CTU、增强MRI和CEUS在肾占位病变定性诊断中准确率的多维度分析  

Multidimensional analysis of accuracy of CTU,contrast-enhanced MRI and CEUS in qualitative diagnosis of renal space-occupying lesions

作　　者：吴林杰 于营 白小杰 戚子昊 郑航[1] 郭中强[1] WU Linjie;YU Ying;BAI Xiaojie;QI Zihao;ZHENG Hang;GUO Zhongqiang(Department of Urology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院泌尿外科,湖北武汉430071

出　　处：《现代泌尿外科杂志》2025年第1期48-52,共5页Journal of Modern Urology

摘　　要：目的多维度比较分析计算机体层成像尿路造影(CTU)、增强磁共振成像(MRI)及超声造影(CEUS)在肾占位性病变中定性诊断的准确率。方法回顾性分析2019年1月—2024年5月武汉大学中南医院泌尿外科经手术病理证实的542例肾占位性病变患者的资料,结合患者临床及病理资料对其CTU、增强MRI及CEUS的检查结果进行分层多维度对比分析。结果3项检查诊断肾占位性病变的准确率分别为CTU 84.50%、增强MRI 83.14%、CEUS 86.14%。同时行3项检查的161例患者中,CEUS对肾占位性病变定性诊断的准确率显著优于CTU(84.16%vs.77.02%,P=0.018),而CTU或CEUS与增强MRI(79.81%)间定性诊断准确率的差异无统计学意义(P>0.05)。分层分析发现,对于≤4 cm肾占位性病变的定性诊断,CEUS与CTU的准确率均为79.55%、增强MRI为76.14%,差异无统计学意义(P>0.05);对>4 cm肾占位性病变的定性诊断,CEUS准确率为89.73%、增强MRI为84.25%、CTU为73.97%,CEUS和增强MRI的准确率明显优于CTU(P<0.05);对于透明细胞癌及良性肾占位的定性诊断,3项检查准确率之间的差异无统计学意义(P>0.05);CEUS对于非透明细胞癌定性诊断的准确率为83.87%、增强MRI为74.19%、CTU为56.45%,增强MRI和CEUS的诊断准确率显著大于CTU(P<0.05)。结论3项检查方法对于肾占位性病变的诊断均具有重要的临床价值,临床上应根据具体情况选择合适的影像学检查方法。CEUS和增强MRI对于肾占位性病变定性诊断的准确率高于CTU,特别是在诊断直径较大的肾占位性病变及非透明细胞癌时。Objective To compare the diagnostic accuracy of three imaging modalities,inlducing CT urography(CTU),contrast-enhanced MRI(CE-MRI),and contrast-enhanced ultrasound(CEUS)in the qualitative diagnosis of renal space-occupying lesions.Methods A retrospective analysis was performed on 542 patients with renal lesions confirmed by surgical pathology in our hospital during Jan.2019 and May 2024.The diagnostic results of CTU,CE-MRI and CEUS were compared and analyzed based on the patients clinical and pathological data.Results The diagnostic accuracy rate of CTU,CE-MRI and CEUS were 84.50%,83.14%and 86.14%,respectively.For the 161 patients who underwent all three examinations,CEUS was significantly more accurate than CTU(84.16%vs.77.02%,P=0.018),while there was no significant difference between CTU or CEUS and CE-MRI(79.81%)(P>0.05).Further analysis found that for lesions≤4 cm,the accuracy of the three examinations was as follows:CEUS=CTU 79.55%,CE-MRI 76.14%,with no significant difference(P>0.05).However,for lesions>4 cm,CEUS ranked the first,followed by CE-MRI and CTU(89.73%vs.84.25%vs.73.97%),and CEUS and CE-MRI were better than CTU(P<0.05).Additionally,for the diagnosis of clear cell renal carcinoma and benign renal space-occupying lesions,there was no statistically significant difference among the three imaging modalities(P>0.05),while for the qualitative diagnosis of non-clear cell renal carcinoma,CEUS ranked the first,followed by CE-MRI and CTU(83.87%vs.74.19%vs.56.45%),and CE-MRI and CEUS were better than CTU(P<0.05).Conclusion All of them have important diagnostic value,and the appropriate selection should be based on patients specifc conditions.CEUS and CE-MRI are more accurate in the qualitative diagnosis of renal space-occupying lesions than CTU,especially for large lesions and non-clear cell carcinoma.

关 键 词：计算机体层成像尿路造影 增强磁共振成像 超声造影 肾占位性病变 定性诊断 

分 类 号：R699.2[医药卫生—泌尿科学]