彩色多普勒超声联合超声造影用于肾实质性肿瘤鉴别诊断的临床观察  

Clinical effect of colour Doppler ultrasonography combined with contrast-enhanced ultrasound in the differential diagnosis of renal parenchymal tumour

作　　者：刘雪 杨崇一 杨丰强 高银 胡增刚 李光银 LIU Xue;YANG Chong-yi;YANG Feng-qiang;GAO Yin;HU Zeng-gang;LI Guang-yin(Department of Special Examination,the First Hospital of Ninghai County,Ningbo,Zhejiang 315600,China;不详)

机构地区：[1]宁海县第一医院超声科,浙江宁波315600 [2]宁海县第一医院泌尿外科 [3]宁海县第一医院放射科

出　　处：《中华全科医学》2022年第3期458-460,472,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2019RC272)。

摘　　要：目的观察彩色多普勒超声检查和超声造影检查用于肾实质性肿瘤定性鉴别诊断的临床效果。方法选择2017年1月—2021年8月于宁海县第一医院就诊并接受治疗的126例肾实质性肿瘤患者为研究对象,全部病例均进行彩色多普勒超声检查和超声造影检查,分析不同性质肾肿瘤在彩色多普勒超声影像信号特征和超声造影信号特征方面的差异,以组织病理检测结果为金标准,分析2种检测手段对不同病理类型和不同病灶大小肾脏肿瘤性质鉴别诊断的诊断效能差异。结果在彩色多普勒超声影像信号特征方面,恶性肾实质性肿瘤病灶多突出肾轮廓外生长,且多存在假包膜,而良性肾实质性肿瘤病灶多未突出肾轮廓外生长,且多不存在假包膜。在超声造影信号特征方面,恶性肾实质性肿瘤以快进灌注、病灶高强度增强且不均匀增强、病灶周围环状增强为主要特征,而良性肾实质性肿瘤以同步或慢进灌注、病灶中低强度且均匀增强、病灶周围无环状增强为主要特征。超声造影检查对小体积肾肿瘤定性诊断灵敏度(91.67%)、特异性(87.04%)和准确率(89.68%)均显著高于彩色多普勒超声检查(72.22%、68.52%和70.63%;χ^(2)=9.199、P=0.002;χ^(2)=5.357、P=0.021;χ^(2)=14.371、P<0.001)。超声造影检查对小体积肾肿瘤定性诊断Kappa值和ROC曲线下面积(0.789和0.894)均高于彩色多普勒超声检查(0.405和0.704)。结论超声造影检查对于小体积肾实质性肿瘤定性鉴别诊断效能优于彩色多普勒超声检查,两者联合应用有助于提高诊断效率。Objective To observe the clinical effect of colour Doppler ultrasonography(CDUS)and contrast-enhanced ultrasound(CEUS)in qualitative differential diagnosis of renal parenchymal tumour.Methods A total of 126 patients with renal parenchymal tumours in our hospital from January 2017 to August 2021 were selected as the research objects.All cases underwent CDUS and CEUS examination to analyse renal tumours with different properties.The histopathological test results were used as the gold standard to statistically analyse the difference in the diagnostic efficacy of the two detection methods in the differential diagnosis of renal tumours with different pathological types and different lesion sizes.Results In terms of CDUS imaging signal characteristics,malignant renal parenchymal tumours mostly protruded outside the renal contour,and most of them had pseudocapsule.Conversely,benign renal parenchymal tumours mostly did not protrude outside the renal contour,and most of them did not have a pseudocapsule.In terms of CEUS signal characteristics,malignant renal tumours were mainly characterised by fast perfusion,high intensity,uneven enhancement of the lesion and annular enhancement around the lesion,whereas benign renal tumours were mainly characterised by synchronous or slow perfusion,medium and low intensity,uniform enhancement of the lesion and no annular enhancement around the lesion.The sensitivity(91.67%),specificity(87.04%)and accuracy(89.68%)of CEUS were significantly higher than those of CDUS(72.22%,68.52%and 70.63%;χ^(2)=9.199,P=0.002;χ^(2)=5.357,P=0.021;χ^(2)=14.371,P<0.001).The Kappa value and area under ROC curve of CEUS for the qualitative diagnosis of small renal tumour(0.789 and 0.894)were higher than those of CDUS(0.405 and 0.704).Conclusion CEUS is superior to CDUS in the qualitative differential diagnosis of small renal tumours.The combined application of CEUS and CDUS can improve the diagnostic efficiency of renal parenchymal tumours and is worthy of clinical application.

关 键 词：彩色多普勒超声 超声造影 肾实质性肿瘤 鉴别诊断 临床效果 

分 类 号：R737.11[医药卫生—肿瘤] R445.1[医药卫生—临床医学]