超声造影诊断输尿管恶性肿瘤的临床应用分析

Clinical use of contrast-enhanced ultrasonography in diagnosing of ureteral malignancy

目的 探讨超声造影对输尿管恶性肿瘤的诊断价值。方法 选取在山西省肿瘤医院进行输尿管超声造影检查及手术治疗的18例患者,对常规超声及超声造影结果进行回顾性分析。结果 本研究中常规超声检查18例患者中13例(72%)探查到输尿管腔内生长的狭长的低回声占位,具体轮廓显示不清晰。2例膀胱壁同时可见菜花状凸起的实性结节,17例患者出现肾盂积水。常规超声8例(44%)正确诊断为输尿管恶性肿瘤,5例(28%)诊断为输尿管低回声结节,5例(28%)漏诊。超声造影增强模式18例都表现为不均匀增强,肿物的轮廓显示明确,5例内部伴有部分不增强区,2例增强后与输尿管周围组织分界不清。超声造影后18例输尿管病变的边界、轮廓、上下范围均显示清晰。其中11例(61%)表现为高增强,7例(39%)表现为低增强。2例膀胱肿物与输尿管肿物同步增强。18例(100%)超声造影均正确诊断为输尿管恶性肿瘤,与病理结果相符合。结论 超声造影对于显示输尿管肿瘤的边界、测量肿物大小、准确诊断方面优于常规超声,值得推广应用。

Objective To investigate the diagnostic value of contrast-enhanced ultrasonography(CEUS) in malignant ureteral tumors. Methods Eighteen patients who underwent ureteral CEUS and surgery in Shanxi Cancer Hospital were included. The findings of conventional ultrasound scanning and CEUS in these patients were reviewed. Results In this study, conventional ultrasound scanning detected hypoechoic space-occupying lesions that lined the narrowed lumen of the ureter,with ill-defined contours in 13(72%) of the 18 patients;concurrently,2 patients had solid,cauliflower-like masses protruding from the bladder wall,and 17 had hydronephrosis. Overall, conventional ultrasonography confirmed ureteral malignancy in 8 patients(44%) and hypoechoic ureteral mass in 5(28%),but resulted in missed diagnosis in the other 5(28%). By CEUS,all 18presented heterogeneous enhancement with clear contours of the masses, although 5 with partially non-enhanced areas inside and 2 with blurred demarcation from the periureteral tissues after enhancement. The boundary,contour and upper to lower extent of the ureteral lesions were clearly demonstrated in all 18 patients by CEUS. Of these,the enhancement was high in 11(61%)and low in 7(39%);moreover,2 patients showed synchronous enhancement of the bladder and ureteral masses. CEUS accurately identified ureteral malignancy in all of 18(100%)patients in consistency with their pathological findings. Conclusion CEUS is superior to conventional ultrasonography in demonstrating the boundaries and the size,and hence in accurate diagnosis of ureteral tumors.These justify its widespread use in clinical practice.