评估肉瘤型肾细胞癌（RCC）的MRI特征及其与生存率的关系。这项回顾性单中心研究纳入了59例在2003年7月至2019年12月接受肾切除前MRI检查的肉瘤型RCC患者。三位放射科医师评估了肿瘤大小、非增强区域、淋巴结转移和T2低信号强度区域（T2LIA）的体积（和百分比）等MRI发现。提取了年龄、性别、种族、基线转移状况、病理细节（分型和肉瘤分化的范围）、治疗类型和随访等临床病理因素。使用Kaplan-Meier方法估计生存率，并采用Cox比例危险回归模型确定与生存相关的因素。其中包括41名男性和18名女性（中位年龄62岁；四分位范围51～68）。43例（72.9%）患者有T2LIA。单因素分析发现，与较短生存相关的临床病理因素包括：更大的肿瘤大小（> 10cm；HR [风险比]=2.44，95% CI 1.15-5.21；p=0.02）、转移淋巴结（存在；HR=2.10，95% CI 1.01-4.37；p=0.04）、非点状肉瘤分化范围（HR=3.30，95% CI 1.55-7.01；p<0.01）、清细胞、乳头状或着色体型以外的亚型（HR=3.25，95% CI 1.28-8.20；p=0.01）、基线转移（HR=5.04，95% CI 2.40-10.59；p<0.01）。与较短生存相关的MRI特征包括淋巴结转移（HR=2.24，95% CI 1.16-4.71；p=0.01）和T2LIA体积（>3.2mL，HR=4.22，95% CI 1.92-9.29；p<0.01）。多因素分析发现，转移疾病（HR=6.89，95% CI 2.79-16.97；p<0.01）、其他亚型（HR=9.50，95% CI 2.81-32.13；p<0.01）和更大的T2LIA体积（HR=2.51，95% CI 1.04-6.05；p=0.04）仍然与较差的生存相关。T2LIA存在于约三分之二的肉瘤型RCC中。T2LIA的体积以及临床病理因素与生存有关。©2023年，作者（们）。

To evaluate MRI features of sarcomatoid renal cell carcinoma (RCC) and their association with survival.This retrospective single-center study included 59 patients with sarcomatoid RCC who underwent MRI before nephrectomy during July 2003-December 2019. Three radiologists reviewed MRI findings of tumor size, non-enhancing areas, lymphadenopathy, and volume (and percentage) of T2 low signal intensity areas (T2LIA). Clinicopathological factors of age, gender, ethnicity, baseline metastatic status, pathological details (subtype and extent of sarcomatoid differentiation), treatment type, and follow-up were extracted. Survival was estimated using Kaplan-Meier method and Cox proportional-hazards regression model was used to identify factors associated with survival.Forty-one males and eighteen females (median age 62 years; interquartile range 51-68) were included. T2LIAs were present in 43 (72.9%) patients. At univariate analysis, clinicopathological factors associated with shorter survival were: greater tumor size (> 10 cm; HR [hazard ratio] = 2.44, 95% CI 1.15-5.21; p = 0.02), metastatic lymph nodes (present; HR = 2.10, 95% CI 1.01-4.37; p = 0.04), extent of sarcomatoid differentiation (non-focal; HR = 3.30, 95% CI 1.55-7.01; p < 0.01), subtypes other than clear cell, papillary, or chromophobe (HR = 3.25, 95% CI 1.28-8.20; p = 0.01), and metastasis at baseline (HR = 5.04, 95% CI 2.40-10.59; p < 0.01). MRI features associated with shorter survival were: lymphadenopathy (HR = 2.24, 95% CI 1.16-4.71; p = 0.01) and volume of T2LIA (> 3.2 mL, HR = 4.22, 95% CI 1.92-9.29); p < 0.01). At multivariate analysis, metastatic disease (HR = 6.89, 95% CI 2.79-16.97; p < 0.01), other subtypes (HR = 9.50, 95% CI 2.81-32.13; p < 0.01), and greater volume of T2LIA (HR = 2.51, 95% CI 1.04-6.05; p = 0.04) remained independently associated with worse survival.T2LIAs were present in approximately two thirds of sarcomatoid RCCs. Volume of T2LIA along with clinicopathological factors were associated with survival.© 2023. The Author(s).