三维超声造影对肾肿瘤血管结构的初步研究  

Pilot study of three-dimensional contrast-enhanced ultrasound in vascular patterns of renal tumors

作　　者：李丛[1] 黄备建[1] 何婉媛[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：《中华超声影像学杂志》2011年第5期393-396,共4页Chinese Journal of Ultrasonography

基　　金：上海市重点学科建设项目（B112）;上海市卫生局课题（2008190）

摘　　要：目的探讨三维超声造影（three—dimensional contrast-enhanced ultrasound，3D-CEUS）在显示肾肿瘤血管结构中的应用价值。方法121例常规超声提示肾肿瘤的患者，均经手术后病理汪实。首先进行常规超声及超声造影检查，待造影剂基本廓清，再次注射造影剂进行3D-CEUS检查并存储图像。应用QLAB工作软件进行3D-CEUS图像重建．按照血供丰富程度将3D-CEUS图像分为4级。结果肾良恶性肿瘤3D-CEUS血管结构表现不同。肾细胞癌实质早期3D-CEUS血管结构主要表现为迂曲扩张的粗网状或杂乱树枝状（83．17％，84／101）．部分存在充盈缺损区（60．40％，61／101）及假包膜（14．85％，15／101）。恶性肿瘤实质早期的血管结构主要是Ⅲ级或Ⅳ级。肾错构瘤实质早期3DICEUS主要表现为云雾状，局部呈网状或树枝状（31．58%，6/19）或云雾状基础上叠加网状（63．16％．12／19）。3D-CEUS对肾肿瘤血管结构的显示优于超声造影。结论肾肿瘤超声造影三维重建是超声造影的有益补充。Objective To evaluate the feasibility of three-dimensional contrast enhanced ultrasound （3D-CEUS） in showing vascular patterns of renal tumors. Methods The images of 3D-CEUS examination were retrospectively analyzed in one hundred and twenty one renal tumors which were confirmed sequentially by pathology. 3D-CEUS was performed after conventional ultrasound and contrast enhanced ultrasound （CEUS）. The 3D-CEUS images were reconstructed by QLAB workstation and classified into 4 grades based on the blood supply characteristics. Results All the tumors were confirmed by pathology and operations,including clear cell renal cell carcinoma （CCRCC） （n = 91）. papillary renal cell. carcinoma （PRCC） （ n = 5 ）, chromopbobe renal cell carcinoma （CRCC） （ n = 5）, renal angiomyolipoma （RAML） （n = 19）, and cystic nephroma （ n = 1 ）. Three-dimensional reconstruction could provide clear stereoscopic views of the interested structures and morphological characteristics of lesions. The three dimensional uhrasonography of a particular renal tumor could be a mixture of different basic grades. There were significant differences between benign and malignant renal tumors in 3D-CEUS. The image quality was the best in early parenchymal phase comparing to other phases. In early parenchymal phase, 84 RCCs （83. 17 % ） were tortuous expansive reticular or irregular messy dendritic,61 cases （60.40%） with filling defect areas and 15 cases （14.85%） with pseudocapsules. Grade Ⅲ and Grade Ⅳ were the main vascular patterns in maglinant tumors. In early parenchymal phase,6 RAMLs （31.58%） were nebulous with dendritic in part. 12 cases（63.16%） were reticular on the basis of nebulous with homogeneous internal structures. The vascular pattern was shown better in 3D-CEUS than CEUS. Conclusions 3D-CEUS can provide clear stereoscopic structures and morphological characteristics of the lesions,it is a useful adjuvant of CEUS for the diagnosis of renal tumors.

关 键 词：超声检查.三维 微气泡 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]