天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (2): 230-233.doi: 10.11958/58950

• 诊断技术 • 上一篇    下一篇

超声造影在肾脏囊性病变良恶性鉴别中的应用价值

忻晓洁， 毛怡然， 张晟   

  1. 天津医科大学肿瘤医院超声诊疗科， 国家肿瘤临床医学研究中心， 天津市肿瘤防治重点实验室 （邮编300060）
  • 收稿日期:2015-05-15 修回日期:2015-08-26 出版日期:2016-02-15 发布日期:2016-02-15

The value of contrast-enhanced ultrasonography in differential diagnosis of cystic renal carcinoma

XIN Xiaojie， MAO Yiran，ZHANG Sheng#br#   

  1. Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laborary of Cancer Prevention and Therapy, Tianjin 300060, China
  • Received:2015-05-15 Revised:2015-08-26 Published:2016-02-15 Online:2016-02-15

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摘要： 目的 探讨超声造影在囊性肾癌诊断中的应用价值。方法 选取我院肾脏囊性病变患者 73 例， 分析二维超声及超声造影检查的图像特征， 73 例均行手术治疗并取得病理结果， 对比病理结果评价 2 种方法的诊断价值。结果 囊性肾癌 64 例， 肾囊肿 9 例。二维灰阶及彩色多普勒超声显示囊性肾癌多表现为形状不规则， 壁厚， 内有实性成分或分隔， 并多伴有血流信号； 肾囊肿多表现为形状规则， 内有少许实性成分或纤薄分隔， 无明显血流信号。超声造影显示囊性肾癌造影剂起始时间 （15.13±4.21） s， 达峰时间 （23.42±5.68） s， 消退时间 （28.42±4.27） s； 增强方式表现为快进快退 22 例（34.3%）、 快进慢退 30 例（46.8%）、 慢进快退 2 例（3.2%）、 慢进慢退 4 例（6.3%）、 等进等退 6 例（9.3%）； 增强强度呈现高增强 42 例（65.6%）、 等及低增强 22 例（34.4%）。肾囊肿中 3 例未见造影剂充盈， 余 6 例造影剂起始时间（16.67±2.73）s， 达峰时间（25.83±3.06）s， 消退时间（34.17±4.26）s； 增强方式表现为快进快退 1 例（16.7%）、 快进慢退 1 例（16.7%）、 等进等退 4 例（66.6%）； 增强强度呈高增强 2 例（33.3%）、 等或低增强 4 例（66.7%）。二维灰阶超声在肾脏囊性病变诊断中的敏感度、 特异度、 阳性预测值、 阴性预测值、 准确度分别为 85.9%、 66.7%、 94.8%、 40.0%、 83.6%， 超声造影为 92.2%、 77.8%、 96.7%、 58.3%、 90.4%。结论 超声造影技术可以作为囊性肾癌诊断及鉴别诊断的一种有效方法。

关键词: 肾肿瘤, 超声检查, 多普勒, 囊性肾癌, 超声造影技术, 敏感性与特异性

Abstract: Objective To evaluate the values of contrast-enhanced ultrasound in diagnosis of cystic renal cell carcinoma. Methods A total of 73 patients with renal cystic lesions were included in this study. The image features of ultrasound and contrast-enhanced ultrasound examination were analysed. All of patients underwent surgical treatment and had pathological results. The diagnostic values of the ultrasound and contrast-enhanced ultrasound were analyzed by evaluating the image features of cystic renal cell carcinoma. Results There were 64 cases of cystic renal cell carcinoma, 9 cases of benign cyst. With ultrasound and color doppler ultrasound， irregular shape, thickness wall, solid ingredients, divisions and more blood flow signals were found in cystic renal cell carcinoma. Renal cyst showed regular shape, few solid component and thin separation and inconspicuous blood flow signals. In contrast-enhanced ultrasound, cystic renal cancer contrast agent appearing time was (15.13±4.21)s, and reached the peak time (23.42±5.68)s, fade time was (28.42±4.27)s. The enhanced mode for fast in and fast out was found in 22 cases (34.3%), fast in and slow out in 30 cases (46.8%), slow in and fast out in 2 cases (3.2%), slow in and slow out in 4 cases (6.4%), and synchronously in and out in 6 cases (9.3%). The hyper-enhancement was found in 42 cases (65.6%), the iso-enhancement and hypo-enhancement in 22 cases (34.4%). In renal cyst, There were three cases out of contrast filling. In other 6 cases, the contrast agent appearing time was (16.67±2.73)s, the peak time was (25.83±3.06)s and fade time was (34.17±4.26)s. The enhanced mode for fast in and fast out was found in 1 case (16.7%), fast in and slow out in 1 case (16.7%) and synchronously in and out in 4 cases (66.6%). The hyper-enhancement was found in 2 cases (33.3%), the iso-enhancement and hypo-enhancement in 4 cases (66.7%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound were 85.9%, 66.7%, 94.8%, 40.0% and 83.6%. The sensitiv⁃ ity, specificity, positive predictive value, negative predictive value and accuracy of contrast- enhanced ultrasound were 92.2%, 77.8%, 96.7%, 58.3% and 90.4%. Conclusion Contrast-enhanced ultrasound can be used in benign and malignancy identification of renal cystic lesion.

Key words: kidney neoplasms, ultrasonography, doppler, cystic renal cell carcinoma, contrast-enhanced ultrasonography techniques, sensitivity and specificitytechniques