超声造影对≤4 cm肾脏良恶性病变的诊断价值

李春香; 姚欣; 李秀英; 徐勇; 杨庆; 叶兆祥

doi:10.3969/j.issn.1000-8179.2011.09.010

摘要: 目的：探讨超声造影对≤4cm肾脏良恶性病变诊断价值，提高小肾肿瘤的诊断和治疗水平。方法：回顾性分析了2007年6月至2009年10月间天津医科大学附属肿瘤医院收治的72例≤4 cm肾肿瘤住院患者超声造影（CEUS）、增强CT （CECT）的影像学特征，比较CEUS和CECT对≤4 cm肾肿瘤判断情况，比较超声造影对≤4 cm肾脏良恶性病变的增强方式，以探讨超声造影对小肾肿瘤的诊断价值。结果：超声造影将4例肾良性肿瘤误诊为肾癌，漏诊1例肾癌病例， 5例不确诊； CECT将5例肾良性肿瘤误诊为肾癌，同样漏诊1例肾癌病例， 14例不确诊。超声造影诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为93.10%、 71.43%、 88.89%、 93.10%、 71.43%，增强CT诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为81.03%、64.29%、 77.78%、 90.38%、 45.00%。CEUS和CECT对≤4cm肾脏良恶性病变诊断结果比较，差异有统计学意义（P<0.05）。超声造影增强方式比较： 58例肾恶性肿瘤中19例表现为快进快出， 31例表现为快进慢出， 3例表现为同进同出， 5例表现为慢进慢出； 14例肾良性肿瘤中1例表现为快进快出， 3例表现为快进慢出， 4例表现为同进同出， 6例表现为慢进慢出，差异有统计学意义（P<0.05）。结论： CEUS可对肿瘤内微血管形态进行描述且具有特殊的增强方式，提高了诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值，减少了诊断的不确定性，与CECT对≤4 cm肾脏良恶性病变判断比较，超声造影优于增强CT，为我们临床医生选择手术方式提供更加可靠的诊断依据。

Abstract: The Value of Contrast-Enhanced Ultrasound in the Diagnosis of Renal Tumors Equal to orSmaller than 4 cmChunxiang LI, Xin YAO, Xiuying LI, Yong XU, Qing YANG, Zhaoxiang YECorrespondence to: Xin YAO, E-mail: yaoxin1969@yahoo.com.cnDepartment of Genitourinary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, ChinaAbstract Objective: To investigate the value of contrast-enhanced ultrasound in the diagnosis of small renal tumors smallerthan 4 cm, and to improve the diagnostic and treatment level of benign and malignant tumors of the kidney. Methods: The imaging fea-tures of contrast-enhanced ultrasound ( CEUS ) and contrast-enhanced CT ( CECT ) in 72 patients with small renal tumor who weretreated in Tianjin Medical University Cancer Institute and Hospital between June 2007 and October 2009 were reviewed. The diagnos-tic results of CEUS and CECT, as well as the enhancement patterns of CEUS for the malignant and benign renal tumors were com-pared. The diagnostic value of CEUS for small renal tumors ≤ 4 cm was evaluated. Results: Four benign renal tumor cases were misdi-agnosed as renal cancer by CEUS, one renal cancer case was missed by CEUS, and CEUS failed to obtain the final diagnosis for 5 cas-es. Five benign renal tumor cases were misdiagnosed as renal cancer by CECT, one renal cancer was missed by CECT, and CECTfailed to provide final diagnosis for 14 cases. The overall diagnostic sensitivity, specificity, accuracy, the positive and negative predic-tive value of CEUS were 93.10%, 71.43%, 88.89%, 93.10%, and 71.43%, respectively. Those of CECT were 81.03%, 64.29%, 77.78%,90.38%, and 45.00%, respectively. Enhancement patterns of CEUS were shown by fast in and fast out in 19 cases, fast in and slowlyout in 31 cases, synchronously in and out in 3 cases, and slowly in and slowly out in 5 cases. Of the 14 cases with benign tumor of thekidney, enhancement patterns of CEUS in small benign renal tumors were shown by fast in and fast out in one case, fast in and slowlyout in 3 cases, synchronously in and out in 4 cases, and slowly in and slowly out in 6 cases. There was statistical significance amongthem ( P < 0.05 ). Conclusion: CEUS is a special mode of enhancement which can be used to delineate the capillary vessels in the tu-mor and has higher sensitivity, specificity, accuracy, and the positive and negative predictive value in diagnosis of small renal tumors.Keywords Renal tumor; Contrast-enhanced ultrasound; Contrast-enhanced CT; Diagnosis