体素内不相干运动扩散加权磁共振成像与肾细胞癌静脉瘤栓的一致性

Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Venous Tumor Thrombus Consistency in Renal Cell Carcinoma.

作者信息

Zhao Jian, Wang Meifeng, Ding Xiaohui, Fu Yonggui, Peng Cheng, Kang Huanhuan, Guo Huiping, Bai Xu, Huang Qingbo, Zhou Shaopeng, Zhang Xiaojing, Liu Kan, Li Lin, Ye Huiyi, Zhang Xu, Ma Xin, Wang Haiyi

机构信息

Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China.

Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, Sichuan, China.

出版信息

J Magn Reson Imaging. 2024 Jan;59(1):134-145. doi: 10.1002/jmri.28763. Epub 2023 May 3.

DOI:10.1002/jmri.28763

PMID:37134147

Abstract

BACKGROUND

Venous tumor thrombus (VTT) consistency of renal cell carcinoma (RCC) is an important consideration in nephrectomy plus thrombectomy. However, evaluation of VTT consistency through preoperative MR imaging is lacking.

PURPOSE

To evaluate VTT consistency of RCC through intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI) derived parameters (D , D , f, and ADC) and the apparent diffusion coefficient (ADC) value.

STUDY TYPE

Retrospective.

POPULATION

One hundred and nineteen patients (aged 55.8 ± 11.5 years, 85 male) with histologically-proven RCC and VTT who underwent radical resection.

FIELD STRENGTH/SEQUENCES: 3.0-T; two-dimensional single-shot diffusion-weighted echo planar imaging sequence at 9 b-values (0-800 s/mm ).

ASSESSMENT

IVIM parameters and ADC values of the primary tumor and the VTT were calculated. The VTT consistency (friable vs. solid) was determined through intraoperative findings of two urologists. The accuracy of VTT consistency classification based on the individual IVIM parameters of primary tumors and of VTT, and based on models combining parameters, was assessed. Type of operation, intra-operative blood loss, and operation length were recorded.

STATISTICAL TESTS

Shapiro-Wilk test; Mann-Whitney U test; Student's t-test; Chi-square test; Receiver operating characteristic (ROC) analysis. Statistical significance level was P < 0.05.

RESULTS

Of the enrolled 119 patients, 33 patients (27.7%) had friable VTT. Patients with friable VTT were significantly more likely to experience open surgery, have significantly more intraoperative blood loss, and significantly longer operative duration. The area under the ROC curve (AUC) values of D of the primary tumor and VTT in classifying VTT consistency were 0.758 (95% CI 0.671-0.832) and 0.712 (95% CI 0.622-0.792), respectively. The AUC value of the model combining D and D of VTT was 0.800 (95% CI 0.717-0.868). Furthermore, the AUC of the model combining D and D of VTT and D of the primary tumor was 0.886 (95% CI 0.814-0.937).

CONCLUSION

IVIM-derived parameters had the potential to predict VTT consistency of RCC.

EVIDENCE LEVEL

3 Technical Efficacy: Stage 2.

摘要

背景

肾细胞癌（RCC）的静脉肿瘤血栓（VTT）质地在肾切除术加血栓切除术时是一个重要的考量因素。然而，术前磁共振成像对VTT质地的评估尚缺乏。

目的

通过体素内不相干运动扩散加权成像（IVIM-DWI）导出参数（D*、D、f和表观扩散系数[ADC]）及ADC值评估RCC的VTT质地。

研究类型

回顾性研究。

研究对象

119例经组织学证实患有RCC和VTT并接受根治性切除术的患者（年龄55.8±11.5岁，男性85例）。

场强/序列：3.0-T；9个b值（0 - 800 s/mm²）的二维单次激发扩散加权回波平面成像序列。

评估

计算原发肿瘤和VTT的IVIM参数及ADC值。通过两名泌尿外科医生的术中所见确定VTT质地（易碎型与实体型）。评估基于原发肿瘤和VTT各自的IVIM参数以及基于参数组合模型对VTT质地分类的准确性。记录手术类型、术中失血量和手术时长。

统计检验

Shapiro-Wilk检验；Mann-Whitney U检验；Student t检验；卡方检验；受试者工作特征（ROC）分析。统计学显著性水平为P < 0.05。

结果

在纳入的119例患者中，33例（27.7%）有易碎型VTT。易碎型VTT患者更有可能接受开放手术，术中失血量显著更多，手术持续时间显著更长。原发肿瘤和VTT的D在对VTT质地分类时的ROC曲线下面积（AUC）值分别为0.758（95%可信区间0.671 - 0.832）和0.712（95%可信区间0.622 - 0.792）。VTT的D和D组合模型的AUC值为0.800（95%可信区间0.717 - 0.868）。此外，VTT的D*和D以及原发肿瘤的D组合模型的AUC为0.886（95%可信区间0.814 - 0.937）。