实时超声造影技术诊断肾脏实性占位病变的价值

Value of real-time contrast-enhanced ultrasound in diagnosis of renal solid renal lesions

目的：探讨实时超声造影技术在肾脏实性占位病变中诊断及鉴别诊断的临床应用价值。方法对140例肾脏实性占位病变患者，年龄22～87岁（平均61.3±15.5岁），共152个病灶，大小0.6～9.7 cm（平均3.1±1.9 cm）。采用经外周静脉团注声诺维（SonoVue），使用对比脉冲序列（CPS）技术进行实时超声造影检查，观察肾脏实性占位病变造影剂的灌注过程，分析其灌注特点。结果经病理学证实，137个为恶性病变（127个肾透明细胞癌、8个肾乳头状癌及2个肾嫌色细胞癌）；15个为良性病变（13个肾血管平滑肌脂肪瘤及2个肾嗜酸性细胞瘤），均表现出不同的增强特征。137个恶性病变中98个（71.5%）表现为造影剂皮质期快速增强，104个（75.9%）表现为髓质晚期或延迟期快速廓清，即“快进快出”，并125个（91.2%）具有假包膜的恶性病灶周边环状高增强。病灶直径D≤2 cm，表现为均匀增强为主；2 cm〈D≤4 cm，表现为不均匀“蜂窝状”增强；D〉4 cm，表现为不均匀增强伴大片坏死。15个良性病变表现为造影剂皮质期缓慢或与肾实质同步增强，随后延迟期缓慢廓清，即“慢进慢出”。与病理诊断比较，实时超声造影技术诊断的特异性、准确性及阳性预测值分别为94.9%、96.1%、73.7%，均高于常规超声诊断（分别为72.3%、71.1%、19.1%），并差异有统计学意义（P〈0.001）；而实时超声造影技术诊断的敏感性及阴性预测值分别为93.3%及99.2%，均高于常规超声诊断（分别为60%及94.3%），但差异无统计学意义（P=0.084及0.062，〉0.05）。结论实时超声造影技术对肾脏实性占位病变诊断及鉴别诊断具有一定的临床应用价值。

Objective To investigate the value of real-time contrast-enhanced ultrasound （CEUS） in the diagnosis and differential diagnosis of renal solid renal lesions （RSLs）. Methods We retrospectively analyzed 140 cases of 152 RSLs with a mean diameter 3.1 ± 1.9 cm. CEUS was performed and the perfusion characteristics were analyzed using contrast pulse sequences （CPS） technique. CEUS findings were compared with biopsy histopathologic findings. Results A total of 137 malignant lesions （including 127 renal clear cell carcinomas, 8 renal papillary carcinomas and 2 chromophobe cell carcinomas） and 15 benign lesions （13 angiomyolipomas and 2 renal oncocytomas） were detected. Of the 137 malignant lesions, 98 （71.5%） showed contrast agent fast perfusion and hyper-enhancement or iso-enahncement in cortical phase, 104 （75.9%） showed hypo-enhancement in later corticalmedullary and late phase, and 125 （91.2%） showed rim-like enhancement. Tumors with a diameter ≤2 cm presented with homogeneous enhancement, and those ranging from 2 to 4 cm showed heterogeneous enhancement with a honeycomb feature; tumors greater than 4 cm featured heterogeneous enhancement with large no-enhancement necrotic areas. Of the benign lesions, 13 angiomyolipomas and 2 renal oncocytomas showed slow wash-in and slow wash-out mode. The diagnostic specificity, accuracy and positive predictive value of CEUS for RSLs were 94.9%, 96.1%, and 73.7%, as compared to 72.3%, 71.1%, and 19.1%with conventional US, respectively （P〈0.001）. The sensitivity and negative predictive value of CEUS were 93.3% and 99.2%, respectively, significantly higher than those of conventional US （60% and 94.3%, P=0.084, and 0.062, respectively）. Conclusion Real-time CEUS can provide valuable information for improving the diagnosis and differential diagnosis of RSLs.