超声造影在鉴别膀胱上皮癌分级中的应用价值  

Role of Contrast-enhanced Ultrasound in the Differentiation of High-and Low-grade Urothelial Carcinoma

作　　者：李秋洋[1] 唐杰[1] 何恩辉[1] 周昀[1] 李岩密[1] 费翔[1] 张艳[1] 

机构地区：[1]中国人民解放军总医院超声科,北京100853

出　　处：《中国医学科学院学报》2012年第4期364-368,共5页Acta Academiae Medicinae Sinicae

基　　金：中国人民解放军总医院博士研究生创新项目(10BCZ02);国家科技支撑计划项目(2009BAI86B05)~~

摘　　要：目的观察膀胱上皮癌实时灰阶超声造影增强模式,探讨其鉴别膀胱高级别与低级别尿路上皮癌的临床价值。方法回顾性分析96例患者96个膀胱上皮癌(高级别55个,低级别41个)的实时灰阶超声造影增强模式,并与病理检查结果对照,采用时间-强度分析软件测量到达时间、达峰时间、峰值强度、廓清时间。总结不同级别膀胱上皮癌的增强模式。结果高级别膀胱上皮癌的峰值强度(P=0.005)和廓清时间(P=0.002)明显大于低级别组,而到达时间(P=0.374)和达峰时间(P=0.386)与低级别组差异无统计学意义。55个高级别病灶中,51个(85.5%)表现为快进慢退;41个低级别病灶中,35个(85.4%)表现为快进快退。以典型增强模式鉴别诊断高级别尿路上皮癌与低级别尿路上皮癌的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为85.5%、90.2%、87.5%、92.2%、82.2%和85.4%、90.9%、88.5%、87.5%、89.3%。结论不同级别的膀胱上皮癌具有不同的增强表现,增强模式的差异是鉴别诊断高、低级别膀胱上皮癌的较重要诊断指标。Objective To investigate the role of contrast-enhanced ultrasound in the differential diag- nosis of high- and low-grade urothelial carcinoma. Methods The radiological data of 96 patients with urotheli- al carcinomas who had undergone gray-scale contrast-enhanced ultrasound from August 2010 to April 2011 were analyzed retrospectively. Pathological examination demonstrated that the tumors were high-grade in 55 cases （high-grade group） and low-grade in 41 cases （low-grade group）. The dynamic images were analyzed by time- intensity curve, and the arrival time （ AT）, peak intensity （ PI）, time to peak （ TFP）, and washout time （WT） were measured. The enhancement patterns of different urothelial carcinomas were analyzed. Results Both PI （P = 0. 005） and WT （P = 0.002） were significantly higher in high-grade group than in low-grade group, whereas AT （P = 0. 374） and TTP （P = 0. 386） showed no significant difference between these two groups. In the high-grade group, 47 cases （85.5%） were identified as fast wash-in and slow wash-out; in thelow-grade group, 35 （85.4%） were identified as fast wash-in and fast wash-out. When the enhancement pat- curacy, positive predictive value, and negative predictive value were 85.5% , 90.2% , 87.5% , 92.2% , and 82.2% for high-grade tumor and 85.4% , 90.9% , 88.5% , 87.5% , and 89.3% for low-grade tumor. Con- elusions Different grade urothelial earcinomas show different enhancement finding on eontrast-enhanced ultra- sound. The enhancement pattern can serve as an important diagnostic indictor.

关 键 词：膀胱上皮癌 超声造影 增强模式 分级 

分 类 号：R445.1[医药卫生—影像医学与核医学]