多模态成像对小肾肿瘤的诊断与不同类型鉴别诊断

Multi-modality imaging in the diagnosis and differential diagnosis of small renal mass

目的比较超声造影、增强CT及超声造影联合增强CT对小肾肿瘤的诊断效能,以及超声造影模式下对不同类型小肾肿瘤的鉴别诊断差异。方法 95例小肾肿瘤中小肾癌组79例,良性肿瘤组16例。以病理结果为"金标准",将3种方法的诊断结果与病理结果对比,判断其诊断效能并绘制ROC曲线,比较曲线下面积。在超声造影模式下利用Q-Lab软件对2组肿物特点进行分析、比较,造影参数有到达时间(AT)、达峰时间(TTP)、峰值强度(PI)。对样本量较多的几类病理类型的小肾肿瘤的超声造影增强模式进行比较,并分析超声造影模式下小肾肿瘤的特征性表现。结果超声造影准确度、敏感度、特异度、阳性预测值、阴性预测值以及ROC曲线下面积(AUC)分别为87.37%、93.67%、56.25%、91.36%、64.29%及0.750;增强CT分别为88.42%、93.67%、62.50%、92.50%、66.67%及0.775;联合检测为95.79%、98.73%、81.25%、96.30%、92.86%及0.869。3种方法敏感度均较高,但特异度均一般。联合检测诊断效能好于单独使用一种诊断方法。超声造影下小肾癌的AT、TTP均早于小肾良性肿瘤,而PI高于小肾良性肿瘤(P<0.05)。透明细胞癌与乳头状细胞癌、嫌色细胞癌、血管平滑肌脂肪瘤在造影的增强方式上差异均有统计学意义(P<0.01);其余各类型间在造影的增强方式上差异不大。超声造影模式下可观测出"假包膜";"囊性区"的检出率较常规超声大幅提高。结论超声造影联合增强CT可提高对小肾肿瘤诊断的准确性;超声造影对小肾肿瘤的鉴别诊断有较高的临床价值,值得推广。

Objective To compare contrast-enhanced ultrasonography(CEUS),contrast-enhanced CT(CECT)andcombined detection of two methods in the diagnosis of small renal masses,and differential diagnosis of different types ofsmall renal masses by CEUS.Methods In95cases of small renal masses,there were79patients with small renal cellcarcinoma and16patients with benign tumor.The diagnostic results of the three methods were compared based on thepathological results,which were used as the"gold standard"for the diagnostic efficacy.The ROC curve was drawn,and thearea under the curve(AUC)was compared.The characteristics of the two groups were analyzed and compared by Q-Labsoftware in CEUS.The angiographic parameters included arrival time(AT),time to peak(TTP)and peak intensity(PI).CEUSpatterns for several pathologic types of renal tumors with larger sample sizes were compared.The characteristicmanifestations of small renal masses under CEUS were analyzed.Results The accuracy,sensitivity,specificity,positivepredictive value,negative predictive value and AUC of CEUS were87.37%,93.67%,56.25%,91.36%,64.29%and0.750,the values for CECT were88.42%,93.67%,62.50%,92.50%,66.67%and0.775,and the values for combined detection oftwo methods were95.79%,98.73%,81.25%,96.30%,92.86%and0.869respectively.The sensitivities of the three methodswere high,but the specificities were the same.The combined detection showed better diagnostic efficacy than that of singlediagnostic method.The AT and TTP of CEUS were earlier in small renal carcinoma group than those of benign nephroticgroup,and PI was higher than that of benign nephrotic group(P<0.05).There were significant differences in the contrasts of contrast enhancement methods between clear cell carcinoma,papillary cell carcinoma,chromophobe cell carcinoma,andangiomyolipoma(P<0.01).There was little difference in contrast enhancement between the other types of carcinoma.Falseenvelope can be observed by CEUS.‘Cystic area’of the detection rate was increased significantly by CEUS than that ofconventional ultrasound.Conclusion Combined detection of CEUS and CECT can improve the diagnostic accuracy ofsmall renal tumors.CEUS has great clinical value in the differential diagnosis of small renal masses,which is worthy ofclinical promoting.