【摘要】 目的 探讨增强MDCT扫描肾透明细胞癌(ccRCC)强化特征与其病理Fuhrman分级的相关性。方法 收集108例ccRCC患者CT图像及临床资料，测量肾癌病灶以及瘤灶同侧肾皮质和主动脉4期CT值，并计算3期绝对及相对强化CT值。根据Fuhrman分级将纳入病例分为低级别(FuhrmanⅠ～Ⅱ级)和高级别(FuhrmanⅢ～Ⅳ级)2组，对2组间肿瘤病灶4期CT值、3期绝对及相对强化CT值进行对比分析。结果 与高级别组比较，低级别组ccRCC病灶平扫CT值低、3期绝对强化CT值以及A1、A2、C1、C2值高，差异有统计学意义(P<0.05)。Spearman相关分析及受试者工作特征(ROC)曲线分析结果显示相关系数较高的为A1(r=-0.311,P<0.05),延迟期绝对强化CT值(r=-0.310,P<0.05)以及静脉期绝对强化CT值(r=-0.304,P<0.05)。ROC曲线曲线下面积(AUC)较高的为A1(0.707)、C1(0.705)以及动脉期绝对强化CT值(0.675)。结论 ccRCC MDCT强化指标与其病理Fuhrman分级呈负性相关关系，有助于术前预测ccRCC的分级，具有一定的临床应用价值。更多还原

【Abstract】 Objective To investigate the correlation between pathological features of clear cell renal cell carcinoma(ccRCC) and Fuhrman classification with enhanced MDCT image findings.Methods CT findings and clinical data of 108 ccRCC patients confirmed by pathology were collected and the CT values of tumor parenchyma, ipsilateral renal cortex and aorta were measured and absolute and relative CT values of tumor parenchyma were calculated.According to the Fuhrman pathological classification, all cases were divided into low grade(Fuhrman Ⅰ-Ⅱ) and high-grade(Fuhrman Ⅲ-Ⅳ) groups and the CT findings included CT attenuation of four phases and the absolute and relative enhancement values were compared respectively.Results Low-grade tumors differed from high-grade tumors with lower attenuation on unenhanced CT scan, absolute enhancement values in three phases were higher, relative enhancement values were also higher in arterial and venous phases, the difference were statistically significant(P<0.05). A1(r=-0.311, P<0.05) and the absolute enhancement in delay(r=-0.310,P<0.05)and nephrographic phase(r=-0.304,P<0.05)were negatively correlated to the Fuhrman grade, A1(AUC=0.707),C1(AUC=0.705)and corticomedullary phase absolute enhancement(AUC=0.675)had the more larger AUCs.Conclusion The MDCT enhancement index of ccRCC is negatively correlated with pathological Fuhrman grading which is helpful to predict the grade of ccRCC before operation and has certain clinical values.更多还原