超声造影检查在肾癌病理分型诊断中的价值

The value of contrast-enhanced ultrasound in diagnosis of renal cell carcinoma subtyping

目的 探讨超声造影检查对肾癌病理分型诊断的价值.方法 2012年6月至2014年6月经手术病理确诊的肾癌患者206例,男113例,女93例.年龄23～80岁,平均54岁.肿瘤直径1.4～ 10.4 cm,平均（3.8±1.6）cm.其中透明细胞癌147例,乳头状肾细胞癌32例,嫌色细胞癌27例.206例术前均行超声造影检查,观察造影剂灌注模式、增强程度、液性坏死区情况,分析其时间-强度曲线,测量造影前后肿瘤直径变化情况.比较3种病理类型肿瘤各项检查参数的差异.结果 灌注模式方面,透明细胞癌主要表现为“快进快退”（94/147,63.9％）,乳头状肾细胞癌和嫌色细胞癌主要表现为“慢进快退”[（19/32,59.4％）和（14/27,51.9％）],差异有统计学意义（P＜0.05）.增强程度方面,透明细胞癌主要表现为高增强（127/147,86.4％）,乳头状肾细胞癌和嫌色细胞癌主要表现为低增强[（22/32（68.8％）和15/27（55.6％）],差异有统计学意义（P＜0.05）.透明细胞癌、乳头状肾细胞癌、嫌色细胞癌分别有92例（62.6％）、19例（59.4％）、5例（18.5％）出现液性坏死区,差异有统计学意义（P＜0.05）.时间-强度曲线分析结果显示,肾皮质的起始时间、达峰时间、达峰强度、曲线下面积分别为（11.06±2.75）s、（23.42±2.79）s、（27.47±3.02） dB、（35.01±2.94） dB;透明细胞癌分别为（8.01±1.89）s、（20.05±3.01）s、（30.03±2.98）dB、（37.64±4.01） dB,与肾皮质比较差异均有统计学意义（P＜0.05）;乳头状肾细胞癌分别为（11.12±2.43）s、（27.29±3.54）s、（20.13±2.67）dB、（34.67±3.24）dB,与肾皮质比较达峰时间和达峰强度差异有统计学意义（P＜0.05）;嫌色细胞癌分别为（11.32±2.90）s,（22.21±3.62）s、（22.02±2.52）dB、（28.67±3.65） dB,与肾皮质比较达峰强度、曲线下面积差异有统计学意义（P＜0.05）.造影后透明细胞癌直径平均增加（0.35±0.11）cm,非透明细胞癌平均增加（0.23±0.10）cm,两者比较差异有统计学意义（P＜0.05）.结论 超声造影检查对肾透明细胞癌、乳头状肾细胞癌和嫌色细胞癌的病理分型诊断具有一定价值.

Objective The purpose of this study was to evaluate the value of contrast-enhanced ultrasound in diagnosis of renal cell carcinoma subtyping.Methods 206 cases with renal tumors were confirmed by pathology and surgery from June 2012 to June 2014,including 113 male cases and 93 female cases.The mean age was 54 years （range 23-80 years）.The subtype of renal tumor included clear cell carcinoma in 147 cases,papillary cell carcinoma in 32 cases,chromophobe cell carcinoma in 27 cases.All patients were received the CEUS before operation.The enhancement patterns,degree of enhancement,the appearance of necrosis and the time-intensity curve by contrast-enhanced ultrasound were analyzed.Results Enhancement patterns of CEUS were showed by fast in and fast out in 63.9% （94/147）cases with clear cell carcinoma,59.4% （19/32） cases with papillary cell carcinoma,51.9% （14/27） cases with chromophobe cell carcinoma.Statistical significant diference was shown among those subtype groups （P 〈 0.05）.Most of the clear cell carcinomas （127/147,86.4%） showed hyperenhancing.While,the papillary renal cell carcinoma （22/32,68.8%） and chromophobe cell carcinoma （15/27,55.6%） showed hypoenhancing （P 〈 0.05）.The rate of necrosis in clear renal cell carcinoma was 62.6% （92/147）,and 59.4% （19/32） in papillary cell carcinoma.necrosis area accounted for only 18.5% （5/27）in chromophobe cell carcinoma （P 〈 0.05）.In the time-intensity curve analysis,the initial time,the average arrival time,the time to peak and area under the curve in renal cortex was （11.06 ± 2.75） s,（23.42 ± 2.79） s,（27.47 ± 3.02） dB,（35.01 ± 2.94）dB,respectively.Significant differences in those items were found in clear cell carcinoma,which was（8.01 ± 1.89） s,（20.05 ± 3.01） s,（30.03 ± 2.98） dB,（37.64 ± 4.01） dB respectively,compared with those in cortex （P 〈 0.05）.The arrival time,time to peak,peak intensity and area under the curve in papillary cell carcinoma were （1 1.12 ± 2.43） s,（27.29 ± 3.54） s,（20.13 ± 2.67） dB,（34.67 ±3.24） dB,respectively.The curve showed the time to peak was higher and the peak intensity were lower than those of renal cortex （P 〈0.05）.The arrival time,time to peak,peak intensity and area under the curve in chromophobe cell carcinoma were （11.32 ± 2.90） s,（22.21 ± 3.62） s,（22.02 ± 2.52） dB,（28.67 ± 3.65） dB,respectively.The curve demonstrated peak intensity and area under the curve were lower than those of surrounding renal cortex （P 〈 0.05）.The increase of tumor diameter after contrast-enhanced ultrasound in clear cell carcinoma was about （0.35 ± 0.11）cm and in nonclear cell carcinoma was about （0.23 ± 0.10） cm （P 〈 0.05）.Conclusion The contrast-enhanced ultrasound played an important role in diagnosis and subtype renal cell carcinoma.