Correlation between CT texture analysis,enhancement features and pathological grade of renal clear cell carcinoma
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摘要: 目的:探讨CT纹理分析及强化特征与肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)患者Fuhrman病理分级的相关性。方法:选择武警湖北省总队医院2012年5月—2020年5月经手术病理证实为ccRCC患者156例,根据Fuhrman病理分级,分为低级别组(G1~G2)119例和高级别组(G3~G4)37例,比较不同病理级别ccRCC患者纹理分析参数(平均灰度值、标准差)与强化特征参数[肿瘤CT值(tumor CT attenuation value,TAV)、绝对强化值(absolute enhancement value,AEV)、相对强化率[肿瘤相对皮质强化率(tumor to cortex ratio,TCR)、肿瘤相对动脉强化率(tumor to artery ratio,TAR)]的差异,应用受试者工作特征(ROC)特征性曲线分析各指标对高级别ccRCC患者的诊断价值,采用Spearman相关性分析各指标与ccRCC患者病理分级的相关性,采用logistic回归分析筛查高级别ccRCC患者的影响因素。结果:与低级别组比较,高级别组患者平均灰度值、标准差明显升高,TAV、AEV、TCR、TAR值明显下降,差异均有统计学意义(P＜0.05);Spearman相关性分析示,平均灰度值、标准差与Fuhrman病理分级高低呈正相关(rs=0.211,P=0.001;rs=0.205,P=0.005);TAV、AEV、TCR和TAR与Fuhrman病理分级高低呈负相关(rs=-0.245,P=0.015;rs=-0.206,P=0.008;rs=-0.315,P=0.001;rs=-0.218,P=0.018);ROC曲线示,平均灰度值、标准差与TAV、AEV、TCR和TAR对高级别Fuhrman病理分级的ccRCC患者具有诊断价值(P＜0.05),其中TCR的诊断效能最大,其曲线下面积(AUC)为0.745;多因素logistic回归分析示肿瘤不规整、肿瘤＞7 cm、平均灰度值＞8.01、TCR≤0.54是ccRCC患者高Fuhrman病理分级的独立预测因子(P＜0.05)。结论:肿瘤CT纹理参数和强化特征参数升高与高级别ccRCC患者相关,有助于术前预测肿瘤侵袭性,对临床决策具有重要参考价值。Abstract: Objective: To explore the correlation between CT texture analysis, enhanced features and the pathological grading of Fuhrman in patients with clear cell renal cell carcinoma(ccRCC).Methods: A total of 156 patients with ccRCC were selected from our hospital from May 2012 to May 2020. According to the pathological grades of Fuhrman, they were divided into 119 patients in the low-grade group(G1—G2) and 37 patients in the high-grade group(G3—G4). The difference of texture analysis parameters(mean gray value, standard deviation) and enhancement characteristic parameters [tumor CT attenuation value(TAV), absolute enhancement value(AEV), relative enhancement rate [tumor to cortex ratio(TCR), tumor to artery ratio(TAR) ] in patients with different pathological grades of ccRCC were compared. The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of each indicator to the higher pathological grades of ccRCC patients, and Spearman correlation was used to analyze the correlation between each indicator and the pathological grades of ccRCC patients. Logistic regression analysis was used to screen the influencing factors of the higher pathological grades of ccRCC patients.Results: Compared with the low-grade group, the average gray value and standard deviation of the high-grade group were significantly increased, while TAV, AEV, TCR and TAR values were significantly decreased, and the difference was statistically significant(All P＜0.05). Spearman correlation analysis showed that mean gray value and standard deviation were positively correlated with the level of Fuhrman pathological grading(rs=0.211, P=0.001; rs=0.205, P=0.005), while TAV, AEV, TCR and TAR were negatively correlated with the pathological grading of Fuhrman(rs=-0.245, P=0.015; rs=-0.206, P=0.008; rs=-0.315, P=0.001; rs=-0.218, P=0.018). ROC curve showed that mean gray value, standard deviation, TAV, AEV, TCR and TAR had diagnostic value for ccRCC patients with high-level Fuhrman pathological grade(All P＜0.05), and TCR had the highest diagnostic efficacy, with an area under curve(AUC) of 0.745. Multivariate Logistic regression analysis showed that irregular tumor, tumor＞7 cm, mean gray value＞8.01, TCR≤0.54 were independent predictors of high Fuhrman pathological grading in ccRCC patients(All P＜0.05).Conclusion: Increased CT texture parameters and enhancement parameters are correlated with Fuhrman's higher pathological grades of ccRCC patients, which is helpful for preoperative prediction of tumor invasiveness and has important reference value for clinical decision-making.
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