School of Biomedical Engineering, ShanghaiTech University, Shanghai, China.
Department of Radiology, Renji hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Magn Reson Imaging. 2024 Feb;59(2):699-710. doi: 10.1002/jmri.28777. Epub 2023 May 20.
Clear cell renal cell carcinoma (ccRCC) is the most common subtype of RCC, and accurate grading is crucial for prognosis and treatment selection. Biopsy is the reference standard for grading, but MRI methods can improve and complement the grading procedure.
Assess the performance of diffusion relaxation correlation spectroscopic imaging (DR-CSI) in grading ccRCC.
Prospective.
79 patients (age: 58.1 +/- 11.5 years; 55 male) with ccRCC confirmed by histopathology (grade 1, 7; grade 2, 45; grade 3, 18; grade 4, 9) following surgery.
FIELD STRENGTH/SEQUENCE: 3.0 T MRI scanner. DR-CSI with a diffusion-weighted echo-planar imaging sequence and T2-mapping with a multi-echo spin echo sequence.
DR-CSI results were analyzed for the solid tumor regions of interest using spectrum segmentation with five sub-region volume fraction metrics (V , V , V , V , and V ). The regulations for spectrum segmentation were determined based on the D-T2 spectra of distinct macro-components. Tumor size, voxel-wise T2, and apparent diffusion coefficient (ADC) values were obtained. Histopathology assessed tumor grade (G1-G4) for each case.
One-way ANOVA or Kruskal-Wallis test, Spearman's correlation (coefficient, rho), multivariable logistic regression analysis, receiver operating characteristic curve analysis, and DeLong's test. Significance criteria: P < 0.05.
Significant differences were found in ADC, T2, DR-CSI V , and V among the ccRCC grades. Correlations were found for ccRCC grade to tumor size (rho = 0.419), age (rho = 0.253), V (rho = 0.553) and V (rho = -0.378). AUC of V was slightly larger than ADC in distinguishing low-grade (G1-G2) from high-grade (G3-G4) ccRCC (0.801 vs. 0.762, P = 0.406) and G1 from G2 to G4 (0.796 vs. 0.647, P = 0.175), although not significant. Combining V , V , and V had better diagnostic performance than combining ADC and T2 for differentiating G1 from G2-G4 (AUC: 0.814 vs 0.643).
DR-CSI parameters are correlated with ccRCC grades, and may help to differentiate ccRCC grades.
2 TECHNICAL EFFICACY STAGE: 2.
透明细胞肾细胞癌（ccRCC）是 RCC 最常见的亚型，准确分级对于预后和治疗选择至关重要。活检是分级的参考标准，但 MRI 方法可以改善和补充分级程序。
评估扩散弛豫相关谱成像（DR-CSI）在 ccRCC 分级中的性能。
前瞻性。
79 例经手术证实的 ccRCC 患者（年龄：58.1 ± 11.5 岁；55 名男性），病理分级为 1 级 7 例，2 级 45 例，3 级 18 例，4 级 9 例。
场强/序列：3.0T MRI 扫描仪。采用扩散加权回波平面成像序列进行 DR-CSI，采用多回波自旋回波序列进行 T2 映射。
使用频谱分段对感兴趣的实体肿瘤区域进行 DR-CSI 分析，使用五个亚区体积分数指标（V1、V2、V3、V4 和 V5）进行分析。根据不同宏观成分的 D-T2 光谱确定频谱分段规则。获得肿瘤大小、体素 T2 和表观扩散系数（ADC）值。对每个病例的组织病理学评估肿瘤分级（G1-G4）。
单因素方差分析或 Kruskal-Wallis 检验、Spearman 相关（系数，rho）、多变量逻辑回归分析、受试者工作特征曲线分析和 DeLong 检验。显著性标准：P<0.05。
ccRCC 分级之间 ADC、T2、DR-CSI V1 和 V5 存在显著差异。ccRCC 分级与肿瘤大小（rho=0.419）、年龄（rho=0.253）、V1（rho=0.553）和 V5（rho=-0.378）存在相关性。V1 的 AUC 略大于 ADC 用于区分低级别（G1-G2）和高级别（G3-G4）ccRCC（0.801 与 0.762，P=0.406）和 G1 与 G2-G4（0.796 与 0.647，P=0.175），尽管没有统计学意义。与联合 ADC 和 T2 相比，联合 V1、V2 和 V5 对区分 G1 与 G2-G4 具有更好的诊断性能（AUC：0.814 与 0.643）。
DR-CSI 参数与 ccRCC 分级相关，可能有助于区分 ccRCC 分级。
2 级技术功效。
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