超微血管成像在肾脏实性肿物诊断中的应用价值

Application value of superb microvascular imaging for diagnosis of renal solid masses

目的:通过与能量多普勒成像(power Doppler imaging,PDI)对比,探讨超微血管成像(superb microvascular imaging,SMI)技术在肾脏实性肿物诊断中的应用价值。方法:回顾性分析2016年10月至2017年3月47例天津医科大学肿瘤医院经超声检查发现的肾脏实性肿物并行PDI及SMI检查的患者资料,共48个病灶,术后病理检查结果中良性病变10个、恶性病变38个。采用Adler法分析肿物的血流分级、分布模式、形态,及周边有、无环状血流,评价PDI及SMI对于肾脏实性肿物的诊断效能。结果:PDI检测显示,肾脏良、恶性肿物的血流分级、分布模式、形态进行比较,差异均无统计学意义(均P>0.05);良、恶性肿物周边有、无环状血流进行比较,差异具有统计意义(P<0.05)。SMI检测显示,肾脏良、恶性肿物的血流分级、分布模式、形态,及周边有、无环状血流进行比较,差异均具有统计学意义(均P<0.05)。PDI诊断的敏感性、特异性、ROC曲线下面积分别为71.05%、70.00%、0.705;SMI诊断的敏感性、特异性、ROC曲线下面积分别为89.47%、90.00%、0.897。PDI与SMI诊断效能比较差异具有统计学意义(P=0.025)。结论:SMI较PDI能够更准确评价血流分级、描绘血流分布模式及形态,并且周边环状血流显示率更高,提高肾脏肿物良、恶性鉴别诊断的准确性。

Objective： To investigate the application value of superb microvascular imaging（SMI） in benign and malignant renal lesions by comparing with power Doppler imaging（PDI）. Methods： Retrospective analysis was performed on 48 cases of renal lesions in 47 patients screened via PDI and SMI at Tianjin Medical University Cancer Institute and Hospital. A total of 10 and 38 cases of benign and malignant lesions were identified, respectively. We compared the diagnostic efficiency between the two methods by determining blood flow grade, distribution pattern, morphology, and ring-like blood flow. Results： Statistically significant differences in ring-like blood flow（P〈0.05） but not in blood flow grade, distribution pattern, and morphology（P〉0.05） were observed between benign and malignant renal tumors as detected by PDI. In SMI, statistically significant differences in blood flow grade, distribution pattern, morphology, and ring-like blood flow were identified between benign and malignant renal tumors（P〈0.05）. The sensitivity, specificity, and area under the receiver operating characteristic curve of PDI and SMI were 71.05%, 70.00%, and 0.705 and 89.47%, 90.00%, and0.897, respectively. Significance in diagnostic efficacy between PDI and SMI was detected（P=0.025）. Conclusion： Compared with PDI,SMI can more accurately describe blood flow grade, distribution pattern, morphology, and ring-like blood. Thus, SMI can improve the accuracy of differential diagnosis of benign and malignant renal tumors.