超声造影诊断肾脏小肿瘤

Contrast enhanced ultrasound in diagnosis of small renal masses

目的探讨CEUS诊断肾脏小肿瘤的价值。方法回顾性分析49例肾脏小肿瘤患者的常规超声与CEUS表现,其中38例为小肾癌(SRCC),11例为肾血管平滑肌脂肪瘤(RAML),主要观察肿块回声、增强模式、增强程度,与常规超声进行比较,评估CEUS鉴别诊断SRCC与RAML的效能。结果 SRCC与RAML的CEUS增强模式比较,二者弥漫不均匀增强[78.94%(30/38)vs 27.27%(3/11),P=0.003)]、延迟相快退[73.68%(28/38)vs 18.18%(2/11),P=0.001)]、病灶周边环状强化[57.89%(22/38)vs 9.09%(1/11),P=0.006)]3个特征检出率的差异均有统计学意义。采用CEUS诊断SRCC的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为86.84%(33/38),63.63%(7/11),89.18%(33/37),58.33%(7/12)和81.63%(40/49)。结论 CEUS特征可用以诊断肾脏小肿瘤,且对SRCC和RAML的鉴别诊断具有较高价值。

Objective To explore the value of CEUS in the diagnosis of small renal masses. Methods The findings of CEUS and conventional ultrasound in 49 patients with small renal masses were retrospectively analyzed, inculding small re- nal cell carcinoma （SRCC） cases （n= 38） and renal angiomyolipoma （RAML） cases （n= 11）. The tumor echogenicity, en- hancement patterns and degrees were observed. Through the comparison with conventional ultrasound, the diagnostic effi- cacy of CEUS in differentiating the two diseases was evaluated. Results The detection rate of three enhancement patterns of CEUS had statistically significant differences between RAML and SRCC cases, i.e. diffuse heterogeneous enhancement （78.94% [30/38] vs 27.27%[3/11], P=0. 003）, wash out from hyperenhancement or isoenhancement to hypoenhance- ment in late phase （73.68% [28/38] vs 18.18% [2/11], P= 0. 001）, and perilesional rim-like enhancement （57.89% [22/38] vs 9.09% [1/11], P=0. 006）. The corresponding sensitivity, specificity, positive predictive value, negative pre- dictive value, and accuracy were 86.84% （33/38）, 63.63% （7/11）, 89.18%（33/37）, 58.33% （7/12）, and 81.63% （40/49）, respectively. Conclusion The features of CEUS can be used in diagnosis of SRCC and show a higher diagnostic efficacy in differentiating SRCC and RAML.