超微血流显像技术在肾囊性病变中的应用价值

Application of superb microvascular imaging in renal cystic masses

目的对比彩色多普勒血流显像（CDFI）与超微血流显像（SMI）技术在肾囊性肿物血流显示中的差异，并比较常规超声结合SMI与超声造影（CEUS）在肾囊性病变Bosniak分级中的一致性，探讨SMI技术在肾囊性病变中的应用价值。方法选取肾囊性病变患者55例，首先行常规超声、CDFI及SMI检查，其中Bosniak分级Ⅱf级以上患者行超声造影，Ⅱf级进一步随访或手术取得病理，Ⅲ级和Ⅳ级手术取得病理。结合超声造影及病理结果，计算SMI诊断肾囊性病变的敏感性、特异性、准确性。结果共55例肿块，手术切除44例，其中恶性38例，良性6例。CDFI和SMI对病变血流信号显示能力差异有统计学意义（P〈0．05）。SMI与超声造影一致性检验Kappa值为0．866。SMI结合Bosniak标准诊断肾囊性病变的敏感性、特异性、诊断符合率、阳性预测值、阴性预测值分别为94．8％、75．0％、89．1％、90．2％、85．7％。结论SMI显示肾囊性病变分隔及实性结构中的微细血流的能力优于CDFI。对肾囊性病变的Bosniak分级，SMI与超声造影一致性较好。SMI可提高无创性超声检查对肾囊性病变良恶性鉴别诊断的准确性。

Objective To compare the difference of colour Doppler flow imaging（CDFI） and superbmicrovascular imaging （SMI） for detecting blood flow in cystic renal mass, and explore the consistency of conventional ultrasound combined with SMI and Contrast-enhanced ultrasonography （CEUS） in the diagnosis of renal cystic masses based on the Bosniak classification system, so as to evaluate the diagnosis value of SMI in renal cystic masses. Methods Fifty-five patients with renal cystic mass were enrolled in this study and underwent conventional ultrasound, CDFI and SMI. Patients with renal cystic mass at category Ⅱ f or higher received contrast-enhanced ultrasonography additionally. The diagnostic performance of SMI and CEUS were evaluated based on final diagnosis obtained by follow-up or pathology diagnosis after surgery. Results In 55 cases, 44 cases got the pathological diagnosis afer surgical resection including 38 cases of malignant masses, and 6 cases of benign masses. CDFI and SMI showed significant difference in tumor flow imaging （ P 〈0.05）. Kappa Value of SMI and CEUS was 0. 866. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SMI were 94.8 %, 75.0 %, 89.1 %, 90.2 and 85.7% respectively. Conclusions SMI is superior to CDFI in displaying micro-vascular of separated and solid structure in renal cystic masses. SMI has a better consistency with CEUS in Bosniak classification. SMI can improve the accuracy of non-invasive ultrasound in the diagnosis of renal cystic lesions.