超声引导衰减参数技术在肾占位病变的良恶性鉴别中的应用  

Application of ultrasound-guided attenuation parameter in differentiation of benign and malignant renal lesions

作　　者：杜怡熳 李秋洋[1] 姜波[1] 朱嘉宁 李静波 张颖[1] 罗渝昆[1] Du Yiman;Li Qiuyang;Jiang Bo;Zhu Jianing;Li Jingbo;Zhang Ying;Luo Yunkun(Department of Ultrasound,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声诊断科,北京100853

出　　处：《中华医学超声杂志（电子版）》2022年第7期694-700,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金(81971635,81801698);部队保健专项课题(21BJZ13)。

摘　　要：目的探究超声引导衰减参数技术(UGAP)在鉴别诊断肾占位良、恶性病变中的临床应用价值。方法本研究为前瞻性研究,连续纳入2021年6月1日至2021年8月31日因肾占位来解放军总医院第一医学中心泌尿外科住院的患者42例,均行常规超声、超声造影检查及UGAP值测量,根据手术病理结果,分为良性组13例与恶性组29例。单因素对比分析2组之间常规超声、超声造影及UGAP参数的差异,并进行Logistic多因素分析。绘制UGAP值诊断肾恶性占位的受试者工作特征曲线,计算截断值及曲线下面积、诊断敏感度、特异度、准确性、阳性预测值、阴性预测值。结果单因素分析显示,常规超声参数中肾占位病变内部回声是否均匀恶性组与对照组比较(均匀/不均匀:6/23 vs 7/6),差异具有统计学意义(P=0.032),肾占位最大径、回声、边界、形态、血流情况比较,差异均无统计学意义(P均>0.05)。与对照组比较,恶性组超声造影参数中肾占位早于肾皮质开始增强(27/29 vs 6/13)、高增强(27/29 vs 8/13)、环状增强(25/29 vs 6/13)、无灌注区(24/29 vs 5/13)比例高,UGAP值低[(0.45±0.13)vs(0.64±0.17)],2组间差异具有统计学意义(χ^(2)=6.606、6.439、5.521、8.241、t=3.807,P=0.010、0.037、0.019、0.004、<0.001)。多因素分析显示UGAP值(OR=0.260,P=0.017,95%CI:0.086~0.788)及肾占位早于肾皮质增强(OR=0.029,P=0.032,95%CI:0.001~0.728)为恶性肾占位的独立危险因素,以0.545作为UGAP诊断的截断值时,诊断敏感度、特异度、准确性、阳性预测值、阴性预测值、曲线下面积分别为72.41%、69.23%、71.43%、84.00%、52.94%、0.801。结论UGAP技术在肾占位性病变良恶性的鉴别诊断中有一定临床应用价值。Objective To assess the clinical value of ultrasound-guided attenuation parameter(UGAP)in the differentiation of benign and malignant renal lesions.Methods This study prospectively included 42 consecutive patients hospitalized at the Department of Urology of our hospital for renal lesions from June 1,2021 to August 31,2021.All patients underwent conventional ultrasound,contrast-enhanced ultrasound(CEUS),and UGAP measurement,and were divided into either a benign group(n=13)or a malignant group(n=29)according to the surgical pathology results.The differences of conventional ultrasound,CEUS,and UGAP between the two groups were analyzed by univariate and logistic multifactor analyses.The receiver operating curve of the UGAP value was plotted to calculate the cutoff value,area under the curve,sensitivity,specificity,accuracy,positive predictive value,and negative predictive value.Results Univariate analysis showed that there was a statistical difference in the homogeneity of internal echo of renal lesions on conventional ultrasound between the benign group and malignant group(6/23 vs 7/6,P=0.032).There was no significant difference in maximum diameter,echo,margin,regularity,or blood flow(P>0.05).Compared with the control group,the percetages of patients with earlier enhancement of renal mass than the renal cortex(27/29 vs 6/13,χ^(2)=6.606,P=0.010),hyperenhancement(27/29 vs 5/13,χ^(2)=6.439,P=0.037),annular enhancement(24/29 vs 6/13,χ^(2)=5.521,P=0.019),and non-perfusion area(24/29 vs 5/13,χ^(2)=8.241,P=0.004)were significantly higher and the UGAP value[(0.45±0.13)vs(0.64±0.17),t=3.807,P<0.001]was significantly lower in the malignant group.Multivariate analysis showed that lower average value of UGAP(odds ratio[OR]=0.260,P=0.017,95%confidence interval[CI]:0.086-0.788)and earlier enhancement of renal lesion than the renal cortex(OR=0.029,P=0.032,95%CI:0.001-0.728)were independent risk factors for malignancy.When 0.545 was used as the cutoff value for UGAP diagnosis,the diagnostic sensitivity,specificity,accuracy,p

关 键 词：肾占位 超声引导衰减参数技术 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737[医药卫生—诊断学]