The Value Gemstone Spectral Imaging (GSI) In Predicting Of Pathologic Grading In Renal Clear Cell Carcinoma

Objective：To evaluate the correlation of pathologic grading with gemstonespectral imaging (GSI) in renal clear cell carcinoma(RCCC), and provide informationfor management of renal cell carcinoma, and especially in patient selection for nephronsparing surgery.Methods： From July2011to April2012,31patients with pathologicallyconfirmed renal clear cell carcinoma were included in the present study. All the patientsunderwent spectroscopy dual-phase CT imaging scan. Patients’ data wereretrospectively evaluated and analyzed to evaluate the correlation of pathologic gradingwith gemstone spectral imaging (GSI). Tumor grading used Furhman grade system. Ofthem,24cases were with well-differentiated tumor (renal clear cell carcinoma withpathologic Furhman grade Ⅰand Ⅱ),7cases with poorly-differentiated renal clear cellcarcinoma (Furhman grade Ⅲ and Ⅳ). All patients were examined plainly andenhanced with GE CT (Discovery CT750HD, GE Healthcare). The original data andthe rebuilding images were transmitted to the Advanced Workstation (AW4.5), and thearterial and venous phase scanning were transmitted to the single-energy image (70kev,0.625mm), the image of iodine-based, water-based imaging applications spectroscopyimaging (Gemstone the Spectral imaging, GSI), all the information were analyzed bythe software mentioned above. The energy decay curves, histograms and scatter plots ofdifferent pathological grades of renal clear cell carcinoma were observed, and tumorsize was measured and recorded. Besides, following indices were also observed,including the regularity of morphology, with or without a pseudo capsule, with orwithout hemorrhage and necrosis,40kev to140kev (10kev intervals) energy levels ofthe CT value (HU), each paired base material and the concentration (mg/ml)(according to the purpose of this study to select the iodine-water). Patients’ general parameters, CT findings and the CT spectrum characteristic parameters were comparedand statistically analyzed.Results:(1) There was no significant difference between well-differentiated groupand poorly-differentiated group in age, sex, symptoms, and location of tumor (P>0.05).(2) There was no significant difference between well-differentiated group andpoorly-differentiated group in tumor general CT findings (the regularity of the shape,with or without a pseudo capsule, with or without necrosis, liquefaction, maximumdiameter, minimum diameter)(P>0.05).(3) The difference between well-differentiatedgroup and poorly-differentiated group analyzed by CT spectrum characteristics ofmonochromatic imaging, in the low-energy levels (40kev-90kev) arterial phase, venousphase difference of CT values were significantly (P <0.05), in the high-energy levels(100kev-140kev) arterial phase, venous phase CT value difference were notsignificantly(P>0.05).(4) In comparison of the based substance concentration betweenwell-differentiated and poorly-differentiated group, the base material and theconcentration of iodine (water) in the arterial phase and venous phase of the poorlydifferentiated renal clear cell carcinoma group were higher than well-differentiatedgroup, and the differences were statistically significant (p <0.05). There was nosignificant differences in refer to base material water (iodine) concentration in thearterial and venous phase (p>0.05).Conclusions:(1) Characteristics of CT spectroscopy imaging inwell-differentiated and the poorly-differentiated renal clear cell carcinoma wassignificantly different, and the single-energy image spectrum curve can be used topredict the well or poor differentiation in renal cellcarcinoma.(2) The iodineconcentration in quantitative analysis has certain value to predict the pathologicalgrading of renal cell carcinoma.