Diagnostic Value Of Multi-detector CT For Renal Sinus Fat Invasion And Fuhrman Grade In CcRCC

1. Diagnostic value of multi-detector CT for renal sinus fat invasion in renal clear cell carcinomaObjective:To study the accuracy of preoperative CT for staging renal sinus fat invasion and the image features in clear cell renal cell carcinoma(cc RCC).Materials and Methods: 113 patients with ccRCC were included who were perform the CT scan. With 27 pathologically confirmed sinus fat invasion, the characteristics of tumors are unilateral single, non-hereditary; Gender: 71 males, 42 females, age range 17-82 years old,(average age 52.1 years old). All cases were treated with MDCT on multi-phase enhanced scan. The tumor characteristics, including tumor size, perfusion feature, invasion of renal pelvis and calyces, tumor margin were noted independently by two readers. Kappa test were used to evaluation the consistency of inter-observer with CT image data in 113 patients. Univariate analysis was performed for qualitative analyses to identify potential factors for predicting renal sinus fat invasion;Multivariate analysis was to evaluation risk factor with renal sinus fat invasion.Results: The evaluation results of MDCT image data consistency is good(K=0.73)。The preoperative accuracy of the evaluation on MDCT for renal sinus fat invasion was 79.2%(χ2=40.85,P <0.001), the sensitivity/specificity were 66.7% and 91.9% respectively. The main predictors of invasion were tumor size, perfusion incline, renal pelvis and calyceal invasion and irregularity of tumor edge. Among them the tumor size and invasion of renal pelvis and calyces increased the odds of sinus invasion.Conclusion: Multi-detector CT shows high diagnostic performance in detecting renal sinus fat invasion of clear cell renal cell carcinoma. It can help to choose the right surgical method and evaluate the prognosis after operation. 2. Correlation Analysis of multi-detector CT and Fuhrman grade in renal clear cell carcinomaObjective:To investigate the relationship between MDCT findings and Fuhrman grade of clear cell renal cell carcinoma(cc RCC), in order to provide evidence for clinical treatment and prognosis evaluation by using MDCT imaging findings.Materials and Methods: A retrospective analysis of MDCT manifestations of 113 patients with pathologically confirmed cc RCC, including 8 cases of Fuhrman grade I, 60 cases of Fuhrman grade II, 30 cases of Fuhrman grade III and 15 cases of grade Fuhrman IV. All cases were unilateral single, non-hereditary tumors, excluding other renal diseases, such as polycystic kidney, horseshoe kidney, isolated kidney and so on. All patients underwent three phases of enhancement scanning. The tumor characteristics, including tumor size, cystic versus solid, calcification, heterogeneity of lesions, percentage of non-enhancing necrotic ratio and growth pattern were noted independently by two readers. Kappa test were used to evaluation the consistency of inter-observer with CT image data in 113 patients. Univariate analysis was performed for qualitative analyses to identify potential factors for predicting Fuhrman grade;Multivariate analysis was to search significant independent predictors with Fuhrman grade.Results: The evaluation results of MDCT image data consistency is good(K=0.75)。fourteen of fifteen(93.3%) cystic cc RCC were low grade(Fuhrman grades 1-2). In predominantly solid cc RCC, twenty of twenty-seven(74%) infiltrative cc RCC were high grade(Fuhrman III-IV grades). Univariate analysis showed that tumor size was larger(critical value 4cm),the Fuhrman grade was higher(χ2=11.441,P<0.001); calcification and ≥60% of non-enhancing area were significantly more common in high grade cc RCC than in low grade cc RCC(χ2=29.007,P<0.001;χ2=18.454,P=0.030). Multivariate analysis showed tumor size, infiltrative growth and 0.6 or more non-enhancing necrotic ratio were Fuhrman III-IV grade of three independent predictors(OR:0.122,95%CI:0.033~0.457,P= 0.002;OR:13.234,95%CI:2.551~68.665,P= 0.002;OR:12.891,95%CI:1.271~130.718,P = 0.031).Conclusion: Multi-detector CT shows great application value in distinguishing Fuhrman grading system of clear cell renal cell carcinoma. Cystic cc RCC tends to be low grade. Infiltrative growth, larger tumor size and 0.6 or more non-enhancing necrotic ratio may increase the likelihood of high grade predominantly solid cc RCC.