常规超声和超声造影在老年患者肾盂尿路上皮癌诊断中的应用价值

The practical value of conventional ultrasound combined with contrast-enhanced ultrasound in the diagnosis of urothelial carcinoma of the renal pelvis in elderly patients

目的分析常规超声和超声造影(CEUS)对老年肾盂尿路上皮癌(UCs)患者的诊断价值.方法回顾性分析,纳入2015年4月至2023年3月陕西省人民医院手术病理结果为肾盂UCs的67例老年患者,分析术前常规二维超声、常规彩色多普勒血流显像(CDFI)和CEUS特点.结果67例患者中,49例(73.13%)病灶局限于肾盂、肾盏内.其中53例(79.10%)能被常规超声清晰识别:等-低回声46例(86.79%),高回声7例(13.21%);CDFI血流显示:22例(41.51%)无血流信号、21例(39.62%)少许血流信号、10例(18.87%)为明显血流信号;阻力指数(RI)平均值0.64.静脉注射声诺维CEUS后观察,62例(92.54%)病灶出现强化而被识别,与同侧肾皮质开始增强时间比较,46例(74.19%)开始增强晚于肾皮质为慢进;14例(22.58%)为同进;2例(3.23%)为快进.峰值强度分析,达峰时43例病灶(69.35%)相对肾皮质呈低增强,10例(16.13%)呈等增强,9例(14.52%)呈高增强;增强均匀程度分析,16例(25.81%)病灶呈不均匀强化,肿瘤坏死或出血,46例(74.19%)病灶呈均匀强化;造影剂消退分析,53例(85.48%)呈快速廓清为快退,6例(9.68%)呈同步廓清,3例(4.84%)呈缓慢退出为慢退.结论老年患者肾盂UCs常规超声多呈等-低回声,CDFI无血流或彩色血流稀疏;CEUS相对肾皮质呈慢进、快退和低增强的特征.常规超声联合CEUS可帮助提高肾盂UCs的诊断正确率.

Objective To assess the combination of conventional ultrasound with contrast-enhanced ultrasound(CEUS)in the diagnosis of urothelial carcinoma(UC)of the renal pelvis in elderly patients.Methods Sixty-seven elderly patients with a histopathologic diagnosis of UC of the renal pelvis and surgically treated at our hospital between April 2015 and March 2023 were retrospectively analyzed.Characteristics of regular preoperative 2D ultrasound,color Doppler flow imaging(CDFI)and CEUS were examined.Results Of 67 patients,49(73.13%)were found to have localized lesions in the renal pelvis and renal calyces.Lesions in 53 patients(79.10%)could be clearly identified by conventional ultrasound,with 46(86.79%)being isoechoic or hypoechoic,and 7(13.21%)being hyperechoic.Analysis of tumor blood flow by CDFI found 22 cases(41.51%)with avascular lesions,21(39.62%)with hypovascular lesions and 10(18.87%)with hypervascular lesions.The average value of the resistance index(RI)was 0.64.Enhancement was seen in 62 lesions(92.54%)by CEUS after injection of SonoVue.Compared with the cortex of the ipsilateral kidney,a slow enhancement pattern was observed in 46(74.19%),14(22.58%)showed simultaneous enhancement,and 2(3.23%)showed fast enhancement.At peak enhancement,43 lesions(69.35%)had hypo-enhancement,10(16.13%)had iso-enhancement,and 9(14.52%)had hyper-enhancement,compared with the cortex.Concerning the homogeneity of enhancement,16(25.81%)displayed heterogeneous enhancement,with tumor necrosis or hemorrhage,and 46(74.19%)had homogeneous enhancement.When the contrast agent washout rate was assessed,a fast washout pattern was observed in 53(85.48%),synchronous washout in 6(9.68%),and slow washout in 3(4.84%).Conclusions UC of the renal pelvis mostly shows isoechoic and hypoechoic lesions on conventional ultrasound,avascular or hypo-vascular lesions on CDFl,and slow-in,fast-out and hypo-enhancement on CEUS,compared with the cortex.Conventional ultrasound combined with CEUS can help improve the diagnostic accuracy of UC of the renal pelvis.