超声造影对提高肾错构瘤诊断率的价值  

The value of contrast-enhanced ultrasonography in improving the diagnostic rate of renal angiomyolipoma

作　　者：黄备建[1] 毛枫[1] 俞清[1] 王希[1] 李超伦[1] 王文平[1] 

机构地区：[1]复旦大学附属中山医院超声诊断科,上海200032

出　　处：《中华医学超声杂志（电子版）》2010年第6期15-17,共3页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：上海市重点学科建设项目(No.B112);上海市卫生局课题(No.2008190)

摘　　要：目的探讨超声造影在肾错构瘤诊断中的价值。方法对37例患者37个经手术病理证实的肾错构瘤常规超声及超声造影声像图进行回顾性分析。常规超声观察肿瘤大小、边界、内部回声、有无彩色血流信号。超声造影观察病灶的增强时相和方式,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果常规超声显示肿块最大直径范围1.7～28.0cm,高回声团块19个,低回声为主团块11个,混合回声6个,无回声1个。19个肿块发现较丰富或丰富彩色血流信号,16个显示周边或内部少量血流信号,2例未见血流信号。术前常规超声诊断符合率为59.5%(22/37)。37个肿块超声造影平均增强起始时间为(13.57±3.34)s,达峰时间为(20.27±4.27)s,开始消退时间为(28.92±5.16)s。皮质期33个病灶呈缓慢向心增强,4个同步增强;达峰值呈高增强15个,等增强14个,低增强8个。其中28例均匀增强。实质期同步消退11个,缓慢消退19个,快速消退7个,发现假包膜2例。联合缓慢向心增强和达峰值均匀等增强或高增强的诊断符合率为75.7%(28/37)。结论造影时缓慢向心增强和均匀等增强或高增强是肾错构瘤的主要表现。Objective To study the value of contrast-enhanced uhrasonography （CEUS） in the di- agnosis of renal angiomyolipoma（AML）. Methods The images of conventional ultrasound （US） and CEUS were retrospectively analyzed in 37 cases of renal AMLs which were confirmed by operation and pathology. The size, boundary, inner echo and color flow signals of renal tumors were observed by conventional US. Then the modality and phases of enhancement were also observed by CEUS, including the arrival time, the peak time, the washout time and the appearance of internal structures. Results The maximum diameter range of renal lesions was from 1.7 to 28.0 em. The tumors displayed 19 hyperechoie lesions, 11 borderline hypoechoic lesions, 6 mixed-echoic lesions and 1 anechoic lesions by conventional US. The color Doppler flow imaging （CDFI） showed rich flow signals in 19 cases, a small amount of flow signals in 16 cases and non-flow signal in 2 cases. The diagnostic accuracy was only 59.5% （22/37） before operation. All lesions showed mean increased start time of 13.57 ± 3.34 seconds, peak time of 20.27 ± 4.27 seconds, wash-out time of 28.92 ± 5.16 seconds respectively on CEUS. In cortical phase, CEUS detected the delayed centripetal increases in 33 cases and synchronously increases in 4 cases. In peak time, compared to the normal renal cortex, hypervascular, isovascular and hypovascular enhancement appeared in 15 cases, 14 cases and 9 cases respectively. The homogeneous enhancement was detected in 28 lesions. In parenchymal phase, CEUS showed isochronous washout in 11 cases, delayed washout in 19 cases and fast washout in 7 cases. Two cases displayed round pseudocapsule of lesions. The diagnostic accuracy was 75.7% （ 28/37 ） by combining delayed enhancement with homogeneous hyperechoic enhancement or isoechoic enhancement in peak time on CEUS. Conclusions The delayed centripetal enhancement and homogeneous hyperechoic enhancement or isoechoic enhancement in peak time on CEUS could be main features of renal AML.

关 键 词：超声造影 肾错构瘤 诊断 

分 类 号：R737.11[医药卫生—肿瘤]