Evaluation Of MRI Display Effect Of Pseudocapsule In T1 Stage Renal Carcinoma And Analysis Of Pseudocapsule Integrity

Objective: To investigate the imaging effect of MRI on the pseudo capsule status of T1 stage renal carcinoma and to analyze the influencing factors of pseudo capsule integrity.Methods: The clinical data of 78 patients with stage T1 renal tumor admitted to the Department of Urology of our hospital from March 2019 to December 2020 were collected.Preoperative MRI examination was performed,and according to the imaging characteristics of the renal tumor pseudo capsule(PC),the pseudo capsule magnetic resonance score(MRI-CAP)was classified as MRI-CAP1(with clearly identifiable PC),MRI-CAP2(with focal defect of PC),and MRI-CAP3(with significant PC disruption and absence).The pseudo-capsule infiltration scoring system(I-CAP)was used to perform the corresponding postoperative pathological classification of renal tumor PC: I-CAP1(intact PC without invasion),I-CAP2(focal absence or microinvasion inside PC),and I-CAP3(local interruption or complete absence of PC).Taking pathology as the gold standard,MRI score was compared with pathology score to evaluate the display effect of MRI on the pseudo capsule status of renal carcinoma.Univariate and multivariate analyses were used to investigate the possible influencing factors of false capsule integrity.Results : The results of MRI-CAP score and I-CAP score were consistent in83%(65/78)of the cases,and Kappa consistency analysis of all levels of scores showed a Kappa value of 0.764(> 0.75).The sensitivity,specificity,PPV,NPV and Spearman rank correlation coefficient(ρ)of MRI-CAP1 were 82.9%,94.6%,94.4%,83.3%,and 0.776.The sensitivity,specificity,PPV and NPV of MRI-CAP2 were76.9%,86.2%,52.6%,94.9%,ρ coefficient was 0.548.The sensitivity,specificity,PPV and NPV of MRI-CAP3 grade were 87.5%,96.3%,91.3% and 94.5%,ρcoefficient was 0.848.Univariate and multivariate binary logistic regression analysis showed that higher BMI(OR value 2.41,P=0.037),larger tumor diameter(OR value2.798,P=0.024),higher nuclear grade(OR value 3.587,P=0.023),and higher NLR(OR value 2.233,P=0.002)were significantly associated with false capsule integrity and were independent risk factors for false capsule invasion.Conclusion: MRI can show the pseudocapsular status of T1 stage RCC well,and the pseudocapsular status of RCC can be classified by MRI-CAP and I-CAP envelope scoring systems,which can enable MRI to accurately evaluate the pseudocapsular status.Higher BMI,nuclear grade,medium-to-luoratio NLR,and larger tumor diameter were associated with a lower probability of false capsule integrity.