超声造影评估复杂性囊性肾脏肿物的作用

目的：探讨超声造影（CEus）在鉴别囊性肾脏肿物良恶性方面的作用，并评估CEUS在预测恶性囊性肾脏肿物组织学类型方面的作用。方法：回顾性分析2007年1月～2011年12月经常规超声（US）和CEUS检查的43例患者的43个囊性肾性肿物，诊断结果经病理及随访证实。US观察肿瘤的位置、大小、多房或单房、囊壁及分隔最厚处厚度、有无钙化、囊内有无实性结节，实性结节有无彩色血流。CEUS观察病灶的囊壁及分隔增强后厚度、多房或单房、囊壁及囊内容物有无增强、增强程度等。结果：43个病灶中良性13例，恶性30例。恶性肿物中，透明细胞肾癌21例，乳头状肾癌2例，多房囊性肾癌5例，卵巢癌肾转移2例。cEus与US诊断恶性囊性肾脏肿物的ROC曲线下面积分别为0．950、0．806，差异有统计学意义（P=0．034）。多房囊性肾癌与其他亚型囊性肾细胞癌CEUS表现有所不同。多房囊性肾癌多表现为多房囊性肿物，囊内见增强分隔，不伴囊内增强实性结节。其他亚型肾细胞癌多可见囊内增强实性结节。结论：CEUS有助于囊性肾脏肿物良恶性鉴别及恶性囊性肾脏肿物组织学类型的判断。

Evaluation of complex cystic renal mass with contrast enhanced ultrasonography

Objective： To investigate the value of contrast enhanced ultrasonography（CEUS） in evaluating cystic renal masses and predicting histological subtype of malignant cystic renal mass. Method： Forty-three cystic renal masses were scanned by conventional ultrasonography（US） and CEUS from Jan 2007 to Dec 2011. All tumors were sequentially diagnosed by pathological tests and follow up. The location, size, multilocular or unilocular, thickness of wall and septum, calcification, intracystic nodule, blood signal of nodule were observed by con- ventional US. Multilocular or unilocular, thickness of enhancing wall and septum, enhancement grade of intracys tic nodule were studied by CELLS. Result： Among 43 renal cysticmasses in 43 patients, 30 masses were malignant and 13 were benign. Thirteen benign cystic renal masses were diagnosed by pathological tests and follow-up . Of 30 malignant cystic renal masses diagnosed by pathological tests, 21 masses were clear cell carcinomas; 5 muttiloc- ular cystic renal cell carcinomas; 2 papillary renal cell carcinomas and 2 metastases. The area under ROC curve of CEUS and US was 0. 950, 0. 806 in diagnosing malignant cystic renal masses respectively. There was significant difference between the two groups（P=0. 034）. The imaging finding of multilocular cytic renal cell carcinoma is different from other subtype cysic renal cell carcinoma. Multilocular cytic renal cell carcinomas manifest multiloeuar mass, which show enhancing septa and no enhancing intracystic nodule. Most of other subtype cysic renal cell carcinomas show enhancing intracystic nodule. Conclusion： CEUS may be helpful in differentiating the nature of cystic renal masses and predicting histological subtype of malignant cystic renal masses.