CAJ | 학술논문

目的：探讨MR磁敏感技术对囊性肾癌(cystic renal cell carcinoma， CRCC)与复杂性肾囊肿(complex renal cysts，CRC)鉴别诊断的价值。材料与方法回顾性分析经病理证实的CRCC14例、CRC13例资料，观察两组病变的T1WI、T2WI、增强T2*加权血管成像(enhanced T2 star weighted angiography， ESWAN)序列后处理得到的幅度图中病灶信号变化，应用卡方检验比较两组病变各序列信号变化的差异；由两位观察者分别对两组病变相位图中磁敏感信号(intratumoral susceptibility signal intensity，ITSS)显示情况进行评分，以Kappa检验比较两位观察者评分一致性，以Mann-Whitney U检验比较两组病变相位图ITSS显示的差异；由两位观察者分别测量两组病变相位值、R2*值，使用组内相关系数(intra-class correlation coefficients，ICC)检验两位观察者测量数据的一致性，并应用Mann-Whitney U检验比较两组病变各参数间差异，根据受试者工作特征曲线(receiver operator characteristic curve，ROC)下面积评估相位值、R2*值对CRCC与CRC鉴别的效能，找出相应界值。结果 CRCC与CRC在T1WI、T2WI、幅度图上信号变化的差异无统计学意义(P＞0.05)；两位观察者对两组病变相位图ITSS显示情况评分结果一致性均较好(Kappa＞0.70)，ITSS评分结果CRCC(1.93±1.14)分＞CRC(0.77±1.01)分，差异具有统计学意义(P=0.01)；两位观察者获得两组图像的相位值及R2*值数据结果一致性良好(ICC＞0.75)，CRCC与CRC的相位值及R2*值分别为(－0.030±0.052)与(0.041±0.085)、(28.14±8.26) Hz与(15.99±6.29) Hz，差异均有统计学意义(P＜0.05)；其ROC曲线下面积为分别为0.786、0.885，相位值≤0.010、R2*值≥17.81 Hz为诊断CRCC的界值，两者敏感度、特异度分别为85.7%、69.2%和100.0%、69.2%。结论对常规MR序列难以鉴别的CRCC和CRC，在相位图上CRCC较CRC有更多的ITSS出现；相位值及R2*值可以作为定量指标对两者进行鉴别，且R2*值更具价值。目的：探討MR磁敏感技術對囊性腎癌(cystic renal cell carcinoma， CRCC)與複雜性腎囊腫(complex renal cysts，CRC)鑒彆診斷的價值。材料與方法迴顧性分析經病理證實的CRCC14例、CRC13例資料，觀察兩組病變的T1WI、T2WI、增彊T2*加權血管成像(enhanced T2 star weighted angiography， ESWAN)序列後處理得到的幅度圖中病竈信號變化，應用卡方檢驗比較兩組病變各序列信號變化的差異；由兩位觀察者分彆對兩組病變相位圖中磁敏感信號(intratumoral susceptibility signal intensity，ITSS)顯示情況進行評分，以Kappa檢驗比較兩位觀察者評分一緻性，以Mann-Whitney U檢驗比較兩組病變相位圖ITSS顯示的差異；由兩位觀察者分彆測量兩組病變相位值、R2*值，使用組內相關繫數(intra-class correlation coefficients，ICC)檢驗兩位觀察者測量數據的一緻性，併應用Mann-Whitney U檢驗比較兩組病變各參數間差異，根據受試者工作特徵麯線(receiver operator characteristic curve，ROC)下麵積評估相位值、R2*值對CRCC與CRC鑒彆的效能，找齣相應界值。結果 CRCC與CRC在T1WI、T2WI、幅度圖上信號變化的差異無統計學意義(P＞0.05)；兩位觀察者對兩組病變相位圖ITSS顯示情況評分結果一緻性均較好(Kappa＞0.70)，ITSS評分結果CRCC(1.93±1.14)分＞CRC(0.77±1.01)分，差異具有統計學意義(P=0.01)；兩位觀察者穫得兩組圖像的相位值及R2*值數據結果一緻性良好(ICC＞0.75)，CRCC與CRC的相位值及R2*值分彆為(－0.030±0.052)與(0.041±0.085)、(28.14±8.26) Hz與(15.99±6.29) Hz，差異均有統計學意義(P＜0.05)；其ROC麯線下麵積為分彆為0.786、0.885，相位值≤0.010、R2*值≥17.81 Hz為診斷CRCC的界值，兩者敏感度、特異度分彆為85.7%、69.2%和100.0%、69.2%。結論對常規MR序列難以鑒彆的CRCC和CRC，在相位圖上CRCC較CRC有更多的ITSS齣現；相位值及R2*值可以作為定量指標對兩者進行鑒彆，且R2*值更具價值。
목적：탐토MR자민감기술대낭성신암(cystic renal cell carcinoma， CRCC)여복잡성신낭종(complex renal cysts，CRC)감별진단적개치。재료여방법회고성분석경병리증실적CRCC14례、CRC13례자료，관찰량조병변적T1WI、T2WI、증강T2*가권혈관성상(enhanced T2 star weighted angiography， ESWAN)서렬후처리득도적폭도도중병조신호변화，응용잡방검험비교량조병변각서렬신호변화적차이；유량위관찰자분별대량조병변상위도중자민감신호(intratumoral susceptibility signal intensity，ITSS)현시정황진행평분，이Kappa검험비교량위관찰자평분일치성，이Mann-Whitney U검험비교량조병변상위도ITSS현시적차이；유량위관찰자분별측량량조병변상위치、R2*치，사용조내상관계수(intra-class correlation coefficients，ICC)검험량위관찰자측량수거적일치성，병응용Mann-Whitney U검험비교량조병변각삼수간차이，근거수시자공작특정곡선(receiver operator characteristic curve，ROC)하면적평고상위치、R2*치대CRCC여CRC감별적효능，조출상응계치。결과 CRCC여CRC재T1WI、T2WI、폭도도상신호변화적차이무통계학의의(P＞0.05)；량위관찰자대량조병변상위도ITSS현시정황평분결과일치성균교호(Kappa＞0.70)，ITSS평분결과CRCC(1.93±1.14)분＞CRC(0.77±1.01)분，차이구유통계학의의(P=0.01)；량위관찰자획득량조도상적상위치급R2*치수거결과일치성량호(ICC＞0.75)，CRCC여CRC적상위치급R2*치분별위(－0.030±0.052)여(0.041±0.085)、(28.14±8.26) Hz여(15.99±6.29) Hz，차이균유통계학의의(P＜0.05)；기ROC곡선하면적위분별위0.786、0.885，상위치≤0.010、R2*치≥17.81 Hz위진단CRCC적계치，량자민감도、특이도분별위85.7%、69.2%화100.0%、69.2%。결론대상규MR서렬난이감별적CRCC화CRC，재상위도상CRCC교CRC유경다적ITSS출현；상위치급R2*치가이작위정량지표대량자진행감별，차R2*치경구개치。
