超声造影诊断输尿管占位的初步探讨

Contrast-enhanced ultrasonography in ureteral lesions ： a preliminary study

目的探讨超声造影诊断输尿管占位的可行性及声像表现。方法对19例19个经手术病理证实为输尿管占位性病变的常规超声及超声造影声像图进行回顾性分析。常规超声观察输尿管占位大小、回声、边界、有无彩色血流信号。超声造影观察病灶的增强方式和增强时相，包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果本组19个肿块最大长径范围2．1～7．7cm，常规超声显示低回声肿块7个，等回声肿块10个，高回声肿块1个，显示欠清1个；8个病灶内发现彩色血流信号，6个仅周边见彩色血流信号，5个未显示彩色血流信号。超声造影19例病灶早期均见增强，同步增强8个，缓慢增强11个；达峰值时呈稍高回声11个，稍低回声3个，等回声5个；增强晚期快速消退16个，同步消退1个，稍慢消退1个，不能比较1个。常规超声的病灶血供检出率、边界清晰显示率和输尿管癌的诊断敏感性分别为74％（14／19）、16％（3／19）和50％（8／16），超声造影的病灶血供检出率、边界清晰显示率和输尿管癌的诊断敏感性分别为100％（19／19）、58％（11／19）和94％（15／16），两组差异有统计学意义。结论超声造影可改善输尿管占位的血供和边界显示，提高诊断敏感性。

Objective To explore the diagnostic value of contrast-enhanced ultrasonography （CEUS） in ureteral lesions. Methods The ultrasonogram of conventional ultrasound and CEUS were retrospectively analyzed in 19 confirmed ureteral lesions cases by operation and pathology. The size,inner echoes,boundary and color blood signal of ureteral lesions were observed by conventional ultrasound. The modality and phases of enhancement,including arrival time, peak time~ washout time and appearance of internal structure, were observed by CEUS. Results The 19 ureteral tumors were of maximum widths between 2.1 to 7.7 cm. Conventional ultrasound showed 7 hypoechoic masses, 10 isoechoic masses, 1 hyperechoic mass and 1 unclear mass. Color Doppler flow imaging showed fairly rich blood signal in 8 tumors, a small amount of blood signal around tumor in 6 tumors and no blood signal in the rest. In early phase, CEUS showed enhancement in all 19 ureteral lesions, including synchronously enhancement in 8 tumors and delayed enhancement in 11 tumors. In peak time, hypoechogenicity compared to the normal renal cortex was shown in 3 tumors, hyperechogenicity in 11 tumors and isoeehogenicity in 5 tumors. In late phase, fast wash-out was displayed in 16 tumors,isochronously wash-out in 1 tumor,delayed wash-out in 1 tumor and unclear in 1 tumor. The detection rates of blood supply and clear boundary in ureteral lesions and the diagnostic sensitivity for ureteral cancer were 74% （14/19）, 16% （3/19）, 50% （8/16） by conventional ultrasound respectively. The detection rates of blood supply and clear boundary in ureteral lesions and the diagnostic sensitivity for ureteral cancer were 100% （19/19）, 58% （11/19）, 94% （15/16） by CEUS respectively. The change of these performances was statistically significant between conventional ultrasound and CEUS. Conclusions CEUS can improve blood supply,boundary and the diagnostic sensitivity of ureteral lesions.