肾癌的磁共振扩散峰度成像研究

Renal cell cancer represents on average over 90% of all malignancies with poor prognosis and the long survival rate is very low. Therefore, to improve the early accurate diagnosis and detected rate is the key to improve the prognosis. However, for some of the atypical imaging or early lesions, malignant lesions with similar imaging findings and some benign or malignant tumors, the conventional imaging methods still have shortcomings. Magnetic resonance diffusion kurtosis imaging (DKI, diffusion kurtosis imaging) as the extension of diffusion tensor imaging (DTI), which has a more accurate evaluation algorithm. Combined with conventional imaging methods (such as CT, MRI, etc.), DKI imaging could clearly show the early stage of renal cancers, improve the accuracy of differential diagnosis of benign and malignant renal lesions and sub-typed pathological renal cancers. In addition, appropriate thresholds would be figured out threshold value according to the acquired data and would be tested in patients enrolled subsequently. Those patients who accept non-surgical therapy or refuse treatment would be evaluated by DKI in curative effects to corresponding treat and sequelae of the diseases respectively.

肾细胞癌占成人肾脏恶性肿瘤的90%以上，预后差，长期存活率很低。因此，提高肾细胞癌的早期检出率及诊断准确率是改善预后的关键。目前常规的影像学检查方法，对一些影像学表现不典型或早期的病变、影像表现相似的恶性病变以及某些良恶性肿瘤的鉴别诊断仍然存在不足。磁共振扩散峰度成像技术（DKI，diffusion kurtosis imaging）作为扩散张量成像(diffusion tensor imaging，DTI)的延伸，具有更为准确且符合活体实际情况的评价算法，联合应用常规影像手段（如CT、 MRI等），DKI成像能更好地显示早期肾癌的病变范围，提高鉴别肾脏病变良恶性及病理亚型的准确性。此外，根据临床研究所得的数据可制定肾脏病变扫描的最佳阈值，并对随后入组的患者进行验证。对非手术治疗及放弃治疗的患者，DKI扫描技术还可评价治疗方案的疗效以及疾病的转归。

肾细胞癌占成人肾脏恶性肿瘤的90%以上，预后差，长期存活率很低。因此，提高肾细胞癌的早期检出率及诊断准确率是改善预后的关键。磁共振扩散峰度成像技术（DKI，diffusion kurtosis imaging）作为扩散张量成像(diffusion tensor imaging，DTI)的延伸，具有更为准确且符合活体实际情况的评价算法，联合应用常规影像手段（如CT、 MRI等），DKI成像能更好地显示早期肾癌的病变范围，提高鉴别肾脏病变良恶性及病理亚型的准确性。.本研究应用磁共振扩散峰度成像技术（DKI，diffusion kurtosis imaging）联合体素内不相干运动扩散加权成像（intravoxel incoherent motion dififusion weighted imaging, IVIM DWI) 研究不同病理亚型肾脏良恶性肿瘤恶性程度及组织血供。以期提高在无创情况下鉴别肾脏肿瘤良恶性及分辨不同亚型的准确性。.本研究结果显示肾透明细胞癌弥散值、慢扩散系数值及灌注分数值明显高于乏脂肪肾血管平滑肌脂肪瘤、乳头状肾细胞癌、肾嫌色细胞癌、原发性肾脏淋巴瘤。乳头状肾细胞癌平均峰度及峰度各向异性值明显高于肾透明细胞癌、乏脂肪肾血管平滑肌脂肪瘤、肾嫌色细胞癌、原发性肾脏淋巴瘤。原发性肾脏淋巴瘤径向峰度值、慢扩散系数值及灌注分数值明显低于肾透明细胞癌、乏脂肪肾血管平滑肌脂肪瘤、乳头状肾细胞癌、肾嫌色细胞癌。乏脂肪肾血管平滑肌脂肪瘤快扩散系数值明显高于肾透明细胞癌、乳头状肾细胞癌、肾嫌色细胞癌、原发性肾脏淋巴瘤。. 常规ADC值和弥散值与肾透明细胞癌病理分级呈负相关，平均峰度、峰度各向异性、以及径向峰度值与肾透明细胞癌病理分级呈正相关。慢扩散系数值、快扩散系数值与肾透明细胞癌病理分级呈负相关，灌注分数值与肾透明细胞癌病理分级呈正相关。.本研究已做肾肿瘤DKI及IVIM 167例， 并已完成肾癌及肾血管平滑肌脂肪瘤的动物模型制备。已刊出SCI文章5篇，中华系列核心3篇，中文核心2篇；已录用SCI文章3篇。已获得省新技术引进奖一等奖一项，二等奖一项；扬州市科学技术进步二等奖一项；扬州市新技术引进奖一等奖二项。