超声造影联合多层螺旋CT鉴别诊断肾嫌色细胞癌与肾嗜酸细胞腺瘤的价值

Value of contrast-enhanced ultrasound combined with multi-slice spiral CT in the differential diagnosis of renal chromophobe cell carcinoma and renal eosinophilic adenoma

目的探讨超声造影联合多层螺旋CT在肾嫌色细胞癌与肾嗜酸细胞腺瘤鉴别诊断中的临床应用价值。方法回顾性分析经手术病理证实的45例肾嫌色细胞癌和30例肾嗜酸细胞腺瘤患者的检查资料,比较其常规超声、超声造影及多层螺旋CT检查情况。绘制受试者工作特征(ROC)曲线分析超声造影、多层螺旋CT单独及联合应用对肾嫌色细胞癌与肾嗜酸细胞腺瘤的鉴别诊断效能,计算曲线下面积(AUC)。结果(1)常规超声表现:肾嗜酸细胞腺瘤与肾嫌色细胞癌病灶最大径、性质、回声、形态、边界及血流情况比较差异均无统计学意义;(2)超声造影表现:肾嗜酸细胞腺瘤与肾嫌色细胞癌峰值强度、增强均匀度、假包膜、肿瘤组织与病灶周围正常肾皮质内造影剂到达时间差值(ΔAT)、达峰时间差值(ΔTTP)、峰值强度差值(ΔPI)比较差异均有统计学意义(均P<0.05);(3)多层螺旋CT检查显示,肾嗜酸细胞腺瘤与肾嫌色细胞癌在星芒状瘢痕、均匀强化方面比较差异均有统计学意义(均P<0.05);肾嗜酸细胞腺瘤皮质期、实质期及排泄期病灶CT值与周围正常肾皮质CT值的比值(LKR)均高于肾嫌色细胞癌,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,多层螺旋CT平扫及增强扫描皮质期、实质期、排泄期LKR鉴别诊断肾嗜酸细胞腺瘤与肾嫌色细胞癌的AUC分别为0.584、0.726、0.732、0.744,超声造影参数ΔAT、ΔTTP、ΔPI的AUC分别为0.754、0.636、0.722,各参数联合诊断的AUC为0.897,均高于其单独应用(均P<0.05)。结论超声造影联合多层螺旋CT鉴别诊断肾嫌色细胞癌与肾嗜酸细胞腺瘤具有较高临床应用价值。

Objective To investigate the clinical application value of contrast-enhanced ultrasound combined with multi-slice spiral CT in the differential diagnosis of renal chromophobe cell carcinoma and renal eosinophilic adenoma.Methods Data of 45 cases of renal chromophobe carcinoma and 30 cases of renal eosinophilic adenoma confirmed by pathology were retrospectively analyzed,and the features of conventional ultrasonography,contrast-enhanced ultrasound and multi-slice spiral CT were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of contrast-enhanced ultrasound and multi-slice spiral CT in renal eosinophilic adenoma and renal chromophobe carcinoma,the area under the curve(AUC)was calculated.Results(1)Conventional ultrasonography showed that there were no significant differences in lesion maxium diameter,nature,echo,morphology,border and blood flow between renal eosinophilic adenoma and renal chromophobe cell carcinoma.(2)Contrast-enhanced ultrasound showed that there were significant differences in peak intensity,enhancement uniformity,pseudocapsule,and differences of contrast agent arrival time,time to peak,peak intensity(ΔAT,ΔTTP,ΔPI)between renal eosinophilic adenoma and renal chromophobe cell carcinoma(all P<0.05).(3)Multi-slice spiral CT showed that there were significant differences in stellate scar and uniform enhancement between renal eosinophilic adenoma and renal chromophobe cell carcinoma(both P<0.05).The lesion-kidney ratio(LKR)of renal eosinophilic adenoma in cortical phase,parenchymal phase and excretory phase were higher than those in renal chromophobe cell carcinoma,the differences were statistically significant(all P<0.05).ROC curve analysis showed that the AUC of LKR in plain scan,cortical phase,parenchymal phase,and excretion phase by multi-slice spiral CT were 0.584,0.726,0.732,0.744,respectively.The AUC ofΔAT,ΔTTP andΔPI were 0.754,0.636,0.722,respectively(P<0.05).The AUC of parameters application combined was0.897,which was higher than that application alone(all P<0.05).Conclusion Contrast-enhanced ultrasound combined with multi-slice spiral CT have high clinical application value in the differential diagnosis of renal eosinophilic adenoma and renal chromophobe cell carcinoma.