对比增强超声评估不确定的肾脏肿块：一项诊断性能研究。

Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study.

机构信息

From Radiology Consultants, 250 DeBartolo Place, Bldg B, Youngstown, OH 44512 (R.G.B., C.P.); Kent State University-Salem Campus, Salem, Ohio (C.P.); and Department of Diagnostic Radiology, University Hospitals of Cleveland, Cleveland, Ohio (A.H.).

出版信息

Radiology. 2014 Apr;271(1):133-42. doi: 10.1148/radiol.13130161. Epub 2013 Nov 18.

DOI:10.1148/radiol.13130161

PMID:24475802

Abstract

PURPOSE

To determine the utility of contrast material-enhanced ultrasonography (US) in the characterization of indeterminate renal masses.

MATERIALS AND METHODS

This retrospective performance study was approved by the institutional review board and was HIPAA compliant, with waiver of informed consent. Patients included 721 individuals referred for contrast-enhanced US with 1018 indeterminate renal masses from 1999 to 2010, identified initially with an imaging study. Three hundred twenty patients (44.4%) were female, and 401 (55.6%) were male. Patient ages ranged from 17 to 95 years (mean ± standard deviation, 70 years ± 15). Lesion size varied from 2 to 161 mm (mean, 26.6 mm ± 19.5). Contrast-enhanced US enhancement patterns were used to characterize masses as benign or malignant. For lesions with a definitive diagnosis, 306 of 1018 (30.0%) were correlated with contrast-enhanced US findings: 167 (54.6%) were benign, and 139 (45.4%) were malignant. For lesions without a pathologic diagnosis, 712 (70.0%) were followed for as long as 10 years. Diagnostic accuracy measures were calculated by using pathologic diagnosis as the reference standard, as well as lesion stability at 3 and 5 years.

RESULTS

Contrast-enhanced US had a sensitivity of 100% (126 of 126; 95% confidence interval [CI]: 97.1%, 100%), specificity of 95.0% (132 of 139; 95% CI: 89.9%, 98.0%), positive predictive value (PPV) of 94.7% (126 of 133), and negative predictive value (NPV) of 100% (132 of 132). The five false-positive masses included three oncocytomas and two Bosniak category 3 cystic lesions. Of the 290 lesions that had follow-up of at least 36 months, none of the lesions demonstrated changes that necessitated lesion reclassification. If these lesions were included, assuming lesions classified as malignant were malignant, then of the 596 lesions, sensitivity was 100% (161 of 161), specificity was 96.6% (420 of 435), PPV was 91.5% (161 of 176), and NPV was 100% (420 of 420).

CONCLUSION

Contrast-enhanced US evaluation is a highly sensitive and specific method for characterization of indeterminate renal masses. Online supplemental material is available for this article.

摘要

目的

确定对比增强超声（US）在诊断不确定的肾脏肿块中的应用价值。

材料和方法

本回顾性性能研究获得了机构审查委员会的批准，并符合 HIPAA 规定，豁免了知情同意。研究纳入了 1999 年至 2010 年间因疑似肾脏肿块而接受对比增强 US 检查的 721 名患者，这些患者最初通过影像学检查发现了 1018 个不确定的肾脏肿块。其中 320 名患者（44.4%）为女性，401 名（55.6%）为男性。患者年龄 17 至 95 岁（平均±标准差，70 岁±15 岁）。病变大小 2 至 161mm（平均 26.6mm±19.5mm）。采用增强 US 增强模式对肿块进行良性或恶性特征分析。对于有明确诊断的病变，1018 个病变中的 306 个（30.0%）与增强 US 结果相关：167 个（54.6%）为良性，139 个（45.4%）为恶性。对于无病理诊断的病变，712 个（70.0%）进行了长达 10 年的随访。使用病理诊断作为参考标准，以及 3 年和 5 年的病变稳定性，计算诊断准确性指标。

结果

增强 US 的敏感度为 100%（126/126；95%置信区间[CI]：97.1%，100%），特异度为 95.0%（132/139；95%CI：89.9%，98.0%），阳性预测值（PPV）为 94.7%（126/133），阴性预测值（NPV）为 100%（132/132）。5 个假阳性肿块包括 3 个嗜酸细胞瘤和 2 个 Bosniak 3 类囊性病变。在至少随访 36 个月的 290 个病变中，没有一个病变出现需要重新分类的变化。如果将这些病变包括在内，假设分类为恶性的病变为恶性，则在 596 个病变中，敏感度为 100%（161/161），特异度为 96.6%（420/435），PPV 为 91.5%（161/176），NPV 为 100%（420/420）。