WHO/ISUP 分级和透明细胞肾细胞癌的病理 T 分期：ZOOMit 扩散峰度成像和化学交换饱和传递成像的价值。
WHO/ISUP grade and pathological T stage of clear cell renal cell carcinoma: value of ZOOMit diffusion kurtosis imaging and chemical exchange saturation transfer imaging.
机构信息
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China.
出版信息
Eur Radiol. 2023 Jun;33(6):4429-4439. doi: 10.1007/s00330-022-09312-2. Epub 2022 Dec 6.
OBJECTIVES
To evaluate the value of ZOOMit diffusion kurtosis imaging (DKI) and chemical exchange saturation transfer (CEST) imaging in predicting WHO/ISUP grade and pathological T stage in clear cell renal cell carcinoma (ccRCC).
METHODS
Forty-six patients with ccRCC were included in this retrospective study. All participants underwent MRI including ZOOMit DKI and CEST. The non-Gaussian mean kurtosis (MK), mean diffusivity (MD), magnetization transfer ratio asymmetry (MTRasym (3.5 ppm)), and S (3.5 ppm)/S were analyzed based on different WHO/ISUP grades and pT stages. Binary logistic regression was used to identify the best combination of the parameters. Pearson's correlation coefficients were calculated between CEST and diffusion-related parameters.
RESULTS
The ADC, MD, and S (3.5 ppm)/S values were significantly lower for higher WHO/ISUP grade tumors, whereas the MK and MTRasym (3.5 ppm) were higher in higher WHO/ISUP grade and higher pT stage tumors. MTRasym (3.5 ppm) combined with MD (AUC, 0.930; 95% CI, 0.858-1.000) showed the best diagnostic efficacy in evaluating the WHO/ISUP grade. MTRasym (3.5 ppm) and MK were mildly positively correlated (r = 0.324, p = 0.028). S (3.5 ppm)/S was moderately positively correlated with ADC (r = 0.580, p < 0.001), mildly positively correlated with MD (r = 0.412, p = 0.005), and moderately negatively correlated with MK (r = -0.575, p < .001).
CONCLUSION
The microstructural and biochemical assessment of ZOOMit DKI and CEST allowed for the characterization of different WHO/ISUP grades and pT stages in ccRCC. MTRasym (3.5 ppm) combined with MD showed the best diagnostic performance for WHO/ISUP grading.
KEY POINTS
• Both diffusion kurtosis imaging (DKI) and chemical exchange saturation transfer (CEST) can be used to predict the WHO/ISUP grade and pathological T stage. • MTRasym (3.5 ppm) combined with MD showed the highest AUC (0.930; 95% CI, 0.858-1.000) in WHO/ISUP grading. • MTRasym at 3.5 ppm showed a positive correlation with mean kurtosis.
目的
评估 ZOOMit 扩散峰度成像（DKI）和化学交换饱和传递（CEST）成像在预测透明细胞肾细胞癌（ccRCC）的世界卫生组织/国际泌尿病理学会（WHO/ISUP）分级和病理 T 分期中的价值。
方法
本回顾性研究纳入了 46 例 ccRCC 患者。所有参与者均接受包括 ZOOMit DKI 和 CEST 在内的 MRI 检查。基于不同的 WHO/ISUP 分级和 pT 分期，分析非高斯平均峰度（MK）、平均弥散度（MD）、磁化转移率不对称（MTRasym（3.5ppm））和 S（3.5ppm）/S。采用二元逻辑回归识别参数的最佳组合。计算 CEST 与弥散相关参数之间的 Pearson 相关系数。
结果
较高的 WHO/ISUP 分级肿瘤的 ADC、MD 和 S（3.5ppm）/S 值显著降低，而较高的 WHO/ISUP 分级和较高的 pT 分期肿瘤的 MK 和 MTRasym（3.5ppm）较高。MTRasym（3.5ppm）联合 MD（AUC，0.930；95%CI，0.858-1.000）在评估 WHO/ISUP 分级方面具有最佳诊断效能。MTRasym（3.5ppm）与 MK 呈轻度正相关（r=0.324，p=0.028）。S（3.5ppm）/S 与 ADC 呈中度正相关（r=0.580，p<0.001），与 MD 呈轻度正相关（r=0.412，p=0.005），与 MK 呈中度负相关（r=-0.575，p<0.001）。
结论
ZOOMit DKI 和 CEST 的微观结构和生化评估能够对 ccRCC 的不同 WHO/ISUP 分级和 pT 分期进行特征描述。MTRasym（3.5ppm）联合 MD 对 WHO/ISUP 分级具有最佳诊断性能。
重点
DKI 和 CEST 均可用于预测 WHO/ISUP 分级和病理 T 分期。
MTRasym（3.5ppm）联合 MD 具有最高 AUC（0.930；95%CI，0.858-1.000），在 WHO/ISUP 分级中表现最佳。
MTRasym 在 3.5ppm 时与平均峰度呈正相关。
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