| 摘要: |
| 目的 研究肾透明细胞癌（ccRCC）与肾血管平滑肌脂肪瘤（RAML）的常规超声及超声造影声像图表现，探讨2种检查方法联合使用在鉴别ccRCC与RAML中的应用价值。方法 对经病理学确诊或增强CT或MRI检查及随访确诊的86例ccRCC患者88枚病灶和31例RAML患者38枚病灶的常规超声及超声造影声像图进行回顾性分析。通过常规超声观察肿瘤的大小、回声、边界、有无彩色血流信号等，超声造影观察指标包括灌注与消退方式、灌注强度、灌注均匀性、周边环状增强等，分析常规超声和超声造影声像图特征对ccRCC与RAML的鉴别诊断价值。结果 ccRCC与RAML病灶的回声水平、血供分布、灌注方式、灌注强度、灌注均匀性及周边环状增强情况差异均有统计学意义（P均<0.05），ccRCC以低回声（78.41%，69/88）、富血供（53.41%，47/88）、快进（95.45%，84/88）、高灌注（93.18%，82/88）和不均匀灌注（71.59%，63/88）为主，周边环状增强较常见（34.09%，30/88）；而RAML病灶以非低回声（86.84%，33/38）、乏血供（68.42%，26/38）、低灌注（65.79%，25/38）、均匀灌注（84.21%，32/38）为主，快进和慢进各占50.00%（19/38），周边环状增强少见（10.53%，4/38）。常规超声结合超声造影对低回声组ccRCC与RAML鉴别诊断的准确度和灵敏度均优于常规超声（准确度89.19% vs 59.46%，灵敏度89.86% vs 57.97%；P均<0.01），对非低回声组ccRCC与RAML鉴别诊断的准确度、灵敏度、阴性预测值均优于常规超声（准确度78.85% vs 55.77%，灵敏度84.21% vs 36.84%，阴性预测值89.29% vs 64.71%；P均<0.05）。结论 常规超声结合超声造影对ccRCC与RAML的鉴别诊断有较好的临床实用价值，但部分表现不典型的病灶仍需结合其他检查资料进行综合判断。 |
| 关键词: 肾肿瘤 透明细胞癌 血管平滑肌脂肪瘤 超声检查 超声造影术 鉴别诊断 |
| DOI：10.16781/j.0258-879x.2021.06.0609 |
| 投稿时间：2021-01-05修订日期：2021-03-04 |
| 基金项目: |
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| Conventional ultrasound combined with contrast-enhanced ultrasound in differential diagnosis of clear cell renal cell carcinoma and renal angiomyolipoma |
| ZHENG Li-li1,REN Xin-ping1,2*,ZHAN Wei-wei2,LIN Yan-yan2 |
(1. Department of Ultrasound, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi 214028, Jiangsu, China;
2. Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 210025, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the conventional and contrast-enhanced ultrasonographic features of clear cell renal cell carcinoma (ccRCC) and renal angiomyolipoma (RAML), and to explore the application value of the 2 methods in the differential diagnosis of ccRCC and RAML. Methods The conventional and contrast-enhanced ultrasound images of 88 foci in 86 ccRCC patients and 38 foci in 31 RAML patients who were diagnosed by pathology, enhanced computed tomography (CT), magnetic resonance imaging (MRI) examination or follow-up were analyzed retrospectively. The size, echo, boundary and vascular architecture of the tumor were observed by conventional ultrasound, the indexes including the modes of perfusion and clearance, intensity and uniformity of perfusion, and peripheral ring enhancement were observed by contrast-enhanced ultrasound, and the value of ultrasonographic features of the conventional and contrast-enhanced ultrasounds in the differential diagnosis of ccRCC and RAML was analyzed. Results There were significant differences in the echo level, blood supply distribution, perfusion modes, perfusion intensity, uniformity and peripheral ring enhancement between ccRCC and RAML (all P<0.05). ccRCC was dominated by hypoechoic (78.41%, 69/88), rich blood supply (53.41%, 47/88), rapid wash-in (95.45%, 84/88), hyperperfusion (93.18%, 82/88) and heterogeneous perfusion (71.59%, 63/88), and peripheral ring enhancement was more common (34.09%, 30/88) in ccRCC; while RAML was dominated by non-hypoechogenicity (86.84%, 33/38), poor blood supply (68.42%, 26/38), hypoperfusion (65.79%, 25/38) and homogeneous perfusion (84.21%, 32/38), rapid or slow wash-in each accounted for 50.00% (19/38), and peripheral ring enhancement was rare (10.53%, 4/38). The accuracy and sensitivity of conventional ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of ccRCC and RAML in the hypoechoic group were better than those of conventional ultrasound (accuracy 89.19% vs 59.46%, sensitivity 89.86% vs 57.97%; both P<0.01); the accuracy, sensitivity and negative predictive value for the differential diagnosis of ccRCC and RAML in the non-hypoechoic group were better than those of conventional ultrasound (accuracy 78.85% vs 55.77%, sensitivity 84.21% vs 36.84%, negative predictive value 89.29% vs 64.71%; all P<0.05). Conclusion Conventional ultrasound combined with contrast-enhanced ultrasound has high clinical value in the differential diagnosis of ccRCC and RAML; some atypical foci, however, need to be diagnosed comprehensively by combining other examinations. |
| Key words: kidney neoplasms clear cell carcinoma angiomyolipoma ultrasonography contrast-enhanced ultrasonography differential diagnosis |
