超声造影在肾上皮样血管平滑肌脂肪瘤中的应用

Value of contrast-enhanced ultrasound in diagnosis of renal epithelioid angiomyolipoma

目的 探讨肾上皮样血管平滑肌脂肪瘤的超声造影表现.方法 对18例经手术病理证实的肾上皮样血管平滑肌脂肪瘤的超声造影图像进行回顾性分析.分别观察病灶常规超声及超声造影声像图特征,利用软件Sonoliver进行定量分析,获得定量参数上升时间、达峰时间、曲线下面积、参数峰值强度及平均渡越时间,并进行统计分析.结果 病理结果显示18个病灶均为上皮样血管平滑肌脂肪瘤,其中7例病灶（38.9％）可见异型细胞,1例（5.6％）伴有肾内播散、脉管癌栓,3例（16.7％）伴坏死或囊性变.常规超声显示14个病灶（77.8％）表现为低回声,16个病灶（88.9％）可测及彩色血流.超声造影时,10例病灶（55.6％）表现为皮质期缓慢增强,其中8例（44.4％）可见周边向中央缓慢填充,15例（83.3％）达峰时呈均匀增强,16例（88.8％）增强程度高于或等于肾皮质,10例（55.6％）实质期同步或缓慢减退,5例（27.8％）可见假包膜.病灶定量参数上升时间、达峰时间及曲线下面积均较肾皮质高（P＜0.05）,峰值强度及平均渡越时间差异无统计学意义（P＞0.05）.结论 超声造影定性及定量分析可以从不同角度反映肾上皮样血管平滑肌脂肪瘤血流灌注特征,为诊断提供更多信息.

Objective To investigate the value of contrast-enhanced ultrasound （CEUS） in diagnosis of renal epithelioid angiomyolipoma （eAML）.Methods The CEUS features of 18 patients with 18 histopathologically proved renal eAMLs were retrospective analyzed using both of qualitative and quantitative approachs.Tumor conventional ultrasound and CEUS features were observed.The Sonoliver software was applied to perform quantitative analysis,which provided five parameters,including the maximum intensity （IMAX）,rise time （RT）,time to peak （TTP）,mean transit time （mTT） and area under the curve （AUC）.Results All of 18 lesions were pathological proved as eAML,among them,heterocyst was observed in 7 lesions,1 lesion had dissemination inter-kidney and vessel invasion,necrosis or cystic degeneration was found in 3 eAMLs.On conventional ultrasound,eAML showed hypoecho,isoecho and hyperecho were 14（77.8%）,3（16.7%） and 1 （5.6%） respectively.Blood flow could be detected in 16 （88.9%） lesions.On CEUS,the characters of slow-in,synchronous-in,slow centripetal enhancement and entire enhancement were observed in 10 （55.6%）,8 （44.4%）,8 （44.4%） and 12 （55.6%） lesions,respectively.Most of eAMLs showed homogeneous enhancement （15/18,83.3%） and hyper-or iso-enhancement （16/18,88.8 %） at peak time.The characters of fast-out,synchronous-out and slow out were observed in 8 （44.4%）,2 （11.2%） and 8 （44.4%） cases,respectively.Pseudocapsule was detected in 5 （27.8%） lesions.The parameters of RT,TP and AUC for eAMLs were higher than that for renal cortex （P 〈 0.05）,while the parameters of IMAX and mTT had no significant statistical difference between eAMLs and renal cortex（P 〉0.05）.Conclusions Qualitative and quantitative analysis of CEUS reflect the blood perfusion of eAMLs in different aspect,which offer some useful informations for the diagnosis of eAMLs.