Roy C, Gengler L, Sauer B, Lang H
Service de Radiologie B, Centre Hospitalier Universitaire de Strasbourg, Hôpital Civil, 1, place de l'hôpital, BP426, 67091 Strasbourg Cedex, France.
J Radiol. 2008 Nov;89(11 Pt 1):1735-44. doi: 10.1016/s0221-0363(08)74478-0.
To evaluate the role of contrast enhanced US in the characterization of renal tumors. Materials and methods. Eighty-six renal tumors (33 solid, 53 cystic) underwent contrast enhanced US after indeterminate CT/MRI (67 lesions) or US (19 lesions). Pathological correlation was available for 42 cases, and follow-up at 3 and 6 months was available for 13 cases. Diagnosis was achieved in 21 cases. Lesions included: 19 renal cell carcinomas (4 conventional, 14 papillary, 1 tubulocystic), 5 oncocytomas, 3 metastases, 6 pseudomasses, and 53 cystic lesions including 6 malignant tumors.
Solid tumors were correctly identified in 100% of cases. Characterization of solid tumors was possible with specificity of 92.9% for papillary carcinoma, 57.1% for clear cell carcinoma, and 100% for oncocytoma. The specificity for distinguishing solid benign from solid malignant tumor was 100% based on the presence of hypoechogenicity relative to normal renal parenchyma on delayed imaging. Contrast enhanced US allowed reclassification of 23 indeterminate lesions on conventional US. It is of limited value for large cystic lesions or cystic lesions with extensive wall calcification.
Contrast enhanced US is easily performed in clinical practice and allows improved characterization of some renal tumors compared to other cross sectional imaging techniques.
评估超声造影在肾肿瘤特征性诊断中的作用。材料与方法。86例肾肿瘤（33例实性，53例囊性）在CT/MRI检查结果不确定（67个病灶）或超声检查结果不确定（19个病灶）后接受了超声造影检查。42例有病理对照，13例有3个月和6个月的随访资料。21例得以确诊。病灶包括：19例肾细胞癌（4例传统型，14例乳头状，1例小管囊性），5例嗜酸细胞瘤，3例转移瘤，6例假性肿块，以及53例囊性病灶，其中包括6例恶性肿瘤。
实性肿瘤在所有病例中均被正确识别。实性肿瘤的特征性诊断可行，乳头状癌的特异性为92.9%，透明细胞癌为57.1%，嗜酸细胞瘤为100%。基于延迟成像时相对于正常肾实质的低回声表现，区分实性良性肿瘤与实性恶性肿瘤的特异性为100%。超声造影使23个在传统超声检查中结果不确定的病灶得以重新分类。对于大的囊性病灶或伴有广泛壁钙化的囊性病灶，其价值有限。
超声造影在临床实践中易于实施，与其他横断面成像技术相比，能更好地对一些肾肿瘤进行特征性诊断。
