肾透明细胞癌超声造影参数成像的应用研究

Parametric imaging for characterizing clear cell renal cell carcinoma with contrast-enhanced ultrasound

目的探讨肾透明细胞癌的超声造影定量分析及参数成像特点。方法对97例经病理证实的肾透明细胞癌行超声造影定量分析，利用肿瘤与周围肾皮质的造影强度差值进行动态血管模型（dynamic vascular pattern，DVP）参数成像构建，DVP曲线分为Ⅰ（正向型）、Ⅱ（先正后负型）、Ⅲ（先负后正型）、Ⅳ（负向型）4种类型，DVP参数图分为Ⅰ、Ⅱ型、Ⅲ、Ⅳ型。结果定量参数峰值强度（maximum intensity，IMAX）、曲线下面积（area under the curve，AUC）、平均渡越时间（mean transit time，mTT）在分析区与参考区之间差异均有统计学意义（P〈0．05），参数上升时间（risingtime，RT）、达峰时间（timetopeak，TTP）差异无统计学意义。肾透明细胞癌在DVP曲线中Ⅰ型占58．8％（57／97），Ⅱ型11．3％（11／97），Ⅲ型10．3％（10／97），Ⅳ型19．6％（19／97）；在DVP参数图中Ⅰ型占58．8％（57／97），Ⅱ型11．3％（11／97），Ⅲ型8．2％（8／97），Ⅳ型21．7％（21／97）。结论超声造影定量分析及参数成像可以从不同角度反映肿瘤的特点，为肿瘤的诊断提供了更加全面的信息。

Objective To investigate the features of quantitative analysis and parametric imaging of contrast-enhanced ultrasound （CEUS） in renal clear cell carcinoma （ccRCC）. Methods Ninety-seven pathologically confirmed ccRCCs underwent conventional ultrasound and CEUS. Both quantitative parameters and dynamic vascular pattern （DVP） reconstructure were analyzed with Sonoliver software. Four types of DVP curves were described with typeⅠ（Unipolar ＋ ） ,type Ⅱ （Bipolar ＋ / - ） ,type Ⅲ（Bipolar - / ＋ ） and type Ⅳ （Unipolar - ）, while the DVP parametric images, similarly, were divided into four types,with type Ⅰ , Ⅱ, Ⅲ and IV, respectively. Results As for the parameter of CEUS, there were statistical differences in maximum intensity （IMAX）, area under the curve （AUC） and mean transit time （mTT） （ P 〈0.05） and no statistic differences in rise time （RT） and time to peak （TTP） between ccRccs and peripheral renal parenchyma. Concerning of DVP of ccRCCs, type Ⅰ , Ⅱ , Ⅲand IV accounted for 58.8% （57/97） ,11. 3% （11/97）,10.3% （10/97） and 19.6% （19/97） respectively. As for each type in DVP parametric images, the percentages were 58.8% （57/97）,11. 3% （11/97）,8.2% （8/97）,21.7%（21/97）, respectively. Conclusions Quantitative analysis and parametric imaging can depict different features of vascularity in ccRCCs and improve the diagnosis of the tumors.