肾癌的三维彩色能量图超声表现与病理分析

Renal cell carcinoma diagnosing by 3D-CDE and pathologic analysis

目的:探讨CDE和3D-CDE血流表现特点在肾癌诊断中的应用价值。方法:经手术证实的43例肾癌患者,观察肾肿瘤的超声表现、CDE和3D-CDE血流特点,结果与病理对比分析。结果:本组发现肾癌43个,均单侧发病,肿物位于左肾23个,右肾20个,全部手术切除肿瘤。病理为透明细胞癌40例,颗粒细胞癌3例。二维声像图表现:低回声型21例(48.8%),混合回声型13例(30.2%),高回声型8例(18.6%),囊肿型1例(2.3%)。CDE和3D-CDE分为两型:血流丰富和血流稀少型。血流丰富型38例,占88.4%,显示肿瘤周边具有粗大的血管,向瘤内发出分支,以细小分支为主,见于二维图像表现为高回声、低回声型和部分(小的)混合回声型肿瘤。血流稀少型5例,占11.6%,见于囊性和较大混合回声肿瘤。结论:超声可以清晰显示肾癌的内部回声特点,结果和病理有良好的相关性,3D-CDE可以良好显示肾癌的血流分布和空间结构,进而对肿瘤良恶性的鉴别提供帮助。

Objective： To investigate tumor vascular type detecting by CDE and 3D-CDE in renal cell carcinoma patients. Methods： We observed the CDE and 3D-CDE vascular characteristics by Doppler ultrasound in 43 patients with renal cell carcinomas who underwent surgery, the results were compared with pathologic result. Results： Forty-three tumors were found by ultrasonography, in which 23 masses were located in left kidney, the other 20 tumors in right kidney. Pathological results showed that 93.02%（40/43） was clear cell carcinoma, 6.98%（3/43） was granular cell carcinoma. Two-dimensional ultrasonic features were classified by echo partern： hypoechoic in 21 cases （48.8%）, mixed echoic in 13 cases （30.2%）, hyperechoic in 8 cases（18.6%）, cystic in 1 case（2.3%）. Vascular type in CDE and 3D-CDE images were divided into two groups： 88.4%（38/43） with rich blood supply and 11.6%（5/43） with poor blood supply. Many peripheral and internal branch vessels were showed in tumors with rich blood supply, mainly in solid and small mixed echoic in sonogram, the other, showed very little blood supply by CDE and 3D-CDE, mainly in bigger mixed echoic and cystic tumors.Conclusions： Tumor internal echoic characteristic can be displayed clearly by ultrasound in renal cell carcinoma patients, and also has good correlations with pathology. 3D- CDE can demonstrate tumor vascular distribution and spatial structure, also may play an important role in diagnosis.