超声造影环状高增强征象诊断肾癌的特异性分析

Specificity analysis of peritumoral hyper-enhanced rim in diagnosis of renal tumors using contrast-enhanced ultrasound

目的 探讨超声造影环状高增强(PHR)征象对于肾常见肿瘤定性诊断的价值。方法 回顾性分析207例肾常见肿瘤(136个肾细胞癌,84个肾错构瘤)患者的超声造影图像,比较PHR在肾癌与肾错构瘤组间以及肾癌不同亚型组间检出率的差异。结果 肾癌组中,PHR的检出率为36.76%(50/136),肾错构瘤组未检出PHR;采用PHR诊断肾癌,其敏感性、特异性、准确性、阳性预测值、阴性预测值、假阳性率及假阴性率分别为36.76%(50/136)、100%(84/84)、60.91%(134/220)、100%(50/50)、49.41%(84/170)、0(0/50)、50.59%(86/170)。PHR在肾透明细胞癌、乳头状肾癌、肾嫌色细胞癌及肾集合管癌四种肾癌亚型间检出率分别为31.03%(36/116)、81.82%(9/11)、62.50%(5/8)、0(0/1)。结论 超声造影检出的PHR征象可作为诊断肾癌的特异性指标,且对于鉴别肾肿瘤的良恶性及肾癌病理亚型有一定的参考价值。

Objective To explore the value of peritumoral hyper-enhanced rim （PHR） in qualitative diagnosis of renal common tumors using contrast-enhanced ultrasound （CEUS）. Methods The CEUS images of 220 common renal tumors including 136 renal cell carcinomas （RCC） and 84 renal angiomyolipomas （RAML） from 207 patients were analyzed retrospectively. The PHR detection differences were evaluated between the RCC group and the RAML group, and among different subtypes of RCCs. Results The PHR detection rate was 36.76%（50/136） in the RCC group, and no PHR was detected in the RAML group. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, false positive and false negative of PHR diagnosing RCC were 36.76%（50/136）, 100% （84/84）, 60.91%（134/220）, 100%（50/50）, 49.41%（84/170）, 0（0/50） and 50.59%（86/170）, respectively. The PHR detection rate of the CRCC group, the PRCC group, the RCCC group and the RCDC group were 31.03%（36/116）,81.82%（9/11）,62.50%（5/8） and 0（0/1 ）, respectively. Conclusion The PHR in common renal tumors detected by CEUS can be used as a specific index for diagnosing RCC, which have a certain reference value in differentiating renal benign and malignant tumors and RCC subtypes.