超微血流显像对不同大小肾实性肿瘤的诊断价值

Application value of superb microvascular imaging for diagnosis of different size renal solid tumors

目的探讨超微血流显像(SMI)对不同大小肾实性肿瘤的诊断价值。方法回顾性分析2017年9月至2019年3月在天津医科大学肿瘤医院行超声检查发现肾实性占位的患者142例,共146个病灶。病灶最大径为0.8~7.3 cm,以3.0 cm为界将患者分为最大径≤3.0 cm组(61例患者,64个病灶)和最大径>3.0 cm组(61例患者,82个病灶)。比较SMI和彩色多普勒显像(CDFI)检测大小不同的肾肿瘤在血流Adler分级、血管形态及周边血流特征方面的差异。结果最大径≤3.0 cm组的64个病灶中,50个恶性,14个良性。最大径>3.0 cm组的82个病灶中,62个恶性,20个良性。使用灰阶超声,最大径≤3.0 cm组的良恶性肿瘤在位置、边界、回声、均匀度、小液性区方面差异均无统计学意义(均P>0.05);最大径>3.0 cm组的良恶性肿瘤在瘤体回声、均匀度及小液性区方面差异均有统计学意义(均P<0.05)。采用SMI和CDFI检测良性肿瘤,二者在血流Adler分级、血管形态及周边血流特征等方面差异均无统计学意义(均P>0.05)。最大径≤3.0 cm组的恶性肿瘤,应用SMI检出血流Adler分级为2~3级的病灶43个,高于CDFI(32个,P<0.05);检出血管形态为树枝状及不规则的病灶38个,高于CDFI(7个,P<0.05);检出周边环形或半环形血流病灶40个,高于CDFI(18个,P<0.05)。但在最大径>3.0 cm组的恶性肿瘤中,仅周边血流特征一项与CDFI差异有统计学意义(P<0.05),应用SMI检出周边环形或半环形血流病灶38个,CDFI检出22个。SMI和CDFI诊断最大径≤3.0 cm肾实性肿瘤的受试者工作特性曲线下面积分别为0.791(灵敏度为94.0%,特异度为64.3%)和0.627(灵敏度为54.0%,特异度为71.4%),差异有统计学意义(P=0.039);诊断最大径>3.0 cm肾实性肿瘤的ROC曲线下面积分别为0.860(灵敏度为91.9%,特异度为80.0%)和0.852(灵敏度为85.5%,特异度为85.0%),差异无统计学意义(P=0.858)。结论SMI能有效检出肾肿瘤内低速血流及细小血管,显著提高恶性肿瘤周边环形血流显示率。当肿瘤最大径≤3.0 cm时,其诊断效能更优。

Objective To discuss the diagnostic value of superb microvacular imaging(SMI)in renal solid tumors of different sizes.Methods A total of 142 patients with 146 renal tumors detected by ultrasound in Tianjin Medical University Cancer Institute and Hospital from September 2017 to March 2019 were retrospectively analyzed.The maximum diameter of lesions was 0.8-7.3 cm,and patients were divided into the maximum diameter≤3.0 cm group(61 patients,64 lesions)and the maximum diameter>3.0 cm group(61 patients,82 lesions).All of the tumors were separately evaluated by SMI and color Doppler flow imaging(CDFI)with Adler grade,vascular morphology and peripheral blood flow.Results In the group with maximum diameter≤3.0 cm,50 lesions were malignant and 14 were benign.In the group with maximum diameter>3.0 cm,62 lesions were malignant and 20 were benign.In the group with maximum diameter≤3.0 cm,there were no significant differences in location,boundary,echo,homogeneity and small cystic area between malignant tumors and benign tumors(P>0.05).In the group with maximum diameter>3.0 cm,there were significant differences in echo,homogeneity and small cystic area between malignant tumors and benign tumors(P<0.05).For all of the benign tumors,there were no significant difference between CDFI and SMI in evaluating Adler grade,vascular morphology and peripheral blood flow(P>0.05).For malignant tumors with maximum diameter≤3.0 cm,43 lesions with Adler grade 2-3 were detected by SMI,which was higher than CDFI(32,P<0.05).There were 38 lesions with dendritic and irregular vascular morphology detected by SMI,which was higher than CDFI(7,P<0.05).The detected rate of peripheral annular or semi-annular blood flow in lesions was 80.0%(40/50),higher than CDFI(18/50,P<0.05).While in malignant tumors with maximum diameter>3 cm,the lesion with peripheral annular or semi-annular blood flow detected by SMI was 38,higher than 22 of CDFI(P<0.05).The area under the receiver operating characteristic(ROC)curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter≤3.0 cm was 0.627(sensitivity:54.0%,specificity:71.4%)and 0.791(sensitivity:94.0%,specificity:64.3%),respectively,with statistically significant difference(P=0.039).The area under the ROC curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter>3.0 cm was 0.852(sensitivity:85.5%,specificity:85.0%)and 0.860(sensitivity:91.9%,specificity:80.0%),respectively,without statistically significance(P=0.858).Conclusions SMI is superior to CDFI in detecting low-velocity blood flow and microvessels in both malignant and benign renal tumors,and can effectively improve the display rate of peripheral blood flow in malignant tumors.Otherwise,SMI can provide better diagnostic efficiency for renal tumors with the maximum diameter≤3.0 cm.