Quantification of Enhancement of Renal Parenchymal Masses with Contrast-Enhanced Ultrasound

The purpose of this study was to investigate the value of quantitative assessment of enhancement in diagnosing renal cell carcinoma (RCC) with contrast-enhanced ultrasound (CEUS). A total of 73 solid renal parenchymal masses underwent both conventional ultrasound and CEUS. We compared the difference in maximum diameters on conventional ultrasound and CEUS between the benign and malignant groups. Enhancement features derived from a time-intensity curve were also analyzed. The diameters of renal cancer were found to be larger on CEUS than on conventional ultrasound (p < 0.05). When cutoff values of 4.74 s for washout time and 8.52% for enhancement intensity at 60 s for diagnosing RCCs were applied, the sensitivity, specificity and area under the receiver operating characteristic curve were 67.3%, 95.2%, 86.5% and 65.4%, 81.0%, 68.4%, respectively. The sensitivity and specificity for these two enhancement characteristics combined as a criterion for differentiating RCCs from benign lesions were 44.0% and 99.1%, respectively. Early washout in the area of maximal intensity in the interior of the lesion and prolonged washout in the whole area of the lesion are specific CEUS manifestations suggestive of RCC.     

高回声肾错构瘤的超声造影表现

目的探讨超声造影在高回声肾错构瘤中的表现。方法对24例24个经手术病理证实的高回声肾错构瘤常规超声及超声造影声像图进行回顾性分析。常规超声观察肾占位大小、回声、边界、有无彩色血流信号。超声造影观察病灶的增强时相和方式,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果常规超声显示24个肿块最大直径范围1.7cm～28.0cm,实质回声团块23个,实质为主的囊实性回声1个;12个肿块发现较丰富或丰富彩色血流信号,10个显示周边或内部少量血流信号,2例未见血流信号;术前常规超声诊断符合率为75%（18/24）。超声造影时24个肿块平均增强起始时间为（14.42±4.06）s,达峰时间为（21.63±5.01）s,开始消退时间（31.29±6.80）s。皮质期21个病灶呈缓慢向心增强,3个同步增强;达峰值呈高增强7个,等增强8个,低增强9个,其中20例均匀增强;实质期同步消退7个,缓慢消退11个,快速消退6个。皮质期缓慢向心增强和达峰值均匀增强共有特征的诊断符合率为83.3%（20/24）。结论超声造影有助于高回声肾错构瘤的诊断。     

肾肿瘤的超声造影研究

目的探讨各种不同肾肿瘤的超声造影表现。方法124例肾肿瘤（平均直径3.4cm）,应用超声造影观察肿块回声增强时间和造影剂消退时间（皮质相与延迟相）,观察肿块的假包膜（与二维声像图对比）,所有患者均行手术和病理证实。结果透明细胞癌和乳头状癌98例,移行细胞癌5例,肾盂鳞癌6例,血管平滑肌脂肪瘤7例,肾盂上皮细胞癌1例,肾母细胞瘤5例,嗜酸细胞瘤2例（潜在恶性）。透明细胞癌98中超声造影有58例出现假包膜（58/98,73.3%）,而二维声像图显示假包膜31例（31/98,17%）;造影剂呈快进快退76例,快进慢退11例,慢进慢退7例,肿块局部回声增强4例。而血管平滑肌脂肪瘤回声增强程度明显低于肾细胞癌。结论超声造影有助于鉴别肾肿瘤,有助于显示出肾细胞癌的假包膜。     

Renal Cell Carcinoma and Renal Angiomyolipoma

Objective. The purpose of this study was to evaluate the usefulness of contrast‐enhanced ultrasonography (CEUS) in differentiating renal cell carcinoma (RCC) from renal angiomyolipoma (RAML). Methods. One hundred nineteen patients with 126 renal lesions (33 RAMLs and 93 RCCs) who had undergone CEUS were retrospectively studied. All of the lesions were histopathologically or clinical proved. Contrast‐enhanced ultrasonography was performed using low–acoustic power modes and a sulfur hexafluoride–filled microbubble contrast agent. The baseline sonograms and CEUS images were retrospectively analyzed in consensus by 2 radiologists. The tumor echogenicity, enhancement patterns, and degree of enhancement at different phases were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was computed and compared. Results. On CEUS, the features of wash‐out from hyperenhancement or isoenhancement to hypoenhancement over time (observed in 3.0% of RAMLs and 71.0% of RCCs; P < .001), heterogeneous enhancement (observed in 12.1% of RAMLs and 74.2% of RCCs; P < .001), and an enhanced perilesional rim (observed in 3.0% of RAMLs and 79.6% of RCCs; P < .001) achieved significant difference between RCCs and RAMLs. Early wash‐out and heterogeneous enhancement or peritumoral rim enhancement yielded the highest diagnostic capability in differentiating RCC from RAML. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88.2% (82 of 93), 97.0% (32 of 33), 98.8% (82 of 83), 74.4% (32 of 43), and 90.5% (114 of 126), respectively. Conclusions. The CEUS features of early wash‐out, heterogeneous enhancement, and an enhanced peritumoral rim highly suggest RCC, whereas homogeneous enhancement and prolonged enhancement are characteristic manifestations of RAML. Contrast‐enhanced ultrasonography is valuable in differentiating RCC from RAML.     

