Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA.
Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA.
Abdom Radiol (NY). 2019 Jan;44(1):180-189. doi: 10.1007/s00261-018-1688-8.
The purpose of the study was to determine if enhancement features and qualitative imaging features on multiphasic multidetector computed tomography (MDCT) were associated with tumor grade in patients with clear cell renal cell carcinoma (ccRCC).
In this retrospective, IRB approved, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low grade (LG) and 43 high grade (HG) ccRCCs underwent preoperative four-phase MDCT in unenhanced (UN), corticomedullary (CM), nephrographic (NP), and excretory (EX) phases. Previously published quantitative (absolute peak lesion enhancement, absolute peak lesion enhancement relative to normal enhancing renal cortex, 3D whole lesion enhancement and the wash-in/wash-out of enhancement within the 3D whole lesion ROI) and qualitative (enhancement pattern; presence of necrosis; pattern of; tumor margin; tumor-parenchymal interface, tumor-parenchymal interaction; intratumoral vascularity; collecting system infiltration; renal vein invasion; and calcification) assessments were obtained for each lesion independently by two fellowship-trained genitourinary radiologists. Comparisons between variables included χ, ANOVA, and student t test. p values less than 0.05 were considered to be significant. Inter-reader agreement was obtained with the Gwet agreement coefficient (AC1) and standard error (SE) was reported.
No significant differences were observed between the LG and HG ccRCC cohorts with respect to absolute peak lesion enhancement and relative lesion enhancement ratio. There was a significant inverse correlation between low and high grade ccRCC and tumor enhancement the NP (71 HU vs. 54 HU, p < 0.001) and EX (52 HU vs. 39 HU, p < 0.001) phases using the 3D whole lesion ROI method. The percent wash-in of 3D enhancement from the UN to the CM phase was also significantly different between LG and HG ccRCCs (352% vs. 255%, p = 0.003). HG lesions showed significantly more calcification, necrosis, collecting system infiltration and ill-defined tumor margins (p < 0.05). Overall agreement between the two readers had a mean AC1 of 0.8172 (SE 0.0235).
Quantitatively, high grade ccRCC had significantly lower whole lesion enhancement in the NP and EX phases on MDCT. Qualitatively, high grade ccRCC were significantly more likely to be associated with calcifications, necrosis, collecting system infiltration, and an ill-defined tumor margin.
本研究旨在确定多期多层 CT（MDCT）上的强化特征和定性成像特征是否与透明细胞肾细胞癌（ccRCC）患者的肿瘤分级相关。
本回顾性研究经机构审查委员会批准，符合 HIPAA 规定，并获得了豁免知情同意的批准。127 例连续患者中，有 89 例低级别（LG）和 43 例高级别（HG）ccRCC 患者在未增强（UN）、皮质髓质（CM）、肾图（NP）和排泄期（EX）进行了术前四期 MDCT。由两位经过 fellowship培训的泌尿生殖系统放射科医生独立对每个病变进行了先前发表的定量（绝对病变增强峰值、绝对病变增强峰值与正常增强肾皮质的比值、3D 全病变增强以及 3D 全病变 ROI 内增强的“洗脱”）和定性（增强模式；坏死的存在；模式；肿瘤边缘；肿瘤-实质界面、肿瘤-实质相互作用；肿瘤内血管；集合系统浸润；肾静脉侵犯；和钙化）评估。变量之间的比较包括χ、ANOVA 和学生 t 检验。p 值小于 0.05 被认为具有统计学意义。使用 Gwet 一致性系数（AC1）获得了读者间的一致性，并报告了标准误差（SE）。
在绝对病变增强峰值和相对病变增强比方面，LG 和 HG ccRCC 队列之间没有显著差异。低级别和高级别 ccRCC 与 NP（71 HU 与 54 HU，p < 0.001）和 EX（52 HU 与 39 HU，p < 0.001）期的肿瘤增强呈显著负相关使用 3D 全病变 ROI 方法。从 UN 到 CM 期的 3D 增强的“洗脱”百分比在 LG 和 HG ccRCC 之间也有显著差异（352%比 255%，p = 0.003）。HG 病变明显更易发生钙化、坏死、集合系统浸润和模糊的肿瘤边缘（p < 0.05）。两位读者之间的总体一致性平均 AC1 为 0.8172（SE 为 0.0235）。
在 MDCT 上，定量上，高级别 ccRCC 在 NP 和 EX 期的全病变增强明显较低。定性上，高级别 ccRCC 更有可能与钙化、坏死、集合系统浸润和模糊的肿瘤边缘相关。
