| Purpose:The purpose of this study was to investigate the correlation between the extracellular volume fraction(EVF)calculated by msct and the degree of pathological differentiation of renal clear cell carcinoma(RCC)Materials and methods:Retrospective analysis of 2013 to 2020 in our hospital after resection of renal clear cell carcinoma and in our hospital before the routine three-phase enhanced MDCT scan.A total of 74 patients,with an average age of 56 and a sex ratio of 26:16,were enrolled in the study.The computed tomography(CT)images were measured and calculated by two radiologists with many years Of experience in radiology.The Region Of Interest(Roi)was placed in the solid Region Of the tumor,the CT values of plain scan and three phases of cortical,medullary and excretory phases were recorded,and the difference of CT values and ECV were calculated at the same time,use SMOTE algorithm to balance it.According to Furhman classification of clear cell renal carcinoma,all patients with grade I and Grade II were classified into low differentiation group,and those with grade III and IV were classified into high differentiation group,the age,sex,the maximum diameter,the location of the lesion,the presence or absence of cystic necrosis,calcification and blood routine parameters were compared between groups Spilman test was used to analyze whether there was a correlation between different differentiation levels.The evaluation of ECV score,CT value and CT difference for predicting the pathological grade of clear cell carcinoma and the determination of corresponding cut-off value were analyzed by receiver operating characteristic(ROC)curve,and the ROC curve was compared and analyzed.Results:There was no significant difference in age,sex,site,cystic change and calcification between the two groups(P > 0.05)The difference was statistically significant with the maximum diameter of the lesion and the hematocrit(p < 0.05).ECV was significantly higher in the well-differentiated group than that in the poorly-differentiated group(0.63(0.52,0.77),and0.88(0.82,0.96),P = 0.0003).The AUC(95% CI)was0.830(0.7500-0.9098),and the sensitivity and specificity were 83.9% and77.4%,respectively.The CT values of cortical stage,medullary stage and excretory stage were statistically different(p = 0.005).There was no significant difference between medullary stage and excretory stage(p =0.184,0.353,> 0.05).The AUC(95% CI)was 0.646(0.5459-0.7465),0.569(0.4650-0.6734),0.548(0.4432-0.6536).The sensitivity and specificity were 88.7% and 48.4%,respectively 96.8%,25.8%,83.9%,38.7%,PPV and NPV were 0.632,0.811,0.566,0.889,0.678,0.706 respectively.The CT values(△s 1,△s 2,△s 3)in cortical,medullary and excretory phases of the lesions were statistically analyzed(p =0.034,0.005,0.008;all < 0.05)The AUC(95% CI)was 0.610(0.5087-0.7109),0.646(0.5391-0.7523)and 0.638(0.5381-0.7376),the sensitivity and specificity were 93.5% and 29.0%,respectively 88.7%,54.8% and 72.6%,58.1%,PPV and NPV were 0.569,0.818,0.663,0.829,0.634,0.679 respectively.Compared with the ROC curve of CT value of each period,AUC(ECV)is higher than AUC(CT value of each period),respectively,and the P value is much less than 0.05;ECV is compared with the ROC curve of CT difference of each period,AUC(ECV)is higher than AUC(CT value in each phase),respectively,0.220,0.184,0.192,P value is much less than 0.05,and the difference in diagnostic value is statistically significant.Conclusion:The extracelluar volume fraction calculated by CT can be used as the imaging index of the degree of pathological differentiation of RCC,and is more valuable than the CT value and the CT differential value... |
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