超声造影与增强CT检查诊断肾癌的比较研究

Comparison study of contrast-enhanced ultrasound and contrast CT on diagnosis of renal cell carcinoma

目的 比较肾癌超声造影和增强CT扫描检查的一致性及特点.方法 2004-2008年,117例肾脏局灶性病变患者共124个病灶接受了超声造影和增强CT检查.男87例,女30例.平均年龄（47.3±14.1）岁.单发病灶者110例,2个病灶者7例.其中肾癌患者63例65个病灶.比较肾癌超声造影和增强CT扫描检查特点,判断超声造影诊断效能. 结果超声造影和增强CT检查对肾癌皮质期富血供、假包膜增强显示率分别为87.7%（57/65）和63.1%（41/65）、89.2%（58/65）和69.2%（45/65）,差异有统计学意义（P〈0.05）.二者对病灶内无增强区的显示率分别为72.3%（47/65）和56.9%（37/65）,差异无统计学意义（P〉0.05）.以增强CT扫描检查为肾癌影像学诊断的金标准,超声造影诊断肾癌的敏感性、特异性、阳性预测值、阴性预测值以及准确性分别为89.1%（57/64）、91.7%（55/60）、91.9%（57/62）、88.7%（55/62）和90.3%（112/124）,与增强CT诊断肾癌的一致性K值为0.806.结论 超声造影与增强CT扫描检查定性诊断肾癌的一致性高,显示肾癌富血供及假包膜增强等影像学特征优于CT.

Objective To compare contrast-enhanced ultrasound（CEUS）and contrast-enhaneed computed tomography（CECT）on the diagnosis of renal cell carcinoma（RCC）. Methods CEUS and CECT were performed on 117 patients（87 men and 30 women）with 124 renal lesions（single nodule in 110 and two nodules in 7）from 2004 to 2008.Among them,there were 63 patients with 65 lesions diagnosed as RCC confirmed by pathology.The tumor enhancement pattern,extent,and dynamic change of CEUS and CECT were compared.The diagnostic efficacy of CEUS and the agreement of CECT and CEUS in diagnosing RCC were analyzed. Results The rate of displaying hypervascular performance on cortical phase,and pseudocapsule enhancement of the RCC lesions by CEUS and CECT were 87.7%（57/65）and 63.1%（41/65）,89.2%（58/65）and 69.2%（45/65）（P〈0.05）.The rate of displaying heterogeneous enhancement were 72.3%（47/65）and 56.9%（37/65）（P〉0.05）Using the diagnosis of CECT as reference diagnostic criteria,the sensitivity,specificity,positive predietive value,negative predictive value,and accuracy of CEUS in diagnosing RCC were 89.1%（57/64）,91.7%（55/60）,91.9%（57/62）,88.7%（55/62）and 90.3%（112/124）.The agreement of CECT and CEUS in diagnosing RCC was high（κ=0.806）. Conclusions CEUS and CECT have the coordinate efficacy in diagnosing RCC.