MSCT与超声诊断肾癌病理分级的价值比较  

Comparison of MSCT and ultrasonography in the diagnosis of renal cell carcinoma

作　　者：黄权生[1] 刘华[1] 唐新旺[2] 梁耀园[3] 蔡奕增 

机构地区：[1]嘉应学院医学院附属医院放射科,广东梅州514031 [2]嘉应学院医学院附属医院超声科,广东梅州514031 [3]广东省妇幼保健院超声科,广东广州510030 [4]广东省梅州市人民医院超声科,广东梅州514031

出　　处：《中国中西医结合影像学杂志》2017年第4期419-422,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：梅州市科技计划项目(2015240)

摘　　要：目的 :比较MSCT和超声在判断肾癌病理分级上的应用价值,并对2种方法行一致性检验,为临床诊断肾癌病理分级提供诊断依据。方法:选取80例肾透明细胞癌(CCRCC)患者,随机分为CT组和超声组各40例,术前CT组行MSCT常规平扫和双期增强扫描,超声组行常规超声和超声造影,观察不同分级肿瘤的CEUS增强模式、程度、均匀性及肿瘤周边环状高增强(PHR)情况。结果 :经手术取病理活检Fuhrman病理分级,CT组Ⅰ级9例,Ⅱ级17例,Ⅲ级11例,Ⅳ级3例;超声组Ⅰ级8例,Ⅱ级19例,Ⅲ级10例,Ⅳ级3例。2组在年龄、性别、病程等方面差异均无统计学意义(均P>0.05)。MSCT组各病理级别平扫CT值及相对密度指数差异不大(P>0.05),而皮质期及髓质期扫描,病理级别越高,CT值、CT差值、增强百分比、增强指数明显降低(均P<0.05)。超声造影显示不同Fuhrman分级CCRCC的PHR差异有统计学意义(P<0.05)。FuhrmanⅠ级肿瘤中PHR检出率相对较高,Ⅳ级肿瘤PHR检出率相对较低。各级肿瘤在强化均匀性和CEUS增强模式上差异无统计学意义(P>0.05)。MSCT和超声造影对不同Fuhrman病理分级的CCRCC诊断效能差异无统计学意义(P>0.05),具有中度一致性(K=0.527,P<0.0001),Fuhrman病理分级不同,两者的诊断效能一致性也有差异。结论:MSCT和超声造影对肾癌不同Fuhrman病理分级的判断具有可行性,诊断效能与Fuhrman具有相关性,但两者诊断效能差异无统计学意义,可为临床诊断CCRCC的Fuhrman病理分级提供更多依据,值得临床推广应用。Objective：To compare the application value of multilayer spiral CT and ultrasound in the diagnosis of renal cell carcinoma pathological grading,the feasibility of comparison of two methods in the diagnosis,and to check the consistency of the two methods,to provide diagnostic basis for clinical feasibility of diagnosis of renal cell carcinoma pathological grading. Meth-ods：80 cases of renal cell carcinoma from March 2011 to June 2016 as the research object ,surgical biopsy to determine Fuhrman pathological classification of various cases of renal cell carcinoma ,80 cases of patients were randomly divided into CT group and ultrasound group,40 cases in each group,the preoperative CT group underwent multi-slice spiral CT routine scan and dual phase enhanced scan,ultrasound group underwent conventional ultrasound and contrast-enhanced ultrasound. Homogeneity and tumor surrounding ring high enhancement mode,and enhance the observation of the different grade of tumor CEUS （PHR）, the Fuhrman grading and operation made to compare the feasibility of the two methods in the diagnosis of renal cell carcino-ma,and to test the feasibility of the method. Results：after surgical biopsy and Fuhrman pathologic grading,CT group of 40 pa-tients,9 cases of grade Ⅰ,17 cases of grade Ⅱ,11 cases of Ⅲ grade,and 3 cases of grade Ⅳ. Ultrasound group of 40 pa-tients,8 cases of grade Ⅰ,19 cases of grade Ⅱ,10 cases of grade Ⅲ,3 cases of grade Ⅳ,no significant difference of age be-tween two groups （P〉0.05）. In multi-slice spiral CT examination group,there were no statistical significant difference of plain CT value and relative density index according to the pathological grade （P〉0.05）,but in cortical and medullary phase scan-ning,the higher pathological grade,the lower CT value,CT value difference,enhanced percentage,enhanced index,the difference had statistical significance （P〈0.05）. Contrast enhanced ultrasonography showed that the PHR of CCRCC in different Fuhrman grades were statistically signific

关 键 词：肿瘤 体层摄影术 X线计算机 超声检查 Fuhrman分级 

分 类 号：R445.1[医药卫生—影像医学与核医学]