Department of Ultrasonography, Linping Campus, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Biomol Biomed. 2024 Sep 6;24(5):1370-1379. doi: 10.17305/bb.2024.10236.
This study aims to evaluate the clinical diagnostic value of contrast-enhanced ultrasound combined with microflow imaging (CEUS-MFI) in the differential diagnosis of benign and malignant renal tumors. All patients underwent CEUS, MFI, color doppler flow imaging (CDFI), and CEUS-MFI. The efficacies of these different diagnostic modalities in diagnosing benign and malignant renal tumors were evaluated by Kappa consistency test and the receiver operating characteristic (ROC) curve, with pathological findings serving as the gold standard. CDFI, MFI and CEUS-MFI all demonstrated higher blood flow in malignant tumors compared with benign tumors. Compared with benign tumors, CDFI detected a higher rate of punctate and linear Adler grade 2 and 3 blood flows in malignant tumors, as well as peripheral semicircular or annular blood flow. MFI identified a high rate of peripheral circumferential blood flow and irregular vascular morphology in malignant tumors, with most exhibiting Adler grade 3 blood flow. In addition, CEUS-MFI showed more dendritic or irregular Adler grade 2 or 3 blood flows in malignant renal tumors than MFI alone. Further analysis showed that CEUS-MFI had the highest consistency with pathological diagnosis (Kappa = 0.808). The ROC curve showed that the area under the curve (AUC) for CEUS-MFI in differentiating between benign and malignant lesions was 0.898, significantly outperforming other single diagnostic methods. With its capability to display microvascular information and assess overall pathological characteristics, MFI can accurately predict the nature of renal tumors and assist in surgical planning.
本研究旨在评估超声造影联合微血管成像（CEUS-MFI）在鉴别良恶性肾肿瘤中的临床诊断价值。所有患者均行 CEUS、MFI、彩色多普勒血流成像（CDFI）及 CEUS-MFI 检查。采用 Kappa 一致性检验和受试者工作特征（ROC）曲线评估不同诊断方法对良恶性肾肿瘤的诊断效能，以病理结果为金标准。CDFI、MFI 和 CEUS-MFI 均显示恶性肿瘤的血流信号高于良性肿瘤。与良性肿瘤相比，CDFI 检测到恶性肿瘤点状及线状 Adler 分级 2 级和 3 级血流的检出率较高，以及周边半圆形或环形血流；MFI 鉴别出恶性肿瘤周边环状血流及不规则血管形态的检出率较高，且多数呈现 Adler 分级 3 级血流；此外，CEUS-MFI 显示恶性肾肿瘤中较 MFI 单独检查更具树枝状或不规则 Adler 分级 2 级或 3 级血流。进一步分析显示，CEUS-MFI 与病理诊断的一致性最高（Kappa=0.808）。ROC 曲线显示，CEUS-MFI 鉴别良恶性病变的曲线下面积（AUC）为 0.898，明显优于其他单一诊断方法。MFI 能够显示微血管信息并评估整体病理特征，可准确预测肾肿瘤的性质，辅助手术规划。