Objective: To explore the value of MR magnetic sensitive technology to identify the cystic renal cell carcinoma (CRCC) and complex renal cysts (CRC). Materials and Methods:Fourteen cases of CRCC and thirteen cases of CRC conifrmed by pathology were retrospectively analyzed. The signal performance on T1WI, T2WI, and on magnitude which were generated from enhanced T2 star weighted angiography (ESWAN) data were observed, the Chi-square test was used to compare the difference between each sequence of two groups. The appearance of intratumoral susceptibility signal intensity (ITSS) on the phase map of two groups were observed and scored by two observers,the Kappa test was used to evaluate the consistency of two observers, and the Mann-Whitney U test was used to compare the score difference appearance of ITSS on the phase map of two groups. The values of phase and R2* of two groups were measured by two observers, the data continuity of two groups were measured by the intra-class correlation coefifcients (ICC), and usedthe Mann-Whitney U test to compare various parameters of two groups whether they have statistical difference. Receiver operator characteristic (ROC) curve was used to calculate the cut-off value of phase, R2* and performance of phase, R2* value for distinguishing the CRCC and CRC.Results:The signal performance of CRCC and CRC had no difference on T1WI, T2WI, magnitude map (P>0.05). The consistency of two observers was good (Kappa>0.70), and the score of the appearance of ITSS on the phase map on CRCC (1.93±1.14) was higher than that on CRC (0.77±1.01) (P=0.01). The phase values and R2* values of the two groups obtained from the two observers were in good consistency (ICC>0.70), and the score of the appearance of ITSS on the phase map on CRCC (1.93±1.14) was higher than that on CRC (0.77±1.01) 0.75), the phase and R2* values of CRCC and CRC were -0.030±0.052 and 0.041±0.085, (28.14±8.26) Hz and (15.99±6.29) Hz respectively, the result was statistically signiifcant (P< 0.05). The AUC of phase and R2* values were 0.786, 0.885, the best cut-off values for phase and R2* in characterizing the CRCC from CRC were 0.010 and 17.81 Hz. The sensitivity, specificity were 85.7%, 69.2% and 100.0%, 69.2% respectively.Conclusion:The CRCC and CRC which conventional MR sequences have dififculty to identify, CRCC had more ITSS on phase map. Phase and R2* values can be used as a quantitative index to identify CRCC and CRC, and R2* value is more valuable.