超微血管显像与超声造影对小肾肿瘤诊断价值的比较分析

Comparative analysis of superb microvascular imaging and contrast-enhanced ultrasound in diagnosis of small renal masses

目的比较超微血管显像(SMI)与超声造影(CEUS)对小肾肿瘤鉴别诊断的价值。方法收集2016年10月至2018年3月于天津医科大学肿瘤医院就诊的肾脏占位患者84例,共86个病灶。男56例、女28例,年龄29~76(54±10)岁。86个小肾肿瘤应用SMI及CEUS两种检查方法,以病理结果为依据,对比两种方法的诊断效果。SMI模式下采用Adler半定量法分析肿物的血流分级,0~1级判定为良性,2~3级判定为恶性。CEUS模式下观察小肾肿瘤的造影表现及增强方式,恶性肿瘤以"快进"、"快退"、"高灌注"作为诊断的主要标准,部分特殊类型肾细胞癌以"慢进"、"快退"、"低灌注"作为诊断的主要标准;良性肿瘤以"慢进"、"慢退"、"低灌注"作为诊断标准。结果86个小肾肿瘤均行外科手术切除,恶性肿瘤76个,良性肿瘤10个。SMI图像上,89.5%(68/76)的恶性肿瘤Adler分级为2~3级,6/10的良性肿瘤Adler分级为0~1级。CEUS模式下,恶性肿瘤中"快进"占77.6%(59/76),"快退"占82.9%(63/76),"高灌注"占76.3%(58/76);良性肿瘤中"慢进"占7/10,"慢退"占5/10,"低灌注"占6/10。SMI对小肾肿瘤诊断的准确度、敏感度、特异度、阳性预测值、阴性预测值及ROC曲线下面积分别为86.0%、89.5%、60.0%、94.4%、42.9%及0.747;CEUS分别为89.5%、92.1%、70.0%、95.9%、53.8%及0.811,两种方法诊断效能比较差异无统计学意义(P=0.288)。结论SMI与CEUS在小肾肿瘤诊断效能方面虽无明显差异,但SMI对小肾肿瘤诊断的准确度、敏感度、阳性预测值较高,能清晰地显示出肿物内细小血管及低速血流,在鉴别诊断小肾肿瘤方面提供了新的方法。

Objective To explore the value of superb microvascular imaging (SMI) and contrast- enhanced ultrasound (CEUS) in differential diagnosis of small renal masses. Methods A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital. There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54±10) years old. These tumors were all examined by using SMI and CEUS. And the imaging diagnostic results were compared based on the pathological results. Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign, 2-3 grade was malignant. Besides,the patterns and enhancement of the small renal masses were observed in CEUS. The main diagnostic criteria of malignant tumors were "fast forward","rapid regression" and "high perfusion". Some special types of renal cell carcinoma were diagnosed by "slow in","rapid regression" and "hypo-perfusion". Benign tumors were diagnosed by "slow in","slow down" and "hypo-perfusion". Results Among 86 cases, 76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis. By SMI, Adler grade of 89.5%(68/76) malignant tumors were 2-3, Adler grade of 6/10 benign tumors were 0-1. By CEUS, 77.6%(59/76) of malignant tumors were "fast forward", 82.9%(63/76) were "rapid regression", 76.3%(58/76) were "high perfusion";7/10 of benign tumors were "slow in", 5/10 were "slow down" and 6/10 were "low perfusion". The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of SMI were 86.0%,89.5%, 60.0%, 94.4%,42.9% and 0.747 respectively. The values for CEUS were 89.5%, 92.1%, 70.0%,95.9%, 53.8% and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI (P=0.288). Conclusions Although there is no statistical significance between SMI and CEUS, the accuracy, sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses. In brief,SMI provides a new method in the differential diagnosis of small renal masses.