CT Analysis Of Pathological Grade Of Renal Clear Cell Carcinoma At T1 Stage

【Objective】By analyzing the differences of the general clinical data(age,gender,clinical symptoms,tumor site),routine CT findings(tumor maximum diameter,shape,margin,calcification,necrosis,pseudocapsule,pseudocapsule integrity)and various CT enhanced scanning related enhancement characteristic parameters between high and low pathological grades in patients with T1 renal clear cell carcinoma(cc RCC),To explore the feasibility and operation methods of predicting the pathological grading of cc RCC at T1 stage by renal CT scan,in order to provide patients with more appropriate treatment decisions and better treatment plans.【Methods】CT images and clinical data of 61 patients with renal clear cell carcinoma confirmed by pathology and subjected to Fuhrman grade in our hospital from October2014 to February 2023 were collected and divided into two groups: In the low-grade group(43 cases of Furhman I-II)and the high-grade group(18 cases of Furhman IIIIV),all the included cases underwent routine CT plain scan and enhanced scan.The study contents included:(1)Statistical analysis was made on the difference of the general data(age,gender,clinical symptoms,tumor location)of cc RCC patients at T1 in the two groups(high grade and low grade).(2)Observe,record and measure the maximum diameter,regular shape,smooth edge,calcification,liquefaction necrosis,false capsule and complete capsule of cc RCC at T1 stage,and statistically analyze the relationship between the difference between the two groups of patients with high and low grade and pathological grade.(3)CT value,absolute enhancement value(net enhancement value),relative enhancement rate and enhancement attenuation difference of cc RCC substantive part in stage 4 of T1 were measured,and the correlation between each measurement value and high and low grade was analyzed,and the diagnostic efficacy was compared.SPSS 23.0 statistical software was used to analyze the general clinical data,routine CT signs and CT measurements.t test was used for measurement data,chi-square test or exact probability method was used for counting data.pearson correlation analysis was used for the correlation between each CT measurement value and the high and low grades,and the correlation coefficient r value was obtained.P < 0.05 was considered statistically significant.Furthermore,receiver operating characteristic(ROC)curves were further drawn to analyze the diagnostic efficacy of enhanced parameters with inter-group differences on the evaluation of high and low pathological grades.【Results】There were no significant differences in age,gender,clinical symptoms and lesion location between the high and low grade groups,with no statistical significance(P>0.05).The analysis of CT routine signs between the two groups showed statistical significance in terms of morphological regularity,but there were no significant differences between the two groups in terms of tumor maximum diameter,smooth edge(yes/no),calcification(yes/no),liquefaction necrosis(yes/no),false capsule(yes/no),and false capsule integrity(yes/no).In terms of related enhancement parameters,cortical CT value,absolute enhancement CT value(cortical CT value),relative enhancement rate(relative renal cortex A1)and enhancement attenuation difference were different between groups(P<0.05),but other enhancement parameters were not statistically significant.The above four parameters also have good correlation in correlation analysis.ROC curve analysis showed that absolute enhanced CT value(cortical phase)had high diagnostic value for the pathological grade of cc RCC.The maximum area under the curve was0.780,the optimal critical value was 83.95 HU,the corresponding sensitivity was83.7%,and the specificity was 58.3%.【Conclusions】The tumor morphology of T1 stage cc RCC is of certain value in the differential diagnosis of high and low grade groups,and the high grade group is more prone to irregular morphology.Tumor maximum diameter,margin,calcification,liquefaction necrosis,and false capsule were not found to be of diagnostic value in distinguishing high and low pathological grades of T1 cc RCC.Cortical CT value,absolute enhanced CT value(cortical phase),enhancement attenuation difference,and relative renal cortical enhancement rate(cortical phase)of cc RCC at T1 can be used to predict pathological Fuhrman grading before surgery.