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

刘雪; 杨崇一; 杨丰强; 高银; 胡增刚; 李光银

doi:10.16766/j.cnki.issn.1674-4152.002377

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

doi: 10.16766/j.cnki.issn.1674-4152.002377

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

基金项目:

浙江省医药卫生科技计划项目 2019RC272

详细信息

通讯作者:
高银, E-mail: shmily_xr@126.com

中图分类号: R737.11 R445.1
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- 被引次数: 0
出版历程
- 收稿日期: 2021-11-02
- 网络出版日期: 2022-08-13

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

1.
Department of Special Examination, the First Hospital of Ninghai County, Ningbo, Zhejiang 315600, China

摘要

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%；χ²=9.199、P=0.002；χ²=5.357、P=0.021；χ²=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。
- 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
Abstract: 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%; χ²=9.199, P=0.002; χ²=5.357, P=0.021; χ²=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.
- Colour Doppler ultrasound /
- Contrast-enhanced ultrasound /
- Renal parenchymal tumour /
- Differential diagnosis /
- Clinical effect

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表 1 不同性质小体积肾实质性肿瘤彩色多普勒超声影像信号特征比较[例(%)]

Table 1. Comparison of signal characteristics of color Doppler ultrasound in smallvolume renal parenchymal tumors with different properties [cases(%)]

肿瘤性质	例数	病灶边缘特征			回声信号特征
肿瘤性质	例数	边缘清晰	边缘不清晰		高回声	等回声	低回声	混合回声
肾脏恶性肿瘤	72	65(90.28)	7(9.72)		31(43.06)	21(29.17)	11(15.28)	9(12.50)
肾脏良性肿瘤	54	46(85.18)	8(14.81)		17(31.48)	20(37.04)	11(20.37)	6(11.11)
χ²值		0.763			2.181
P值		0.382			0.536

肿瘤性质	例数	病灶生长特征					假包膜情况
肿瘤性质	例数	突出肾轮廓外生长		未突出肾轮廓外生长			存在假包膜	不存在假包膜
肾脏恶性肿瘤	72	52(72.22)		20(27.78)			47(65.28)	25(34.72)
肾脏良性肿瘤	54	13(24.07)		41(75.93)			17(31.48)	37(68.52)
χ²值		28.643					14.101
P值		＜0.001					＜0.001

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表 2 不同性质小体积肾实质性肿瘤超声造影信号特征比较[例(%)]

Table 2. Comparison of contrast-enhanced ultrasound signal characteristics of small volume renal parenchymal tumors with different properties [cases(%)]

肿瘤性质	例数	灌注特征				病灶信号特征			病灶周围信号特征
肿瘤性质	例数	快进	同步	慢进		均匀增强	不均匀增强		环状增强	未见环状增强
肾脏恶性肿瘤	72	61(84.72)	8(11.11)	3(4.17)		8(11.11)	64(88.89)		65(90.28)	7(9.72)
肾脏良性肿瘤	54	4(7.41)	34(62.96)	16(29.63)		51(94.44)	3(5.56)		2(3.70)	52(96.30)
χ²值		73.912				86.061			92.885
P值		＜0.001				＜0.001			＜0.001

肿瘤性质	例数	病灶信号强度特征						消退特征
肿瘤性质	例数	高强度	中强度		低强度			快进	同步	慢进
肾脏恶性肿瘤	72	59(81.94)	12(16.67)		1(1.39)			32(44.44)	27(37.50)	13(18.06)
肾脏良性肿瘤	54	7(12.96)	22(40.74)		25(46.30)			26(48.15)	17(31.48)	11(20.37)
χ²值		64.816						0.499
P值		＜0.001						0.779

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表 3 不同检查方法对小体积肾实质性肿瘤定性诊断效能情况(例)

Table 3. Effectiveness of different examination methods in qualitativediagnosis of small volume renal parenchymal tumors (cases)

组织病理诊断结果	超声造影检查		彩色多普勒超声检查		合计
组织病理诊断结果	恶性	良性	恶性	良性	合计
肾脏恶性肿瘤	66	6	52	20	72
肾脏良性肿瘤	7	47	17	37	54
合计	73	53	69	47	126

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表 4 不同检查方法对小体积肾实质性肿瘤定性诊断效能ROC分析

Table 4. ROC analysis of qualitative diagnostic efficacy of different examination methods for small volume renal parenchymal tumors

检查方法	AUC	SE	P值	95% CI
超声造影检查	0.894	0.033	＜0.001	0.830~0.957
彩色多普勒超声检查	0.704	0.048	＜0.001	0.610~0.797

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