超声造影在肾细胞癌分型中的应用价值

Contrast-enhanced ultrasound in renal cell carcinoma subtyping

目的探讨超声造影在肾细胞癌分型中的应用价值。方法对经手术病理证实的70个肾细胞癌(包括58个肾透明细胞癌,7个乳头状细胞癌,5个嫌色细胞癌)的超声造影图像进行分析,对比观察肿瘤及瘤旁肾皮质显影过程,检测指标包括开始增强方式、消退方式、到达时间、达峰时间、达峰强度及消退强度(后4项由时间-强度曲线得到)。结果53个透明细胞癌表现为肿瘤开始增强较肾皮质早或同时,消退较慢,肿瘤内造影剂灌注量多于肾皮质,即富血供表现。以富血供表现诊断透明细胞癌的特异性及敏感性为100%和91%。其余肾细胞癌为乏血供表现,其中嫌色细胞癌全部以均匀增强、消退期肿瘤周边出现高增强晕环,达峰强度稍低于肾皮质为特征性表现;乳头状细胞癌及乏血供透明细胞癌造影表现有交叉。结论超声造影有助于肾细胞癌的分型诊断。

Objective To discuss the value of contrast-enhanced ultrasound (CEUS) in renal cell carcinoma (RCC) subtyping.Methods The CEUS features of RCC in 70 cases, including 58 clear cell carcinomas, 7 papillary carcinomas, 5 chromphobe carcinomas and all identified by operation and pathology were reviewed. The enhanced eches was compared between tumors and peripheral cortex using washing-in and washing-out pattern, arrival time (AT), time-to-peak (TTP), peak intensity (PI) and the intensity in 60s after agent injection (the latter four items were derived from time-intensity curve).Results The hyper-vascular pattern was showed in 53 clear cell carcinoma characterized by earlier (or simultaneously) washing-in, later washing out, and more agent in the tumor than in the cortex. The specificity and sensibility of diag-nosing clear cell carcinoma was 100% and 91% using hypervascular pattern. In other tumors which showed the contrary hypovascular pattern, chromophobe carcinoma was all characterized by homogeneous and later washing-in, slightly less agent in the tumor than in its surrounding cortex, and hyper-echoed capsule in washing-out process. CEUS performance overlapped in hypovascular clear cell carcinoma and papillary carci-noma.Conclusions CEUS is of certain significance to differentiate RCC subtyping.