常规超声结合超声造影诊断肾占位性病变的价值  

The value of conventional ultrasound combined with contrast-enhanced ultrasound in the diagnosis of renal space occupying lesions

作　　者：汪朝阳 黄鹏飞[1] 张晴 杨斌[1] WANG Zhao-yang;HUANG Peng-fei;ZHANG Qing;YANG Bin(Department of Ultrasound Diagnosis,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Ultrasound Diagnosis,the Affiliated People′s Hospital of Jiangsu University,Zhenjiang 212000,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)超声诊断科,南京210002 [2]南京市中医院 [3]江苏大学附属人民医院超声诊断科,镇江212000

出　　处：《东南国防医药》2021年第5期479-483,共5页Military Medical Journal of Southeast China

摘　　要：目的探讨常规超声结合超声造影对诊断肾占位性病变的临床价值。方法回顾性分析2014年1月至2017年12月东部战区总医院收治的肾占位性病变患者174例的临床资料,所有患者术前均进行常规超声及超声造影检查,术后均行病理检查,其中恶性病变148例,良性病变26例。比较超声造影特征中肾良恶性占位的灌注情况、强化程度以及廓清情况,分析肾良恶性占位性病变的诊断价值。结果良性病变与恶性病变患者之间肿瘤大小、回声比较差异有统计学意义(P<0.01),而性别、年龄、血流、边界比较差异无统计学意义(P>0.05),其中肾血管平滑肌脂肪瘤在良性病变中占比最高[73%(19/26)],其超声造影特征为皮质期等增强;肾透明细胞癌在恶性病变中占比最高[84%(125/148)],其超声造影特征为皮质期高增强、周边环状假包膜及内部回声不均匀;两者在灌注方式及强化程度上差异具有统计学意义(P<0.05)。超声造影诊断肾良恶性占位性病变的特异度为84.6%,灵敏度为97.3%,准确度95.4%。结论超声造影皮质期高增强、周边环状假包膜及内部回声不均匀是诊断肾恶性占位的重要特征,而皮质期等增强是诊断肾良性占位的主要特征。超声造影皮质期对肾占位性病变具有重要的诊断价值。Objective To evaluate the clinical value of conventional ultrasound combined with contrast-enhanced ultrasound in the diagnosis of renal space occupying lesions.Methods The clinical data of 174 patients with renal space occupying lesions in Nanjing General Hospital of Nanjing military region from January 2014 to December 2017 were analyzed retrospectively.all patients were examined by routine ultrasound and contrast-enhanced ultrasound before operation.pathological examination was performed after operation,including 148 cases of malignant lesions and 26 cases of benign lesions.The perfusion,enhancement and clearance of benign and malignant renal space occupying lesions in contrast-enhanced ultrasonography were compared,and the diagnostic value of benign and malignant renal space occupying lesions was analyzed.Results There was significant difference in tumor size and echo between patients with benign and malignant lesions(P<0.01),while there was no significant difference in sex,age,blood flow and boundary(P>0.05).Renal angiomyolipoma accounts for the highest proportion of benign lesions[73%(19 in 26)],and its contrast-enhanced ultrasound is characterized by cortical phase enhancement.Renal clear cell carcinoma accounted for the highest proportion of malignant lesions[84%(125 in 148)].Its contrast-enhanced ultrasound was characterized by cortical phase hyperenhancement,peripheral annular pseudocapsule and uneven internal echo.There is a statistically significant difference between the two groups in the mode of perfusion and the degree of enhancement(P<0.05).The specificity,sensitivity and accuracy of contrast-enhanced ultrasound in the diagnosis of benign and malignant renal space occupying lesions were 84.6%,97.3%and 95.4%,respectively.Conclusion The high enhancement of contrast-enhanced ultrasound in cortical phase,peripheral annular pseudocapsule and uneven internal echo are important features in the diagnosis of malignant renal space occupying,while cortical phase enhancement is the main feature in the diagnos

关 键 词：肾占位性病变 超声造影 常规超声 高增强 环状增强 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]