肾透明细胞癌的常规超声及超声造影声像图表现特征及鉴别诊断分析

Characteristics and Differential Diagnosis of Conventional Ultrasound and Contrast-enhanced Ultrasound in CCRCC

目的:探讨肾透明细胞癌(CCRCC)的常规超声及超声造影声像图表现特征及鉴别诊断价值。方法:选取2020年9月至2022年8月在我院治疗的CCRCC患者76例(CCRCC组),其中Fuhrman分级:Ⅰ~Ⅱ级48例,Ⅲ~Ⅳ级28例。同时选取同期治疗的肾血管平滑肌脂肪瘤(RAML)患者50例作为对照(RAML组),比较两组常规超声及超声造影图像差异,同时分析不同Fuhrman分级CCRCC病灶常规超声及超声造影图像差异,以及常规超声联合超声造影的诊断价值。结果:CCRCC组病灶直径为(35.54±11.02)mm,明显高于RAML组(P<0.05);CCRCC组低回声、血流丰富、“快进”灌注、高灌注强度、不均匀灌注、有周边环状增强比例分别为81.58%、57.89%、94.74%、93.42%、73.68%和42.11%,明显高于RAML组(P<0.05)。CCRCC组Ⅲ~Ⅳ级病灶直径为(41.25±10.03)mm,明显高于Ⅰ~Ⅱ级病灶(P<0.05);CCRCC组Ⅲ~Ⅳ级病灶有周边环状增强比例为56.25%,明显高于Ⅰ~Ⅱ级病灶(P<0.05)。常规超声+超声造影并联诊断CCRCC的灵敏性为94.74%,明显高于常规超声、超声造影(P<0.05);常规超声+超声造影并联诊断CCRCC的准确性、阴性预测值分别为86.51%和90.24%,明显高于常规超声(P<0.05);超声造影诊断CCRCC的准确性为83.33%,明显高于常规超声(P<0.05)。结论:与RAML相比,CCRCC的常规超声及超声造影图像特征有一定差异,常规超声联合超声造影鉴别诊断CCRCC有较好的应用价值。

Objective:To investigate the characteristics and differential diagnostic value of conventional ultrasound and contrast-enhanced ultrasound in renal clear cell carcinoma(CCRCC).Methods:A total of 76 patients(CCRCC group)with CCRCC who were treated in our hospital from September 2020 to August 2022 were selected,including Fuhrman classification:48 cases of gradeⅠ~Ⅱand 28 cases of gradeⅢ-Ⅳ.,and 50 patients with renal angiomyolipoma(RAML)who were treated at the same time were selected as the control group(RAML group).The differences between conventional ultrasound and contrast-enhanced ultrasound images of the two groups were compared,and the differences between conventional ultrasound and contrast-enhanced ultrasound images of CCRCC lesions with different Fuhrman grades were analyzed,as well as the diagnostic value of conventional ultrasound combined with contrast-enhanced ultrasound.Results:The diameter of lesions in CCRCC group was(35.54±11.02)mm,which was significantly higher than that in RAML group(P<0.05).The proportion of hypoechoic,rich blood flow,"fast forward"perfusion,high perfusion intensity,uneven perfusion and peripheral annular enhancement in CCRCC group was 81.58%,57.89%,94.74%,93.42%,73.68%and 42.11%respectively,which was significantly higher than that in RAML group(P<0.05).Compared with gradeⅠ~Ⅱlesions,the diameter of gradeⅢ~Ⅳlesions in CCRCC group was(41.25±10.03)mm,which was significantly higher(P<0.05).Compared with in gradeⅠ~Ⅱlesions,the percentage of peripheral annular enhancement in gradeⅢ~Ⅳlesions in CCRCC group was 56.25%,which was significantly higher(P<0.05).Compared with conventional ultrasound and contrast-enhanced ultrasound,the sensitivity of conventional ultrasound+contrast-enhanced ultrasound in the diagnosis of CCRCC was 94.74%,which was significantly higher(P<0.05).The accuracy and negative predictive value of conventional ultrasound+contrast-enhanced ultrasound in the diagnosis of CCRCC were 86.51%and 90.24%,respectively,which were significantly higher than those of conventional ultrasound(P<0.05).The accuracy of contrast-enhanced ultrasound in the diagnosis of CCRCC was 83.33%,which was significantly higher than that of conventional ultrasound(P<0.05).Conclusion:Compared with RAML,the image features of conventional ultrasound and contrast-enhanced ultrasound of CCRCC are different to some extent,the combination of conventional ultrasound and contrast-enhanced ultrasound has better application value in differential diagnosis of CCRCC.