超声造影在不同亚型肾细胞癌诊断中的应用价值分析

Value of contrast-enhanced ultrasonography in diagnosis of different subtypes of renal cell carcinoma

目的应用超声造影观察不同亚型肾细胞癌血流灌注特点，探讨其诊断价值。方法回顾性分析106例经病理证实为不同亚型肾细胞癌患者并分为3组：透明细胞癌组、乳头状细胞癌组、嫌色细胞癌组，观察超声造影特点并进行对比分析。结果应用QLab软件分析时间一强度曲线，比较三组开始增强时间差（△AT=AT肾细胞癌—AT周边正常肾实质），峰值强度差值（API=PI肾细胞癌—PI周边正常肾实质）。三组间△AT、API比较，透明细胞癌组与乳头状细胞癌组和嫌色细胞癌组间差异有统计学意义（P〈0．05），乳头状细胞癌组与嫌色细胞癌组相比较差异无统计学意义（P〉0．05）。大多数透明细胞癌“快进高增强”，即造影剂填充快速，早于或同步于周围肾组织，达峰时间早于或同步于周围。肾组织，与。肾乳头状癌及嫌色细胞癌相比峰值强度高，部分周边呈现环状高增强征象。乳头状细胞癌及嫌色细胞癌造影增强慢于周边正常肾脏组织，峰值强度明显低于周围肾组织，造影呈现“慢进低增强”。结论超声造影能够为肾细胞癌的诊断及亚型诊断提供重要的参考价值。

Objective To observe the characteristics of different blood perfusion in renal cell carcinoma by contrast-enhanced ultrasound and prove its diagnostic value. Methods One hundred and six cases of renal cell carcinoma confirmed by patholog were involved, and were divided into three groups：clear cell carcinoma group, papillary cell carcinoma group, and chromophobe cell carcinoma group. Their imaging characteristics were observed. Time-intensity curve was analyzed by using QLab software. The difference oftime of beginning to increase （△AT = ATrenal cell carcinoma - ATsurrounding normal renal parenchyma ） and the difference of peak intensity（△PI = PIrenal cell careinoma - PI surrounding normal renal parenchyma ） in three groups were compared. ResultsAAT and △PI in clear cell carcinoma group were different from those in the papillary cell carcinoma group and chromophobe cell carcinoma group （ P 〈0.05）. The difference between papillary carcinoma group and chromophobe carcinoma group was not significant （ P 〈0.05）. Contrast agent filled very fast in most clear cell carcinomas, filled speed and time to peak were early or synchronously with the surrounding renal tissue. Compared with renal papillary carcinoma and chromophobe carcinoma group, clear cell carcinoma group showed a high peak intensity and part of the surroundings appeared high increasing signs, like of a ring. Contrast agents filled slow in papillary carcinomas group and chromophobe carcinomas group, and the peak intensities were low. Conclusions Contrast enhanced ultrasound can provide important clinical value for the diagnosis of renal cell carcinoma and subtype diagnosis.