CT 平扫呈等密度的肾脏肿块：应用超声造影进行特征性分析。

Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound.

机构信息

1 Department of Radiology, University of Trieste, Strada di Fiume 447, Trieste 34149, Italy.

出版信息

AJR Am J Roentgenol. 2015 May;204(5):W557-65. doi: 10.2214/AJR.14.13375.

DOI:10.2214/AJR.14.13375

PMID:25905962

Abstract

OBJECTIVE

The purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes.

MATERIALS AND METHODS

Forty-seven renal lesions (range, 0.8-7.7 cm; average, 2.6 cm) with equivocal enhancement at CT underwent contrast-enhanced ultrasound using sulfur hexafluoride-filled microbubbles. Examinations were digitally recorded for retrospective blinded evaluation by two radiologists with 20 and 10 years' experience in urologic imaging. Histologic results were available for 30 of 47 (64%) lesions (25 primary malignant tumors, two metastases, and three primary benign lesions). Two lesions increased in size and complexity during the follow-up and were considered malignant. One Bosniak category III and 14 category IIF cysts were stable after a follow-up of at least 3 years and were considered benign. ROC curve analysis was used to assess the capability of contrast-enhanced ultrasound to differentiate benign from malignant lesions.

RESULTS

Twelve likely complex cystic lesions at gray-scale ultrasound were cystic also on contrast-enhanced ultrasound and reference procedures. Eleven of 34 lesions that appeared solid at gray-scale ultrasound were cystic on contrast-enhanced ultrasound and reference procedures. One lesion considered likely solid by one radiologist and possibly cystic by the other was a solid tumor at contrast-enhanced ultrasound and histologic analysis. The diagnostic performance of contrast-enhanced ultrasound to characterize the lesions as benign or malignant was high for both readers (AUC, 0.958 and 0.966, respectively).

CONCLUSION

Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.

摘要

目的

本文旨在回顾性研究在两个放射学中心中，对比增强超声在 CT 增强程度不明确（即平扫和增强扫描之间密度增加 10-20HU）的肾肿块的特征描述中的作用，这些肿块在常规超声模式下无法明确诊断。

材料和方法

47 个肾病变（范围 0.8-7.7cm；平均 2.6cm）在 CT 增强程度不明确的情况下进行了对比增强超声检查，使用六氟化硫填充的微泡。由两位具有 20 年和 10 年泌尿科成像经验的放射科医生对检查进行了数字记录，并进行了回顾性盲法评估。30 个病变（25 个原发性恶性肿瘤、2 个转移瘤和 3 个原发性良性病变）获得了组织学结果。2 个病变在随访过程中增大且变得复杂，被认为是恶性的。1 个 Bosniak Ⅲ类和 14 个ⅡF 类囊肿在至少 3 年的随访后保持稳定，被认为是良性的。ROC 曲线分析用于评估对比增强超声区分良恶性病变的能力。

结果

12 个在灰阶超声上表现为可能复杂囊性病变的病变在对比增强超声和参考程序上也是囊性的。34 个在灰阶超声上表现为实性病变的病变中有 11 个在对比增强超声和参考程序上是囊性的。一位放射科医生认为可能是实性病变，另一位医生认为可能是囊性病变的 1 个病变在对比增强超声和组织学分析中是实性肿瘤。两位读者对病变进行良性或恶性特征描述的对比增强超声诊断性能均较高（AUC 分别为 0.958 和 0.966）。