小儿肾透明细胞肉瘤的超声影像学特征

Ultrasonographic features of renal clear cell sarcoma in children

目的分析小儿肾透明细胞肉瘤(CCSK)超声检查的影像学特征。方法选取郑州大学附属儿童医院2017年1月至2017年12月CCSK患儿70例(经病理证实)作为研究对象,给予彩色多普勒超声及超声造影检查。比较两种影像学阳性检出情况、诊断价值,分析其影像学特征。结果彩色多普勒超声阳性率为97.14%(68/70),超声造影阳性率为75.71%(53/70),差异有统计学意义(P<0.05)。彩色多普勒超声诊断敏感性(78.62%)、灵敏性(85.74%)、特异性(89.63%)均高于超声造影(69.35%、75.26%、75.68%),差异有统计学意义(P<0.05)。超声造影特征:病灶多表现为回声或低回声,后方出现衰减表现为混合型回声或无回声。形态以类圆型为主,多为肾内占位性,表面局部凹凸。彩色多普勒超声:超声显示肿瘤直径>10 mm有32例,形态不规则,可见包膜结构,尚完整。6例患者与残余肾脏组织分界不清。肿瘤内部呈现不同匀质回声,其中中等回声35例,强回声33例。5例患儿呈现实质性回声,16例患儿伴有大小不等的无回声,其中1例为混杂强回声。9例患儿可见血流,其中5例患儿血流丰富,1例患儿血流较丰度,呈现"抱团征"。3例患儿肿瘤纤维血管间隔增多,呈现"鸡爪样",1例呈现"树枝样"。结论彩色多普勒超声对小儿肾透明细胞肉瘤有较高的诊断价值,且影像学特征较明确,容易鉴别及诊断,建议使用。

Objective To analyze the imaging features of renal clear cell sarcoma(CCSK)in children.Methods From January 2017 to December 2017,70 children with CCSK(confirmed by pathology)from children’s Hospital Affiliated to Zhengzhou University were selected as the study objects,and color Doppler ultrasound and contrast-enhanced ultrasound were performed.To compare the positive detection and diagnostic value of two kinds of imaging,and analyze the imaging characteristics.Results The positive rate of CDUS was 97.14%(68/70),and that of contrast-enhanced ultrasound was 75.71%(53/70),the difference was significant(P<0.05).The diagnostic sensitivity(78.62%),sensitivity(85.74%)and specificity(89.63%)of color Doppler ultrasound were higher than those of contrast-enhanced ultrasound(69.35%,75.26%and 75.68%),the differences were significant(P<0.05).Contrast-enhanced ultrasound features:most lesions showed echo or low echo,and the attenuation in the rear showed mixed echo or no echo.The shape is mainly round type,mostly occupying in kidney,with local concave convex surface.Color Doppler ultrasound:there were 32 cases with tumor diameter more than 10 mm.The shape was irregular and the capsule structure was still intact.The boundary between 6 patients and residual kidney was not clear.There were different homogeneous echoes in the tumor,including 35 cases with moderate echo and 33 cases with strong echo.There were 5 children with solid echo,16 children with non echo of different sizes,one of them was mixed strong echo.Blood flow was found in 9 children,5 cases of them were rich in blood flow,and 1 case of them was rich in blood flow.In 3 cases,the tumor fibrovascular septa increased,showing"chicken claw like",and in 1 case showing"branch like".Conclusions Color Doppler ultrasound has high diagnostic value for children’s renal clear cell sarcoma,and the imaging features are clear,easy to distinguish and diagnose,it is recommended to use.