超声造影和增强CT在肾细胞癌分型中的诊断价值

The value of contrast-enhanced ultrasound and contrast-enhanced computed-tomography in diagnosis of renal cell carcinoma subtyping

目的探讨超声造影及增强CT在肾细胞癌诊断中的作用。方法 672例肾细胞癌,其中肾透明细胞癌562例,乳头状细胞癌68例,嫌色细胞癌42例,对其先行超声造影检查,分析其时间-强度曲线,再行增强CT检查。结果 537例肾透明细胞癌瘤灶呈富血供造影表现,造影剂到达时间及曲线达峰时间低于肾皮质(P<0.05),曲线上升斜率、达峰绝对值、曲线下面积高于周围肾皮质(P<0.05),25例呈乏血供表现;肾嫌色细胞癌均呈乏血供造影表现,达峰绝对值、曲线下面积低于肾皮质(P<0.05);肾乳头状细胞癌多呈乏血供造影表现,曲线达峰时间高于周围肾皮质(P<0.05),达峰绝对值低于肾皮质(P<0.05)。512例肾透明细胞癌动态增强皮质期显著不均匀强化,强化程度等于或高于周围肾皮质;肾嫌色细胞癌皮髓质期强化程度最高,但强化程度明显低于肾皮质;肾乳头状细胞癌增强扫描肿瘤实性部分轻-中度均匀强化,54例皮髓交界期强化程度与肾皮质较一致或略强于肾皮质。结论超声造影和增强CT的时间-强度曲线分析对肾细胞癌的分型均具有一定的诊断价值。

Objective To explore the value of contrast-enhanced ultrasound（CEUS） and contrast-enhanced computed -tomography（CECT） in diagnosis of renal cell carcinoma. Methods Sixty hundred and seventy-two patients with renal cell carcinoma were confirmed by pathology and surgery, including 562 cases of clear cell carcinoma, 68 cases of papillary cell carcinoma and 42 cases of chromophobe cell carcinoma. CEUS was performed and the time - intensity curve of CEUS was analyzed, then CECT was performed on the patients. Results By CEUS, 537 cases of clear cell carcinoma showed hypervascular imaging performance, time - intensity curve showed the arrival time and the time to peak were lower than those of renal cortex （ P〈0.05 ）, slop of the risig curve, difference of peak intensity and area under the curve were higher than those of surrounding renal cortex （ P〈0.05 ） , 25 cases showed a lack of blood supply performance. While ehromophobe cell carcinoma showed poor blood supply compared with the renal cortex, the difference of peak intensity and area under the curve were lower than those of renal cortex （P〈0.05） , papillary renal cell carcinoma showed poor blood supply compared with the renal cortex, time to peak was higher than that of surrounding renal cortex （ P〈0.05 ） , difference of peak intensity was lower than that of renal cortex （ P〈 0.05 ）. By CECT, 512 cases of clear cell carcinoma tumor showed obvious heterogeneous enhancement during cortical phase. The enhancement was higher than the renal cortex; Chromophobic cell renal carcinoma showed enhancement in the whole scanning process, but the enhancement was lower than the cortex; papillary cell carcinoma showed mild-moderate homogeneous enhancement in the solid part of the tumors, in 54 cases, the degree of enhancement was equivalent to or slightly stronger than the renal cortex during in the corticomedullary phase. Conclusion CEUS and CECT all play important roles in diagnosis and typing of renal cell carcinoma.