超声造影在肾脏良恶性病变诊断中的价值

Value of contrast-enhanced ultrasound （ CEUS ） in the differential diagnosis between benign andmalignant renal neoplasms

目的探讨超声造影在肾脏良恶性病变诊断中的价值。方法对245例经术后病理证实为肾脏占位性病变患者的超声造影表现进行回顾分析，观察其增强程度、增强均匀度、增强、消退时间及增强方式。结果肾脏恶性肿瘤210例，肾脏良性病变35例。210例肾脏恶性肿瘤超声造影模式表现为快进快退82例，快进慢退64例，慢进快退18例，慢进慢退46例；高增强150例（71．4％）；不均匀增强180例（85．7％）。造影剂充盈缺损区和囊实性病变实性成分增强为肾脏恶性病变的重要特征。35例肾脏良性病变超声造影模式表现为快进快退4例，快进慢退8例，慢进快退10例，慢进慢退13例；均匀增强19例（54．3％）；低增强18例（51．4％）。肾脏良恶性病变在增强模式、增强水平和增强形态间的差异均有统计学意义（均P〈0．05）。肾脏良恶性病变的始增时间、达峰值时间、达峰值强度和峰值强度比之间的差异均有统计学意义（均P〈0．05）。超声造影对肾脏良恶性病变的诊断正确率分别为77．1％和83．8％，二维超声对肾脏良恶性病变的诊断正确率分别为68．6％和76．7％，差异有统计学意义（P〈0．05）。结论超声造影可提高肾脏良恶性病变诊断准确性，在肾脏良恶性病变的鉴别诊断中有重要作用。

Objective To investigate the value of contrast enhanced ultrasound （CEUS） imaging in the differential diagnosis between benign and malignant renal neoplasms. Methods Two hundred and forty- five cases of renal space-occupying lesions confirmed by biopsy or surgical pathology were included in this study. The CEUS features of the renal space-occupying lesions, i.e. , the enhancement degree, homogeneity of enhancement, washing-in and washing-out time and enhancement pattern, were retrospectively analyzed. Results There were 210 cases of malignant renal tumors and 35 cases of benign lesions. The CEUS modes of the malignant renal tumors included ＂quick in and quick out＂ 82 cases, ＂quick in and slow out＂ 64 cases, ＂slow in and quick out＂ ! 8 cases and ＂slow in and slow out＂ 46 cases; good enhancement 150 cases （71.4%） and inhomogeneous enhancement 180 cases （85.7%）. Both the contrast agent filling defect area and solid component enhancement of solid-cystic tumors were important features of malignant renal tumors. In the 35 cases of benign lesions, the CEUS modes included ＂quick in and quick out＂ 4 cases, ＂quick in and slow out＂ 8 cases, ＂slow in and quick out＂ 10 cases and ＂slow in and slow out＂ 13 cases. Most of the benign tumors showed low enhancement 51.4% （18/35） and inhomogeneous enhancement 54.3% （19/35）. There were significant differences between the malignant and benign renal neoplasms in CEUS mode, degree of enhancement and homogeneity of enhancement （ P 〈 0.05 ）, and in time of increasing, peak time, peak intensity and peak intensity ratio （ P 〈 0. 05 ）. The accuracy rates of contrast-enhanced ultrasound for diagnosis of benign and malignant tumors were 77.1% and 83.8% , respectlve[y, while the two-dimensional ultrasound diagnosis of benign and malignant tumors were 68. 6% and 76. 7%, respectively, with a significant difference （P 〈 0. 05 ）. Conclusions CEUS may provide more information to improve the diagnostic accuracy for renal neoplasms, and may play important role in differential diagnosis between benign and malignant renal lesions.