A Clinical Trial Of 3.0T Dynamic Enhanced Magnetic Resonance Imaging (DCE-MRI) In The Evalution Of Renal Tumors

[Objective]:Explore the value of dynamic contrast-enhanced magnetic resonance multi-parameter quantitative analysis in the differential diagnosis of different types of renal tumors including benign and malignant reanl tumors and the diagnostic efficacy of Fuhrmaning renal clear cell carcinoma.[Methods]:A total of 52 patients with renal tumors who underwent surgery and had definite postoperative pathology were included in the study.The study was approved by the ethics committee as a single center prospective study.All the patients underwent 3.0T routine MRI and e-THRrVE sequence DCE scan bdfore operation.The dynamic enhanced MRI perfusion sequence data were analyzed using Extended Tofts two compartment pharmacokinetic model and the texture algorithm was used to calculate the quantitative parameters of the ROI.The parameters could reflect the hemodnamic characteristics of the ROI that were Ktrans?Kep?Ve.The patients were divided into two groups,clear cell carcinoma group and non clear cell carcinoma.The data were compared through non parametric test(Mann-whitney U test)associated with tumor pathology.Then the clear cell carcinoma patients were divided into three groups according to the degree of tumor dififerentiation,Fuhrman 1,Fuhrman 2,Fuhrman 3-4.The data were compared by nonparametric test(Kruskall wallis).Finally,we count the microvessel density(MVD)and observed the relationship between the different parameters of DCE-MRI and MVD in the pathologieal sections of renal tumor patients after irnunohistochemical staining of CD34.[Results]:there were 52 patients enrolled in the study including 40 CCRCC(clear cell renal cell carcinoma),5PRCC(papillaiy renal cell carcinoma),3 CHR(chomophobe cell carcinoma),1 ONC(oncocytoma),3 AML(angiomyolipoma).The mean values of DCE-MRI parameters Ktrans and Ve can differentiate between clear cell renal carcinoma and non clear cell renal carcinoma,the differences are significant(P<0.05)but there is no significant difference between them on Kep(P>0.05),According to the above results,we made the ROC curves on Ktrans and Ve.The postoperative pathological results are regarded as the gold standard.The area under the curve of Ktrans and Ve were 0.719 and 0.794.according to Youden index,the best diagnostic limits of Ktrans and Ve were 0.0944,0.1507 min-1.The clear cell renal carcinoma by Fuhrman nuclear grade 1,grade 2,grade 3-4 were divided into 3 groups.There were no significant differences among them on Ktrans?Kep?Ve CP>0.05).The number of MVD in clear cell renal carcinoma group was 125.06�42.28,the non group was 42.85�12.43,there was significant significant difference between them(P<0.05).the correlation between different DCE-MRI parameters and MVD was statistically analyzed.The correlation between Ktrans and MVD was 0.199,Kep was-0.102,and there was no significant difference(P>0.05).the correlation between Ve and MVD was 0.502,there was significant difference(P<0.05).[Conclusions]:DCE-MRI could be a non-invasive assessment of renal tumors in the value of hemodynamic changes that can evaluate renal tumors from the perspective of the pathophysiological changes.The quantitative parameters are helpful in the differential diagnosis between clear cell carcinoma and non-clear cell carcinoma that are Ktrans and Ve.In addition,the quantitative parameter Ve could well reflect the microvessel density of renal cell caicinoma so that it coulde reveal the formation of tumor angiogenesis.