Zhang D, Xin X J, Mu J, Mao Y R, Zhang S
Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
Zhonghua Yi Xue Za Zhi. 2019 Jun 18;99(23):1778-1781. doi: 10.3760/cma.j.issn.0376-2491.2019.23.005.
To explore the value of superb microvascular imaging (SMI) and contrast- enhanced ultrasound (CEUS) in differential diagnosis of small renal masses. A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital. There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54±10) years old. These tumors were all examined by using SMI and CEUS. And the imaging diagnostic results were compared based on the pathological results. Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign, 2-3 grade was malignant. Besides,the patterns and enhancement of the small renal masses were observed in CEUS. The main diagnostic criteria of malignant tumors were "fast forward" , "rapid regression" and "high perfusion" . Some special types of renal cell carcinoma were diagnosed by "slow in" , "rapid regression" and "hypo-perfusion" . Benign tumors were diagnosed by "slow in" , "slow down" and "hypo-perfusion" . Among 86 cases, 76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis. By SMI, Adler grade of 89.5% (68/76) malignant tumors were 2-3, Adler grade of 6/10 benign tumors were 0-1. By CEUS, 77.6% (59/76) of malignant tumors were "fast forward" , 82.9% (63/76) were "rapid regression" , 76.3% (58/76) were "high perfusion" ; 7/10 of benign tumors were "slow in" , 5/10 were "slow down" and 6/10 were "low perfusion" . The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of SMI were 86.0%,89.5%, 60.0%, 94.4%,42.9% and 0.747 respectively. The values for CEUS were 89.5%, 92.1%, 70.0%,95.9%, 53.8% and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI (0.288). Although there is no statistical significance between SMI and CEUS, the accuracy, sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses. In brief,SMI provides a new method in the differential diagnosis of small renal masses.
探讨超微血管成像（SMI）和超声造影（CEUS）在小肾肿块鉴别诊断中的价值。2016年10月至2018年3月，天津医科大学肿瘤医院共收集84例肾肿块患者的86个病灶。其中男性56例，女性28例，年龄29至76岁，平均年龄（54±10）岁。所有肿瘤均行SMI和CEUS检查，并根据病理结果对比影像学诊断结果。对SMI检查的肿瘤进行Adler血流半定量分级评估，评估标准如下：0 - 1级为良性，2 - 3级为恶性。此外，观察CEUS检查中小肾肿块的血流灌注方式及增强情况。恶性肿瘤主要诊断标准为“快进”“快退”“高灌注”。部分特殊类型肾细胞癌表现为“慢进”“快退”“低灌注”。良性肿瘤表现为“慢进”“慢退”“低灌注”。86例中，病理诊断确诊恶性肿块76例，良性肿块10例。SMI检查中，89.5%（68/76）的恶性肿瘤Adler分级为2 - 3级，6/10的良性肿瘤Adler分级为0 - 1级。CEUS检查中，77.6%（59/76）的恶性肿瘤表现为“快进”，82.9%（63/76）表现为“快退”，76.3%（58/76）表现为“高灌注”；7/10的良性肿瘤表现为“慢进”，5/10表现为“慢退”，6/10表现为“低灌注”。SMI的准确度、灵敏度、特异度、阳性预测值、阴性预测值及AUC分别为86.0%、89.5%、60.0%、94.4%、42.9%和0.747。CEUS的相应值分别为89.5%、92.1%、70.0%、95.9%、53.8%和0.811。CEUS与SMI诊断效能差异无统计学意义（0.288）。虽然SMI与CEUS之间无统计学差异，但SMI在小肾肿块诊断中的准确度、灵敏度及阳性预测值更高，能清晰显示微血管并精准检测小肾肿块内的低速血流。总之，SMI为小肾肿块的鉴别诊断提供了一种新方法。
