超声造影与增强CT诊断良、恶性肾脏占位性病变的对照研究

A comparative study of contrast-enhanced ultrasound and contrast-enhanced computed tomography in the diagnosis of benign and malignant space occupying renal lesions

目的比较良、恶性肾脏占位性病变超声造影(CEUS)和增强CT灌注特点,评价CEUS与增强CT对良、恶性肾脏占位性病变的诊断价值。方法回顾性分析山西医科大学第一医院2008年1月至2010年12月收治的52例肾脏占位性病变患者共52个病灶的CEUS与增强CT检查资料,并进行比较。所有患者均经手术和病理证实。结果 52个肾脏占位性病灶中,恶性病灶42个,包括透明细胞癌32个(其中囊性肾癌4个),嫌色细胞癌2个,乳头状细胞癌4个,移行细胞癌4个;良性病灶10个,包括肾血管平滑肌脂肪瘤6个,肾囊肿3个,肾球旁细胞瘤1个。42个恶性肾脏占位性病灶CEUS及增强CT均以快进快退及高增强为主。10个良性肾脏占位性病灶CEUS均以慢进慢退及低增强为主,而增强CT则均以快进慢退及低增强为主。CEUS、增强CT诊断良、恶性肾脏占位性病变的敏感度、特异度及准确性分别为88.1%、80.0%、86.5%和90.5%、60.0%、82.7%,两种方法诊断效果间差异无统计学意义(Fisher精确概率检验,P值分别为1.000、0.628、0.780)。结论 CEUS和增强CT在肾脏占位性病变良、恶性诊断中均有较高价值,两者结合有助于肾脏占位性病灶良、恶性的明确诊断。

Objective To compare the enhanced characteristics of renal masses with contrast-enhanced ultrasound（CEUS）and contrast-enhanced CT and to evaluate the diagnostic value of CEUS and contrast-enhanced CT in renal masses.Methods The CEUS and contrast-enhanced CT examination data of 52 patients with renal masses（52 lesions） treated in the First Hospital of Shanxi Medical University from January 2008 to December 2010 were analyzed retrospectively and compared.All patients were proved by operation and pathology.Results Among 52 lesions with renal masses,42 lesions were malignant,including 32 clear cell carcinomas（of which 4 lesions were cystic renal cell carcinomas）,2 chromophobe cell carcinomas,4 papillary cell carcinomas and4 transitional cell carcinomas;10 lesions were benign,including 6 renal angiomyolipomas,3 renal cysts and 1 renal juxtaglomerular cell tumor.Enhancement patterns of CEUS and contrast-enhanced CT in the majority of 42 renal malignant lesions showed ＇fast-in and fast-out＇ and ＇hyper-enhanced＇.The enhancement patterns of the majority of 10 renal benign lesions showed ＇slow-in and slow-out＇ and ＇hypo-enhanced＇ in CEUS and ＇fast-in and slow-out＇ and ＇hypo-enhanced＇ in contrast-enhanced CT.The diagnostic sensitivity,specificity,accuracy of benign and malignant space occupying renal lesions was 88.1%,80.0% and 86.5% for CEUS and 90.5%,60.0% and 82.7% for contrast-enhanced CT respectively,and there was no statistical significance（Fisher＇s exact test,P=1.000,0.628 and 0.780,respectively）.Conclusions CEUS and contrast-enhanced CT may also be of value in evaluating and differentiating renal tumors.The combination of CEUS with contrast-enhanced CT is helpful to obtain the definite diagnosis of renal masses.