超声造影诊断肾肿瘤的临床研究

Clinical research of contrast enhanced ultrasonography on renal tumors

目的探讨超声造影对不同类型肾肿瘤的鉴别诊断价值。方法对49个肾肿瘤进行超声造影检查,首先由2名医生独立观察肿瘤的造影表现,包括造影剂进入时间、达峰时间、峰值强度、退出时间、灌注均匀度及有无假包膜等,对各类肿瘤的差异进行比较;其次应用QontraXt软件定量测量肿瘤的峰值强度(P)及达峰时间(TP),借助"肿瘤的相对增强百分数"(ΔP%)及"肿瘤与皮质的达峰时间差"(ΔTP)两指标定量分析并比较各类肿瘤的差异;最后评价超声造影对肾肿瘤的诊断价值。结果 27个肾透明细胞癌的造影特征与4个低度恶性肾癌、6个肾盂尿路上皮癌、12个血管平滑肌脂肪瘤有显著差异(P<0.05),主要体现在峰值强度、达峰时间、增强均匀度及灌注起始时间等四个指标上,定量分析中透明细胞癌的ΔP%显著高于其他4类肿瘤(P<0.05);以"快速达峰+高峰值强度"为诊断透明细胞癌的主要标准,辅以"不均匀增强"、"早期进入"为参考标准,诊断准确性达94%。结论超声造影对肾透明细胞癌有较高的鉴别诊断价值。

Objective To evaluate the value of contrast enhanced ultrasonography （CEUS） in differential diagnosis among different types of renal tumors. Methods 47 patients with 49 renal lesions who had undergone CEUS were retrospectively studied. All of the lesions were histopathologieally or clinical proved. First, CEUS images were retrospectively analyzed in consensus by 2 radiologists. The enhancement patterns, the peak intensity, the homogeneity of enhancement, the pseudocapsule were evaluated. Then, the Peak Intensity （P） and the time to Peak（TP）were measured with QontraXt, the index A P% and A TP were used when analysing quantitatively the CEUS features of renal tumors. At last, the diagnostic value of CEUS was evaluated in renal tumors. Results There were significant difference between the 27 clear cell renal carcinoma（CCRCC） and the other types of renal tumors, including 4 low malignant lesions, 6 urothelium carcinoma of the renal pelvis, 12 renal angiomyolipoma （P〈0.05） The differences lie in the peak intensity, the homogeneity, the time to peak and wash-in. The A p% of the CCRCC was higher than the other tumors （P〈0.05）. Take ＂fast to peak＂ and ＂high peak intensity＂ as the main criteria, with ＂heterogeneous enhancement＂ and ＂fast in＂ as the secondary criteria and the diagnostic accuracy of CCRCC was 94%. Conclusion CEUS is highly valuable in differentiating CCRCC from other tumors.