超声造影在鉴别小肾癌与脂肪缺乏型肾错构瘤中的应用价值

The value of contrast-enhanced ultrasound in the diagnosis of small renal cell carcinoma and renal angiomyolipoma with minimal fat

目的 探讨超声造影在鉴别小肾癌与脂肪缺乏型肾错构瘤中的应用价值.方法 回顾性分析2013年9月至2015年12月行超声检查并手术治疗的47例小肾癌和8例肾血管平滑肌脂肪瘤的常规超声及超声造影声像资料.男39例,女16例.年龄31 ～73岁,平均（54.8±9.8）岁.肿瘤均单发,直径均≤3 em.常规超声检查观察肾肿物大小、回声、边界、有无彩色血流信号.超声造影观察病灶的增强时相和方式,包括起始时间、达峰时间、消退时间及病灶内部结构的增强表现,并进行对比分析.结果 肾细胞癌超声造影增强方式主要为快进和快退,脂肪缺乏型肾错构瘤造影增强方式主要为慢退.在时间-强度曲线上,小肾癌的峰值强度（PI）高于脂肪缺乏型肾错构瘤,达峰时间（TTP）明显快于脂肪缺乏型肾错构瘤（P＜0.05）.另外,小肾癌的假包膜出现率及不均匀增强等造影特征,明显较脂肪缺乏型肾错构瘤发生率高（P＜0.05）.结论 超声造影增强特征及时间-强度曲线定量分析有助于小肾癌与脂肪缺乏型肾错构瘤术前诊断与鉴别.

Objective To investigate the value of contrast-enhanced ultrasonography （CEUS） in the diagnosis of small renal cell carcinoma （SRCC） and renal angiomyolipoma （AML） with minimal fat.Methods The images and data of conventional ultrasound （US） and CEUS were retrospectively reviewed in 47 cases of small renal cell carcinoma and 8 cases of AML with minimal fat （d 〈 30mm）,which were confirmed by operation and pathologicall study,including 39 males and 16 females.The mean age of the patients was （54.8 ± 9.8） years old,ranged from 31 to 73 years old.The size,echo,boundary and color flow signals of renal lesions were observed by conventional US.Then the modality and phases of enhancement were observed,including the arrival time,the peak time,the washout time and the appearance of internal structures.Results On contrast-enhanced sonography,fast wash-in and wash-off were observed in most of SRCC,while slow wash-off were observed in most of RAML with minimal fat.The statistically significant differences were found between SRCC and RAML with minimal fat in the values of TFP （time a to peak） and PI （peak-intensity）.The occurrence of round pseudo-capsule and contrast-enhancement characteristics in SRCC was far more often than RAML with minimal fat.Conclusions Contrast-enhanced sonography combined with time-intensity analysis provides more useful information for the diagnosis of SRCC and AML with minimal fat.