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目的以组织病理学结果为参照,评价肾脏实性肿物的动脉自旋(ASL)MRI灌注特征与价值。材料与方法这项前瞻性研究符合HIPAA原则,获得单位伦理委员会的批准。所有病人均于检查前签署了知情同意书。42例怀疑肾肿物的病人在进行常规1.5T临床MRI检查前,进行了ASL检查。1名放射医师在不知最终病理结果的情况下,通过对兴趣区的分析,计算肿瘤灌注的平均值和峰值水平。通过方差分析检验灌注值与病理学结果的相关性。采用线性模型评价肾透明细胞癌的肿瘤体积与灌注值之间的相关性。P<0.05为差异具有统计学意义。结果 34例病人[男28例,女6例;(60.4±11.7)岁]获得组织病理学结果。乳头型肾细胞癌的平均灌注值[(27.0±15.1)mL/(min.100g)]低于透明细胞型[(171.6±61.2)mL/(min.100g),P=0.001]、嫌色细胞型[(152.9±80.7)mL/(min.100g),P=0.04]、未分类型肾细胞癌[(208.0±41.1)mL/(min.100g),P=0.001]和肾嗜酸细胞瘤[(373.9±99.2)mL/(min.100g),P<0.001]。肾嗜酸细胞瘤的灌注平均值和峰值水平[分别为(373.9±99.2)mL/(min.100g)和(512.3±146.0)mL/(min.100g)]高于乳头型[(27.0±15.1)mL/(min.100g)和(78.2±39.7)mL/(min.100g),两者P<0.001],嫌色细胞型[分别为(152.9±80.7)mL/(min.100g),P<0.001和(260.9±61.9)mL/(min.100g),P=0.02]和未分类型肾细胞癌[分别为(208.0±41.1)mL/(min.100g),P=0.01和(273.3±83.4)mL/(min.100g),P=0.03]。肾嗜酸细胞瘤的平均肿瘤灌注值高于透明细胞癌(P<0.001)。结论动脉自旋标记MR成像可在灌注水平上区分和诊断不同病理类型的肾脏肿物。肾嗜酸细胞瘤的灌注水平高于肾细胞癌,乳头型肾细胞癌的灌注水平低于其他亚型的肾细胞癌。
Objective To evaluate the characteristics and value of arterial spin-staging (ASL) MRI perfusion of solid renal masses with reference to histopathological findings. Materials and Methods This prospective study is in line with HIPAA principles and is approved by the unit ethics committee. All patients signed an informed consent form prior to the examination. Forty-two patients with suspected nephrotic masses underwent ASL examinations prior to routine 1.5T clinical MRI examination. A radiologist calculated mean and peak values of tumor perfusion by analyzing the regions of interest without knowing the final pathology results. The correlation between perfusion and pathology was tested by analysis of variance. A linear model was used to evaluate the correlation between tumor volume and perfusion values in renal clear cell carcinoma. P <0.05 for the difference was statistically significant. RESULTS: Histopathological findings were obtained in 34 patients [28 males and 6 females; (60.4 ± 11.7) years old]. The average perfusion value of papillary renal cell carcinoma [(27.0 ± 15.1) mL / (min.100g)] was lower than that of the clear cell type [(171.6 ± 61.2) mL / 100g, P = 0.001] (152.9 ± 80.7) mL / (min.100g), P = 0.04], unclassified renal cell carcinoma [(208.0 ± 41.1) mL / (min.100g), P = 0.001] and renal oncocytoma [(373.9 ± 99.2) mL / (min.100g), P <0.001]. The mean and peak perfusion of renal oncocytoma were (373.9 ± 99.2) mL / (min.100g) and (512.3 ± 146.0) mL / (min.100g), respectively, higher than that of papillary type (27.0 ± 15.1 (152.9 ± 80.7) mL / (min.100g), P (0.001g / mL) and P (0.001g / mL), P <0.001 and (260.9 ± 61.9) mL / (min.100g), P = 0.02] and unclassified renal cell carcinoma [208.0 ± 41.1 mL / (min.100 g), P = 0.01 and (273.3 ± 83.4) mL / (min.100 g), P = 0.03]. Renal oncocytomas had a higher average tumor perfusion value than clear cell carcinoma (P <0.001). Conclusion Arterial spin-labeled MR imaging can differentiate and diagnose different pathological types of renal masses at perfusion level. Renal oncocytoma perfusion is higher than renal cell carcinoma, and papillary renal cell carcinoma has a lower perfusion than other subtypes of renal cell carcinoma.