超声造影结合Bosniak分级诊断囊性肾癌的可行性

Feasibility of contrast-enhanced ultrasonography combined with Bosniak classification in diagnosis of cystic renal cell carcinoma

目的探讨超声造影结合Bosniak分级诊断囊性肾癌的可行性。方法回顾性分析经手术病理证实的24例囊性肾癌的常规超声及超声造影表现,评估指标包括囊隔数目、囊隔或囊壁厚度、有无实性结节以及囊壁、囊隔或结节处血供情况。根据超声造影声像图特征进行Bosniak分级并统计其诊断符合率。结果常规超声声像图表现:2个病灶内未见分隔,8个见少量分隔,14个见多条分隔;5个囊壁或囊隔厚度≤1 mm,19个>1 mm;7个病灶内见实性结节;11个病灶的囊壁、囊隔或结节处可见彩色血流信号。超声造影声像图表现:8个病灶内见少量分隔,16个见多条分隔;1个囊壁或囊隔厚度≤1 mm,23个>1 mm;9个病灶内见实性结节;所有病灶的囊壁、囊隔或结节处均可见造影剂灌注增强。Bosniak分级示Ⅲ级15个,Ⅳ级9个,诊断符合率为100%。结论与常规超声相比,超声造影能清晰显示囊性肾癌的血供和复杂的内部结构,超声造影结合Bosniak分级可用于诊断囊性肾癌。

Objective To investigate the feasibility of contrast-enhanced ultrasonography（CEUS） combined with Bosniak classification in diagnosis of cystic renal cell carcinoma（CRCC）.Methods Routine and contrast-enhanced ultrasonic manifestations of 24 patients（24 lesions） of CRCC confirmed with operation and pathology were retrospectively analyzed.The number of septa,thickness of wall and septa,with or without solid nodules and blood supply were evaluated.Each tumor was categorized on CEUS images using the Bosniak classification system,and the diagnostic coincidence rate was calculated.Results On routine ultrasonographic images,there were 2 lesions without septa,8 with a few septa and 14 with multiple septa,5 lesions with septa and（or） wall thickness ≤1 mm and 19 lesions thickness 1 mm;solid nodules were shown in 7 lesions and the color flow was shown in 11 lesions.On CEUS images,there were 8 lesions with a few septa and 16 with multiple septa,1 lesion with septa and（or） wall thickness ≤1 mm and 23 lesions thickness 1 mm;solid nodules were shown in 9 lesions,and the enhancement could be demonstrated in all the lesions.According to Bosniak classification system,CEUS demonstrated 15 grade Ⅲ and 9 grade Ⅳ lesions.The diagnostic coincidence rate of CEUS combined with Bosniak classification was 100%.Conclusion The blood supply and sophisticated internal structures of CRCC can be shown better with CEUS than routine ultrasonography.CEUS combined with Bosniak classification can be used for the diagnosis of CRCC.