肾脏良恶性占位性病变超声造影增强模式分析

Contrast enhanced ultrasonography in study on enhancement patterns of renal masses

目的分析比较肾脏良恶性占位性病变超声造影增强模式。方法对52例肾脏占位性病变患者共52个病灶进行超声造影,观察超声造影增强模式,分析肾脏恶性占位性病灶超声造影时间-强度曲线定量参数,包括峰值强度、达峰时间、曲线尖度、曲线下面积。采用配对t检验比较上述各参数在肾脏恶性占位性病灶与癌周正常肾皮质间的差异。结果 52个肾脏占位性病灶中恶性42个,良性10个。42个恶性肾脏占位性病灶中,32个透明细胞癌以快进、明显高增强为主(28/32,87.5%);2个嫌色细胞癌中,1个表现为快进、明显高增强,另1个表现为慢进、低增强;4个乳头状细胞癌均表现为慢进、轻度高增强;4个移行细胞癌表现为快进、高增强。10个肾脏良性占位性病灶中6个肾血管平滑肌脂肪瘤以慢进、低增强为主(5/6,83.3%);3个肾囊肿始终无增强;1个肾球旁细胞瘤呈慢进、低增强。肾脏恶性占位性病灶的峰值强度、曲线下面积分别为(47.189±11.245)%、(3.893±2.587)/s,均高于癌周正常肾皮质的(38.563±9.030)%、(2.552±1.464)/s,且差异均有统计学意义(t值分别为-3.723、-3.035,P均<0.01);肾脏恶性占位性病灶的达峰时间为(34.196±14.996)s,早于癌周正常肾皮质的(41.365±17.700)s,且差异有统计学意义(t=2.124,P<0.05)。肾脏恶性占位性病灶与癌周正常肾皮质的曲线尖度分别为(0.082±0.054)/s、(0.065±0.032)/s,差异无统计学意义(t=-1.672,P=0.112)。结论肾脏占位性病变超声造影增强模式结合时间-强度曲线可为鉴别病变良恶性提供依据。

Objective To explore the enhancement patterns of renal masses by contrast enhanced ultrasonography(CEUS).Methods Fifty-two patients with renal masses were examined by CEUS.The enhancement patterns of renal masses were observed and the time-intensity curves of the malignant lesions were assessed,and obtained the perfusion parameters of the renal malignant lesions and the normal renal cortex of themselves,the perfusion parameters:the peak intensity,the time-to-peak,the sharpness of the curve,the area under the curve of the renal malignant lesions and the normal renal cortex of themselves were compared with the paired t test.Results The 52 masses included 42 malignant and 10 benign lesions confirmed by pathological examination.In the malignant lesions,most of the 32 renal clear-cell carcinomas(87.5%)presented 'fast-in and hyper-enhanced significantly'.One renal chromophobe cell carcinoma displayed 'fast-in and hyper-enhanced',the other renal chromophobe cell carcinoma presented 'slow-in and hypo-enhanced significantly'.The enhancement patterns of 4 papillary renal cell carcinomas were 'slow-in and hyper-enhanced slightly'.Four transitional cell carcinomas showed 'fast-in and hyper-enhanced'.In the benign lesions,the enhancement patterns of angiomyolipomas were mainly 'slow-in and hypo-enhanced'.The renal cysts showed no enhancement.The peak intensity and area under the curve in the malignant lesions were higher than the normal renal cortex of themselves significantly[(47.189±11.245)% vs(38.563±9.030)%,(3.893±2.587)/s vs(2.552±1.464)/s,t=-3.723,-3.035,P<0.01].The time-to-peak was earlier than the normal renal cortex[(34.196±14.996)s vs(41.365±17.700)s,t=2.124,P<0.05].Conclusion The enhancement patterns combined with time-intensity curves of renal masses can provide the basis for the differential diagnosis of lesions.