散系数（ADC）作为RCC成像生物标志物用于鉴别SRM的可行性。
方法
158例患有170个SRM的成年患者纳入本研究。对照组为临床和影像学检查结果正常的健康志愿者（n = 15）。所有参与者均接受了包含DWI序列的MRI检查。
结果
实性RCC的平均ADC值（1.65 ± 0.38×10⁻³mm²/s）低于健康肾实质（2.47 ± 0.12×10⁻³mm²/s，p < 0.05）。透明细胞RCC（ccRCC）、乳头状RCC（pRCC）和嫌色细胞RCC（chRCC）的平均ADC值之间无差异（分别为1.82 ± 0.22×10⁻³、1.61 ± 0.07×10⁻³和1.46 ± 0.09×10⁻³mm²/s，p = 无统计学意义）。观察到实性ccRCC的平均ADC值与Fuhrman核异型性分级之间呈负相关：I级 - 1.92 ± 0.11×10⁻³mm²/s，II级 - 1.84 ± 0.14×10⁻³mm²/s，III级 - 1.79 ± 0.10×10⁻³mm²/s，IV级 - 1.72 ± 0.06×10⁻³mm²/s。仅在I级和IV级肿瘤之间差异有统计学意义（p < 0.05）。观察到实性RCC、良性肾肿瘤和肾囊肿的平均ADC值之间存在显著差异（p < 0.05）（分别为1.65 ± 0.38×10⁻³、2.23 ± 0.18×10⁻³和3.15 ± 0.51×10⁻³mm²/s）。此外，良性囊肿和囊性RCC的平均ADC值之间存在显著差异（p < 0.05）（分别为3.36 ± 0.35×10⁻³和2.83 ± 0.21×10⁻³mm²/s）。
结论
b值为0和800 s/mm²的ADC图可作为成像生物标志物，用于鉴别良性SRM和恶性SRM。使用1.75×10⁻³mm²/s的ADC值阈值可将实性RCC与实性良性肾肿瘤区分开来，灵敏度为91%，特异性为89%；2.96×10⁻³mm²/s的ADC值阈值可将囊性RCC与良性肾囊肿区分开来，灵敏度为90%，特异性为88%。然而，利用ADC值区分ccRCC组织学亚型和分级的可能性有限。
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