超声造影鉴别诊断肾透明细胞癌和肾血管平滑肌脂肪瘤

Contrast-enhanced ultrasonography in differential diagnosis of clear cell renal cell carcinoma and angiomyolipoma

目的比较肾透明细胞癌(CCRCC)和肾血管平滑肌脂肪瘤(AML)的超声造影声像图表现,探讨超声造影对二者的鉴别诊断价值。方法回顾106个CCRCC和25个AML的超声造影声像图表现,观察指标包括肿瘤的增强程度、增强均匀度、包膜增强、增强消退情况以及增强方式,分析超声造影声像图特征对肾癌的鉴别诊断价值。结果肿瘤的增强程度和增强消退时间在CCRCC与AML之间差异无统计学意义(P>0.05),而增强均匀度、包膜增强以及增强方式差异有统计学意义(P<0.01)。表现为不均匀增强、包膜增强以及弥漫性增强的肿瘤具有恶性倾向,其阳性预测值分别为97.26%、100%、94.74%。如将肿瘤同时具有这3种声像图特征作为CCRCC的诊断标准,其阳性预测值和阴性预测值达100%及95.00%。结论CCRCC和AML具有不同的超声造影声像图特征,超声造影有助于二者的鉴别诊断。

Objective To compare contrast-enhanced ultrasonography（CEUS）features of clear cell renal cell carcinoma（CCRCC）and angiomyolipoma（AML）,and to explore the value of CEUS for differential diagnosis.Methods CEUS appearance of 106 CCRCCs and 25 AMLs confirmed pathologically were analyzed retrospectively.For each lesion,the enhancement degree,the homogeneity of enhancement,the presence of perilesional enhancement,the washing-in and washing-out pattern and the process of enhancement（i.e.diffuse,centrifugal or centripetal enhancement）were evaluated.The results were compared with the pathologic findings.Results There was no statistically significance in the degree of enhancement and the washing-in and washing-out pattern between CCRCC and AML（P 〉0.05）.However,significantly different was found in the homogeneity of enhancement,the presence of perilesional enhancement and the process of enhancement between CCRCC and AML（P 〈0.01）.Heterogeneous enhancement,perilesional enhancement and diffuse enhancement were mainly seen in CCRCC,and the positive predictive value for CCRCC was 97.26%,100% and 94.74%,respectively.When all the three CEUS findings combined were used as criterion for differentiating CCRCC from AML,the positive and negative predictive values was 100% and 95.00%,respectively.Conclusion CEUS characteristics of CCRCC is different from that of AML.CEUS is useful for the differential diagnosis of CCRCC and AML.