| 摘要: |
| 目的 分析肾脏乏血供肿瘤的常规超声及超声造影特征，探讨2种方法联合应用在肾脏乏血供肿瘤良恶性诊断方面的应用价值。方法 回顾性分析2009年10月13日至2022年10月26日于上海交通大学医学院附属瑞金医院及其无锡分院经术后病理确诊、穿刺活检病理诊断或CT/MRI增强并长期随访证实的99例患者的104个肾脏乏血供肿瘤［包括76个良性病灶（良性组）和28个恶性病灶（恶性组）］的常规超声和超声造影资料。通过常规超声观察病灶的位置、大小、内部回声、形态、病灶内部及周边血供情况，通过超声造影观察病灶的灌注方式、消退方式、灌注均匀性及有无环状增强征象。以病理结果或CT/MRI增强并长期随访证实结果为金标准，分析常规超声联合超声造影特征对肾脏乏血供肿瘤良恶性的鉴别诊断价值。结果 两组间患者的性别、年龄及病灶的内部回声、造影剂消退方式和环状增强征象方面差异均有统计学意义（均P＜0.05），其中恶性组多为男性患者（78.6%，22/28），年龄较大［（58.29±11.76）岁］，病灶多为低回声（64.3%，18/28），超声造影以快退为主（60.7%，17/28）；良性组多为女性患者（55.3%，42/76），年龄较小［（50.64±14.88）岁］，病灶多为高回声（64.5%，49/76），超声造影以同退为主（56.6%，43/76）。超声造影表现为环状增强的3个（10.7%，3/28）病灶均为恶性。环状增强＋低回声对肾脏乏血供肿瘤良恶性的诊断准确度（82.7%）、特异度（88.2%）较高，环状增强＋低回声＋快退的诊断灵敏度（85.7%）和阴性预测值（92.3%）较高。结论 常规超声联合超声造影对肾脏乏血供肿瘤良恶性的鉴别诊断有较好的临床实用价值，环状增强对诊断肾脏乏血供恶性肿瘤具有高度特异性，但当这一征象并不显著而常规超声表现为低回声或超声造影表现为快退者，应高度警惕恶性可能。 |
| 关键词: 超声检查 超声造影 肾肿瘤 乏血供肿瘤 |
| DOI：10.16781/j.CN31-2187/R.20240107 |
| 投稿时间：2024-02-10修订日期：2024-05-07 |
| 基金项目: |
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| Clinical value of conventional ultrasound combined with contrast-enhanced ultrasound in diagnosis of benign and malignant hypovascular renal tumors |
| FENG Meijing1,REN Xinping1,2*,LI Junjian1,ZHENG Lili1,ZHANG Lu2,ZHAN Weiwei1,2,DU Yiyan1 |
(1. Department of Ultrasound, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Xinrui Hospital of Xinwu District), Wuxi 214028, Jiangsu, China;
2. Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the characteristics of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in hypovascular renal tumors, and to explore the application value of combining the 2 methods in diagnosing benign and malignant hypovascular renal tumors. Methods The conventional ultrasound and CEUS data of 104 hypovascular renal tumors (76 benign lesions ［benign group］ and 28 malignant lesions ［malignant group］) from 99 patients, who were confirmed by postoperative pathology, biopsy pathology or computed tomography (CT)/magnetic resonance imaging (MRI) enhancement combined with long-term follow-up in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and its Wuxi Branch from Oct. 13, 2009 to Oct. 26, 2022, were retrospectively analyzed. The location, size, internal echo, morphology, internal and peripheral blood supply of the lesions were observed by conventional ultrasound, and the perfusion mode, regression pattern, perfusion uniformity and ring enhancement signs were observed by CEUS. Taking the pathological results or confirmed results of CT/MRI enhancement combined with long-term follow-up as the gold standard, the value of conventional ultrasound combined with CEUS in the differential diagnosis of benign and malignant hypovascular renal tumors was analyzed. Results There were significant differences in gender, age of patients and internal echo, contrast agent regression and ring enhancement signs of lesions between the 2 groups (all P＜0.05). The malignant tumors were mostly found in males (78.6%, 22/28) with an average age of (58.29±11.76) years old; the masses were mostly hypoechoic (64.3%, 18/28), and rapid washout was predominant with CEUS (60.7%, 17/28). In the benign group, most of the patients were female (55.3%, 42/76), with an average age of (50.64±14.88) years old; the majority of the masses were hyperechoic (64.5%, 49/76), and CEUS showed simultaneous washout as the main lesion (56.6%, 43/76). Three patients (10.7%, 3/28) with ring enhancement signs were all malignant. The diagnostic accuracy (82.7%) and specificity (88.2%) for benign and malignant hypovascular renal tumors were relatively high when combining the diagnostic indicators of ring enhancement signs and hypoechoic. The diagnostic sensitivity (85.7%) and negative predictive value (92.3%) were relatively high when combining the 3 diagnostic indicators of ring enhancement, hypoechoic, and rapid washout. Conclusion Conventional ultrasound combined with CEUS has significant clinical practical value in the differential diagnosis of benign and malignant hypovascular renal tumors. The ring enhancement sign is highly specific in the diagnosis of malignant hypovascular renal tumors. However, if this sign is not significant and conventional ultrasound shows hypoechoic or CEUS exhibits rapid washout, there is a strong suggestion that the mass may be a malignant lesion. |
| Key words: ultrasonography contrast-enhanced ultrasound kidney neoplasms hypovascular tumors |
