天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (8): 872-876.doi: 10.11958/20170163

• 临床研究 • 上一篇    下一篇

多模态成像对小肾肿瘤的诊断与不同类型鉴别诊断

张岱， 忻晓洁△， 张晟， 穆洁， 王莹   

  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， 天津市恶性肿瘤临床医学研究 中心 （邮编 300060）
  • 收稿日期:2017-02-09 修回日期:2017-06-21 出版日期:2017-08-15 发布日期:2017-08-15
  • 通讯作者: △通讯作者 E-mail：xinxj@126.com E-mail:xinxj@126.com
  • 作者简介:张岱 （1988）， 女， 学士， 医师， 主要从事肿瘤影像学研究

Multi - modality imaging in the diagnosis and differential diagnosis of small renal mass

ZHANG Dai, XIN Xiao-jie△, ZHANG Sheng, MU Jie, WANG Ying   

  1. Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’ s Clinical Research Center for Cancer, Tianjin 300060, China
  • Received:2017-02-09 Revised:2017-06-21 Published:2017-08-15 Online:2017-08-15
  • Contact: △Corresponding Author E-mail：xinxj@126.com E-mail:xinxj@126.com

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摘要： 目的 比较超声造影、 增强 CT 及超声造影联合增强 CT 对小肾肿瘤的诊断效能， 以及超声造影模式下对 不同类型小肾肿瘤的鉴别诊断差异。方法 95 例小肾肿瘤中小肾癌组 79 例， 良性肿瘤组 16 例。以病理结果为 “金 标准” ， 将 3 种方法的诊断结果与病理结果对比， 判断其诊断效能并绘制 ROC 曲线， 比较曲线下面积。在超声造影模 式下利用 Q-Lab 软件对 2 组肿物特点进行分析、 比较， 造影参数有到达时间（AT）、 达峰时间（TTP）、 峰值强度（PI）。 对样本量较多的几类病理类型的小肾肿瘤的超声造影增强模式进行比较， 并分析超声造影模式下小肾肿瘤的特征 性表现。结果 超声造影准确度、 敏感度、 特异度、 阳性预测值、 阴性预测值以及 ROC 曲线下面积（AUC）分别为 87.37%、 93.67%、 56.25%、 91.36%、 64.29%及 0.750； 增强 CT 分别为 88.42%、 93.67%、 62.50%、 92.50%、 66.67%及 0.775； 联合检测为 95.79%、 98.73%、 81.25%、 96.30%、 92.86%及 0.869。3 种方法敏感度均较高， 但特异度均一般。联 合检测诊断效能好于单独使用一种诊断方法。超声造影下小肾癌的 AT、 TTP 均早于小肾良性肿瘤， 而 PI 高于小肾 良性肿瘤 （P＜0.05）。透明细胞癌与乳头状细胞癌、 嫌色细胞癌、 血管平滑肌脂肪瘤在造影的增强方式上差异均有统 计学意义 （P＜0.01）； 其余各类型间在造影的增强方式上差异不大。超声造影模式下可观测出 “假包膜” ； “囊性区” 的 检出率较常规超声大幅提高。结论 超声造影联合增强 CT 可提高对小肾肿瘤诊断的准确性； 超声造影对小肾肿瘤 的鉴别诊断有较高的临床价值， 值得推广。

关键词: 肾肿瘤, 体层摄影术, 螺旋计算机, 诊断, 鉴别, 敏感性与特异性, ROC 曲线, 超声造影, 增强 CT

Abstract: Objective To compare contrast- enhanced ultrasonography (CEUS), contrast- enhanced CT (CECT) and combined detection of two methods in the diagnosis of small renal masses, and differential diagnosis of different types of small renal masses by CEUS. Methods In 95 cases of small renal masses, there were 79 patients with small renal cell carcinoma and 16 patients with benign tumor. The diagnostic results of the three methods were compared based on the pathological results, which were used as the "gold standard" for the diagnostic efficacy. The ROC curve was drawn, and the area under the curve (AUC) was compared. The characteristics of the two groups were analyzed and compared by Q-Lab software in CEUS. The angiographic parameters included arrival time (AT), time to peak (TTP) and peak intensity (PI). CEUS patterns for several pathologic types of renal tumors with larger sample sizes were compared. The characteristic manifestations of small renal masses under CEUS were analyzed. Results The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of CEUS were 87.37%, 93.67%, 56.25%, 91.36%, 64.29% and 0.750, the values for CECT were 88.42%, 93.67%, 62.50%, 92.50%, 66.67% and 0.775, and the values for combined detection of two methods were 95.79%, 98.73%, 81.25%, 96.30%, 92.86% and 0.869 respectively. The sensitivities of the three methods were high, but the specificities were the same. The combined detection showed better diagnostic efficacy than that of single diagnostic method. The AT and TTP of CEUS were earlier in small renal carcinoma group than those of benign nephrotic group, and PI was higher than that of benign nephrotic group (P＜0.05). There were significant differences in the contrasts of contrast enhancement methods between clear cell carcinoma, papillary cell carcinoma, chromophobe cell carcinoma, and angiomyolipoma (P＜0.01). There was little difference in contrast enhancement between the other types of carcinoma. False envelope can be observed by CEUS.‘Cystic area’of the detection rate was increased significantly by CEUS than that of conventional ultrasound. Conclusion Combined detection of CEUS and CECT can improve the diagnostic accuracy of small renal tumors. CEUS has great clinical value in the differential diagnosis of small renal masses, which is worthy of clinical promoting.

Key words: kidney neoplasms, tomography, spiral computed, diagnosis, differential, sensitivity and specificity, ROC curve, contrast-enhanced ultrasonography, contrast-enhanced CT