彩色多普勒超声对鉴别良恶性肾肿瘤的意义

Significance of color Doppler ultrasonography for differentiating benign and malignant renal neoplasms

目的探讨彩色多普勒超声(CDUS)对鉴别肾脏良、恶性肿瘤的意义。方法32例由手术病理证实的肾肿瘤患者(23例肾细胞癌,6例肾盂移行细胞癌,以及3例肾错构瘤)均经CDUS检查,首先分析其二维声像图特征,其次测量其肾动脉峰值血流速度及阻力指数,并将良、恶性患者的测量均值进行比较。结果肾脏良、恶性肿瘤具有不同的声像图特征,恶性肿瘤患者肾动脉峰值流速高于良性肿瘤患者,RI低于良性肿瘤患者。在32例中,CDUS定位诊断准确率为100%,2例恶性肿瘤被误诊为良性肿瘤,2例良性肿瘤被误诊为恶性肿瘤,CDUS的诊断敏感性为93.5%,特异性33.3%,准确性87.5%。结论CDUS,尤其是彩色多普勒血流显像(CDFI)技术对肾动脉血流参数的检测及对肿瘤内血流分布的评价,在鉴别肾脏良、恶性肿瘤中起重要作用。

Objective To explore the significance of color Doppler ultrasonography （CDUS） for differentiating benign and malignant renal neoplasms. Methods Thirty-two patients with surgically and pathologically proved renal neoplasms which comprised 23 renal cell carcinomas, 6 pyelic transitional-cell carcinomas, and 3 hamartomas underwent CDUS examinations, i.e.first analyzing the 2D sonographic characteristics and then measuring the maximal systole velocity（Vmax） of renal artery and the minimal diastole velocity（Vmin） of renal artery as well as the resistance index （RI） of intratumoral renal artery. The average value measured from the both of benign and malignant tumors was statistically compared. Results CDUS showed different sonographic characteristics in benign and malignant renal tumors, for example, the Vmax and the Vmin in patients with malignant tumor were significantly higher than those in patients with benign tumor, however, the RI in patients with malignant tumor was slightly lower than that in patients with benign tumor. In the group patients, the localized accuracy of CDUS was 100%. Two patients with malignant tumors were misdiagnosed as benign tumors , while two patients with benign tumors were misdiagnosed as malignant tumors. The diagnostic sensitivity, specificity and accuracy of CDUS were 93.5%,33.3% and 87.5%, respectively. Conclusion CDUS, especially color Doppler flow imaging （CDFI） technique used for the detection of renal artery blood-flow parameters and the evaluation of intratumoral blood-flow distribution play important role to differentiate benign and malignant renal tumors.