Zubarev A V, Nasnikova I Iu, Kozlov V P, Grishin M A, Sal'nikov D V
Ter Arkh. 2001;73(8):46-50.
To evaluate diagnostic efficacy of advanced ultrasound (US) techniques in early and differential diagnosis of malignant tumors of the kidneys.
A total of 394 patients with renal mass lesions were studied. They had: renal cell carcinoma (n = 96), renal parenchyma pseudotumors (n = 22), lipoma (n = 48), angiomyolipoma (n = 19), renal abscess (n = 2), renal sinus lipomatosis (n = 1), parenchymal cysts (n = 205), retroperitoneal leiomyosarcoma with invasion in the kidney (n = 1). The following examinations were made: gray scale study with tissue harmonic imaging, panoramic scanning, US-angiography (color doppler imaging--CDI, power doppler imaging--PDI, 3D-reconstruction of the kidney vessels, 3D dynamic contrast enhanced angiography (DCEA) in the second harmonic mode with an echo-contrast agent levovist. Pulse Doppler with qualitative and quantitative evaluation of the doppler spectrum was used as an additional method. Verification of the diagnosis was made by conventional angiography, computer tomography, MR-tomography, histomorphological analysis after surgery in 91, 310, 6 and 88 patients, respectively.
New US techniques allow differentiation of malignant tumors with renal lipomas and angiomyolipomas, focuses of inflammation, pseudotumors of the renal parenchyma and atypical renal cysts. CDI has revealed big pathologic vessels with arterio-venous and arterio-arterial shunts in renal cancer in 63.5% of the cases. PDI visualized a net of pathologically changed vessels in 74.8% of the cases. 3D-reconstruction in PDI was highly sensitive (90%) in visualization of neoplastic vessels. US-angiography was used for pre- and postoperative monitoring in 18 patients subjected to conservative renal surgery. In 23 patients DCEA with levovist allowed monitoring of all phases of contrast enhancement of renal vessels. Injection of contrast agent revealed tumor microvasculature in an early arterial phase (20-30 seconds).
US-angiographic techniques in diagnosis of renal cancer increases sensitivity and specificity of the US method compared to conventional B-mode US from 55 and 60% to 98 and 95%, positive and negative predictive value from 58 and 57% to 95 and 98%, respectively.
评估先进超声（US）技术在肾脏恶性肿瘤早期诊断及鉴别诊断中的效能。
共研究了394例肾占位性病变患者。其中包括：肾细胞癌（n = 96）、肾实质假瘤（n = 22）、脂肪瘤（n = 48）、血管平滑肌脂肪瘤（n = 19）、肾脓肿（n = 2）、肾窦脂肪增多症（n = 1）、实质囊肿（n = 205）、侵犯肾脏的腹膜后平滑肌肉瘤（n = 1）。进行了以下检查：组织谐波成像的灰阶研究、全景扫描、超声血管造影（彩色多普勒成像——CDI、能量多普勒成像——PDI、肾脏血管的三维重建、使用超声造影剂声诺维的二次谐波模式下的三维动态对比增强血管造影（DCEA）。使用脉冲多普勒对多普勒频谱进行定性和定量评估作为辅助方法。分别通过传统血管造影、计算机断层扫描、磁共振断层扫描、91例、310例、6例和88例患者术后的组织形态学分析对诊断进行验证。
新的超声技术能够区分恶性肿瘤与肾脂肪瘤、血管平滑肌脂肪瘤、炎症灶、肾实质假瘤和非典型肾囊肿。CDI显示63.5%的肾癌病例存在伴有动静脉和动脉-动脉分流的大病理血管。PDI在74.8%的病例中显示出病变血管网络。PDI中的三维重建在显示肿瘤血管方面高度敏感（90%）。超声血管造影用于18例接受保留肾手术患者的术前和术后监测。在23例患者中，使用声诺维的DCEA能够监测肾血管造影增强的所有阶段。注射造影剂在动脉早期（20 - 30秒）显示出肿瘤微血管。
与传统B型超声相比，超声血管造影技术在肾癌诊断中提高了超声方法的敏感性和特异性，分别从55%和60%提高到98%和95%，阳性和阴性预测值分别从58%和57%提高到95%和98%。
