超声造影定性及定量评价不同大小肾透明细胞癌

Qualitative and quantitative evaluation of different sizes of clear cell renal cell carcinomas by contrast-enhanced ultrasound

目的定性及定量评价不同大小肾透明细胞癌(ccRCCs)超声造影特征。方法回顾性分析106例ccRCCs患者超声造影图像,根据最大径将病灶分为≤4 cm组46例、4~7 cm组40例及>7 cm组20例。定性分析癌灶造影剂到达时间、增强程度、灌注是否均匀,以及是否有环状高增强征象;定量分析癌灶及周围正常肾皮质峰值强度、上升时间、达峰时间、灌注速率、平均渡越时间及曲线下面积,组间比较上述参数。结果三组达到时间、灌注是否均匀及环状高增强征象分布情况比较差异均有统计学意义(均P<0.01);癌灶内峰值强度及曲线下面积比较差异均有统计学意义(均P<0.05)。≤4 cm组癌灶与周围正常肾皮质定量参数比较差异均无统计学意义;在4~7 cm及>7 cm组中,癌灶峰值强度及曲线下面积大于周围正常肾皮质,差异均有统计学意义(均P<0.05)。结论不同大小ccRCCs超声造影特征不同;超声造影可对ccRCCs进行定性和定量评价。

Objective To evaluate qualitatively and quantitatively the contrast-enhanced ultrasound(CEUS)features of different sizes of clear cell renal cell carcinomas(ccRCCs).Methods The CEUS images of 106 ccRCCs were retrospectively evaluated.All tumors were divided into 3 groups according to tumor size:≤4 cm(46 cases),4~7 cm(40 cases)and >7 cm(20 cases). The ultrasound contrast agent arrival time,peak enhancement degree,perfusion heterogeneity and the peritumoral hyperenhanced rim(PHR) were compared among groups by qualitative observation. Quantitative parameters including the maximum intensity(IMAX),rise time(RT),time to peak(TTP),wash in perfusion rate(WIR),mean transit time(mTT)and the area under the curve(AUC)were compared,and the peripheral renal cortex(PRC)within group and that of the tumor among groups.Results There were significant differences in the contrast agent arrival time,perfusion heterogeneity and the PHR detection among groups(all P<0.01). In quantitative analysis,IMAX and AUC values of the renal cell carcinomas were significantly different among groups(both P<0.05).All quantitative features showed no significant difference between the tumor and the PRC in the ≤4 cm group.In the 4~7 cm and >7 cm groups,IMAX and AUC were higher in the tumor than those in the PRC(both P<0.05).Conclusion The CEUS features of different sizes of ccRCCs are different,and qualitative and quantitative analysis can be used to evaluate ccRCC by CEUS.