Objective:To investigate the relationship between MDCT findings and Fuhrman grade of clear cell renal cell carcinoma (ccRCC).Materials and Methods:A retrospective analysis of MDCT manifestations of 113 patients with pathologically confirmed ccRCC,including 8 cases of Fuhrman grade Ⅰ,60 cases of Fuhrman grade Ⅱ,30 cases of Fuhrman grade Ⅲ and 15 cases of Fuhrman grade Ⅳ.The tumor characteristics,including tumor size,cystic versus solid,calcification,heterogeneity of lesions,percentage of non-enhancing necrotic ratio and growth pattern were noted independently by two radiologists,and statistical analysis was performed.Results:Fourteen of fifteen(93.3％) cystic ccRCC were low grade(Fuhrman grades Ⅰ ～ Ⅱ).In predominantly solid ccRCC,twenty of twenty-seven (74％) infiltrative ccRCC were high grade (Fuhrman grades Ⅲ～Ⅳ).Univariate analysis showed that larger tumor size (critical value 4 cm) had higher grade (x2=1 1.441,P＜0.001);calcification and necrotic ratio ≥0.6 were significantly more common in high grade ccRCC than in low grade ccRCC (x2=29.007,P＜0.001;x2=18.454,P=0.030).Multivariate analysis showed tumor size;infiltrative growth and necrotic ratio ≥0.6 were Fuhrman grades Ⅲ～Ⅳ of three independent predictors (OR:0.122,P=0.002;OR:13.234,P=0.002;OR:12.891,P=-0.031).Conclusion:Multidetector CT shows great application value in distinguishing Fuhrman grading system of ccRCC.Cystic ccRCC tends to have low grade.Infiltrative growth,larger tumor size and necrotic ratio ≥0.6 may increase the likelihood of high grade predominantly solid ccRCC.%目的:探讨肾透明细胞癌(ccRCC)MDCT影像学表现与Fuhrman分级之间的关系.方法:回顾性分析113例经手术病理证实的ccRCC的MDCT影像资料.两名放射科医生双盲记录患者的影像学特征,包括肿瘤大小、囊性或实性、钙化、不均匀性、坏死比、生长方式等,并与Fuhrman分级结果进行统计学分析.结果:14/15例囊性ccRCC为低级别(Fuhrman Ⅰ～Ⅱ级);在相对较多的实性ccRCC中,20/27例浸润型ccRCC为高级别(FuhrmanⅢ～Ⅳ级).单因素分析显示肿瘤越大(临界值为4 cm),Fuhrman分级越高(x2=1 1.441,P＜0.001);高级别以实性为主ccRCC中钙化和坏死比≥0.6较低级别实性ccRCC多见(x2=29.007,P＜0.001;x2-18.454,P=0.030).多因素分析提示肿瘤大小、浸润性生长、坏死比≥0.6是实性为主ccRCC FuhrmanⅢ～Ⅳ级的独立预测因素(OR:0.122,P=0.002;OR:13.234,P=0.002;OR:12.891,P=0.031).结论:MDCT对预测ccRCC Fuhrman分级有较大的应用价值.囊性ccRCC倾向于低级别.以实性为主ccRCC中,肿瘤越大、浸润性生长、坏死比(≥0.6)越高,均预示较高的Fuhrman分级.
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