超声造影结合增强模式及定性分析在鉴别乏血供实性肾病变中的作用

Role of Contrast-Enhanced Ultrasound With the Enhancement Pattern and Qualitative Analysis for Differentiating Hypovascular Solid Renal Lesions.

作者信息

Li Jing, Huang Xiao, Wang Lan, Wang Xiaofeng, Li Yan, Liu Xuehui, Ye Na, Yang Shaoqing, Nie Fang

机构信息

Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.

出版信息

Ultrasound Med Biol. 2024 Feb;50(2):295-303. doi: 10.1016/j.ultrasmedbio.2023.11.002. Epub 2023 Nov 23.

DOI:10.1016/j.ultrasmedbio.2023.11.002

PMID:37996360

Abstract

OBJECTIVE

The aim of the work described here was to explore the clinical value of contrast-enhanced ultrasound (CEUS) with the enhancement pattern and qualitative analysis in distinguishing different types of hypovascular solid renal lesions.

METHODS

A total of 140 patients with 140 renal tumors (all diagnosed by pathology), which manifested hypo-enhancement on CEUS, were included in this study. We compared conventional ultrasound (US) and CEUS features in five common hypovascular renal tumors, including renal angiomyolipoma (RAML), clear cell renal cell carcinoma (ccRCC), renal pelvic urothelial carcinoma (RPUC), papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC). The diagnostic value of conventional US and qualitative parameters of CEUS for differentiating hypovascular solid renal lesions were evaluated.

RESULTS

The mean age of patients with a benign renal lesion was younger than that of patients with a malignant renal lesion (p < 0.05). Echogenicity and qualitative parameters such as wash-out, perfusion defects and perilesional rim-like enhancement (PRE) in the two groups differed significantly (all p values <0.05). Benign renal lesions exhibited mainly slow wash-out, whereas malignant renal lesions exhibited predominantly fast wash-out on CEUS (p < 0.05). There were significant differences in echogenicity, such as between RAML and ccRCC, between RAML and RPUC and between RAML and pRCC (all p values <0.05). The rates of appearance of perfusion defect in ccRCC (48%, 13/27) and pRCC (53%, 10/19) were significantly higher than the rate in RAML (14%, 6/43) (p < 0.05). The rates of appearance of PRE in ccRCC (15%, 4/27), pRCC (26%, 5/19) and chRCC (24%,4/17) were significantly higher than the rate in RAML (9%, 4/43) (p < 0.05).

CONCLUSION

CEUS with the enhancement pattern and qualitative analysis may be helpful in distinguishing malignant from benign hypovascular renal lesions.

摘要

目的

本文所述工作的目的是探讨超声造影（CEUS）及其增强模式和定性分析在鉴别不同类型乏血供实性肾病变中的临床价值。

方法

本研究纳入了140例患有140个肾肿瘤（均经病理诊断）的患者，这些肿瘤在CEUS上表现为低增强。我们比较了五种常见乏血供肾肿瘤的传统超声（US）和CEUS特征，包括肾血管平滑肌脂肪瘤（RAML）、透明细胞肾细胞癌（ccRCC）、肾盂尿路上皮癌（RPUC）、乳头状肾细胞癌（pRCC）和嫌色细胞肾细胞癌（chRCC）。评估了传统US和CEUS定性参数对鉴别乏血供实性肾病变的诊断价值。

结果

良性肾病变患者的平均年龄低于恶性肾病变患者（p<0.05）。两组的回声性以及定性参数如消退、灌注缺损和病灶周围边缘样增强（PRE）有显著差异（所有p值<0.05）。良性肾病变在CEUS上主要表现为缓慢消退，而恶性肾病变主要表现为快速消退（p<0.05）。回声性存在显著差异，如RAML与ccRCC之间、RAML与RPUC之间以及RAML与pRCC之间（所有p值<0.05）。ccRCC（48%，13/27）和pRCC（53%，10/19）的灌注缺损出现率显著高于RAML（14%，6/43）（p<0.05）。ccRCC（15%，4/27）、pRCC（26%，5/19）和chRCC（24%，4/17）的PRE出现率显著高于RAML（9%，4/43）（p<0.05）。