超声造影在肾脏囊性病变良恶性鉴别中的应用价值

The value of contrast-enhanced ultrasonography in differential diagnosis of cystic renal carcinoma

目的探讨超声造影在囊性肾癌诊断中的应用价值。方法选取我院肾脏囊性病变患者73例,分析二维超声及超声造影检查的图像特征,73例均行手术治疗并取得病理结果,对比病理结果评价2种方法的诊断价值。结果囊性肾癌64例,肾囊肿9例。二维灰阶及彩色多普勒超声显示囊性肾癌多表现为形状不规则,壁厚,内有实性成分或分隔,并多伴有血流信号;肾囊肿多表现为形状规则,内有少许实性成分或纤薄分隔,无明显血流信号。超声造影显示囊性肾癌造影剂起始时间(15.13±4.21)s,达峰时间(23.42±5.68)s,消退时间(28.42±4.27)s;增强方式表现为快进快退22例(34.3%)、快进慢退30例(46.8%)、慢进快退2例(3.2%)、慢进慢退4例(6.3%)、等进等退6例(9.3%);增强强度呈现高增强42例(65.6%)、等及低增强22例(34.4%)。肾囊肿中3例未见造影剂充盈,余6例造影剂起始时间(16.67±2.73)s,达峰时间(25.83±3.06)s,消退时间(34.17±4.26)s;增强方式表现为快进快退1例(16.7%)、快进慢退1例(16.7%)、等进等退4例(66.6%);增强强度呈高增强2例(33.3%)、等或低增强4例(66.7%)。二维灰阶超声在肾脏囊性病变诊断中的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为85.9%、66.7%、94.8%、40.0%、83.6%,超声造影为92.2%、77.8%、96.7%、58.3%、90.4%。结论超声造影技术可以作为囊性肾癌诊断及鉴别诊断的一种有效方法。

Objective To evaluate the values of contrast-enhanced ultrasound in diagnosis of cystic renal cell carcino- ma. Methods A total of 73 patients with renal cystic lesions were included in this study. The image features of ultrasound and contrast-enhanced ultrasound examination were analysed. All of patients underwent surgical treatment and had pathological results. The diagnostic values of the ultrasound and contrast-enhanced ultrasound were analyzed by evaluating the image features of cystic renal cell carcinoma. Results There were 64 eases of cystie renal cell carcinoma, 9 cases of benign cyst. With ultrasound and color doppler ultrasound, irregular shape, thickness wall, solid ingredients, divisions and more blood flow signals were found in cystic renal cell carcinoma. Renal cyst showed regular shape, few solid component and thin separation and inconspicuous blood flow signals. In contrast-enhanced ultrasound, cystic renal cancer contrast agent appearing time was （15.13±4.21）s, and reached the peak time （23.42±5.68）s, fade time was （28.42±4.27）s. The enhanced mode for fast in and fast out was found in 22 cases （34.3%）, fast in and slow out in 30 eases （46.8%）, slow in and fast out in 2 eases （3.2%）, slow in and slow out in 4 cases （6.4%）, and synchronously in and out in 6 cases （9.3%）. The hyper-enhancement was found in 42 eases （65.6%）, the iso-enhancement and hypo-enhaneement in 22 cases （34.4%）. In renal cyst, There were three cases out of contrast filling. In other 6 cases, the contrast agent appearing time was （16.67±2.73）s, the peak time was （25.83±3.06）s and fade time was （34.17±4.26）s. The enhanced mode for fast in and fast out was found in 1 case （16.7%）, fast in and slow out in ] case （16.7%） and synchronously in and out in 4 eases （66.6%）. The hyper-enhaneement was found in 2 cases （33.3%）, the iso-enhancement and hypo-enhaneement in 4 cases （66.7%）. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound were 85.9%, 66.7%, 94.8%, 40.0% and 83.6%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of eontrast-enhanced ultrasound were 92.2%, 77.8%, 96.7%, 58.3% and 90.4%. Conclusion Contrast-enhanced ultrasound can be used in benign and malignancy identification of renal cystic lesion.