少脂肪肾错构瘤的超声造影表现

目的：探讨超声造影在少脂肪肾错构瘤中的表现。方法：对11例11个经手术病理证实的少脂肪肾错构瘤的常规超声及超声造影声像图进行回顾分析。常规超声检查观察肾占位大小、回声、边界、有无彩色血流信号。超声造影观察病灶的增强时相和方式,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果：11个肿块最大直径范围2．4～15．3cm,常规超声显示低回声为主不均团块9个,囊实性团块2个,均发现较丰富或丰富彩色血流信号,术前诊断准确率仅36．4％（4／11）。超声造影显示皮质期11个病灶均缓慢增强、向心型填充;达峰值时均呈高回声或等回声,9例均匀增强;实质期同步消退4个,缓慢消退5个,快速消退2个,发现类似“假包膜”征2例。结论：造影时缓慢向心增强和达峰值均匀增强是低回声少脂肪肾错构瘤的主要表现。     

Contrast-Enhanced Ultrasound Findings and Differential Diagnosis of Hepatic Epithelioid Angiomyolipoma Compared with Hepatocellular Carcinoma

Hepatic epithelioid angiomyolipoma (EAML) has malignant potential that can easily be misdiagnosed as hepatocellular carcinoma (HCC), but the treatment options of these conditions are different. This retrospective study investigated whether contrast-enhanced ultrasound (CEUS) can differentiate EAML from HCC. We included 24 patients with pathologically confirmed EAML and 36 patients with HCC who underwent pre-operative conventional ultrasound and CEUS. The conventional ultrasound and CEUS features of the two groups were analyzed. Time intensity curves (TICs) were analyzed for all lesions using quantitative perfusion analysis software. This study found that significant differences existed between the EAML and HCC groups in terms of clinical features such as sex, age, symptoms, alpha-fetoprotein and history of hepatitis B virus infection (p < 0.05). Tumor size, number, border and echogenicity on conventional ultrasound were significantly different between EAML and HCC (p < 0.05). Regarding CEUS, EAML was more likely to have a centripetal enhancement pattern than HCC (p < 0.05). The tumor enhancement degree in the delayed phase in CEUS was significantly different between EAML and HCC (p < 0.05). Quantitative analysis of CEUS parameters revealed that the wash-in area under the curve (AUC) was larger in EAML than in HCC (p < 0.05). Time to peak was significantly shorter in EAML than in HCC (p < 0.05). The peak intensity was significantly stronger in EAML than in HCC (p < 0.05). Regarding the diagnostic performance of CEUS parameters that showed statistical significance on univariate analysis, the sensitivity and specificity for distinguishing EAML from HCC was 66.7%–100.0% and 55.6%–91.7%, respectively. Overall, CEUS could be valuable in differentiating EAML from HCC. Specific features such as the centripetal filling and prolonged enhancement patterns on CEUS, higher peak intensity, bigger wash-in AUC and shorter time to peak on TICs may contribute to a more confirmative differential diagnosis of EAML.     

误诊为肾细胞癌的少脂肪型肾脏血管平滑肌脂肪瘤的CT表现

目的 回顾性分析术前误诊为肾细胞癌(RCC)而接受手术治疗的少脂肪型肾脏血管平滑肌脂肪瘤(AML)的CT表现,以期提高对此病变的认识。 方法 5例少脂肪型AML患者(8个病灶)纳入AML组,17例肾透明细胞癌(CCRCC)作为对照1组,7例低强化RCC(LERCC,包括乳头状肾癌和嫌色细胞癌)作为对照2组,分析少脂肪型AML的CT征象,包括平扫高密度、肿瘤与肾实质交界的角征,增强扫描皮髓质期强化均匀与否。手工放置ROI并计算肿瘤的下述指标:皮髓质期瘤-皮强化比值和排泄期瘤-皮强化比值。 结果 AML组5例8个瘤体均为均匀高密度,2例CCRCC为均匀高密度,1例以高密度为主,1例乳头状肾癌为不均匀高密度,各组间差异有统计学意义(P<0.001)。AML组和对照2组均在皮髓质期均匀强化(100%),与对照1组差异有统计学意义(P=0.004)。AML组有7个,对照1组有10个,对照2组有7个瘤体为外凸型,AML组角征阳性率高于其余两组(P=0.003)。无论皮髓质期和排泄期的瘤-皮强化比值均表现为对照2组显著低于AML组和对照1组(P均<0.05),而后两者间差异无统计学意义(P=0.331、0.321)。 结论 易误诊为RCC的少脂肪型AML的可能CT表现包括:平扫高密度,外凸型者角征阳性,增强扫描均匀明显强化。如肾脏肿瘤有上述CT表现,应考虑到少脂肪型AML的可能。     

超声造影诊断肾脏小肿瘤

目的 探讨CEUS诊断肾脏小肿瘤的价值。方法 回顾性分析49例肾脏小肿瘤患者的常规超声与CEUS表现,其中38例为小肾癌(SRCC),11例为肾血管平滑肌脂肪瘤(RAML),主要观察肿块回声、增强模式、增强程度,与常规超声进行比较,评估CEUS鉴别诊断SRCC与RAML的效能。结果 SRCC与RAML的CEUS增强模式比较,二者弥漫不均匀增强[78.94%(30/38)vs 27.27%(3/11),P=0.003)]、延迟相快退[73.68%(28/38)vs 18.18%(2/11),P=0.001)]、病灶周边环状强化[57.89%(22/38)vs 9.09%(1/11),P=0.006)]3个特征检出率的差异均有统计学意义。采用CEUS诊断SRCC的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为86.84%(33/38),63.63%(7/11),89.18%(33/37),58.33%(7/12)和81.63%(40/49)。结论 CEUS特征可用以诊断肾脏小肿瘤,且对SRCC和RAML的鉴别诊断具有较高价值。     

肾上腺腺瘤的超声造影增强模式分析

目的分析肾上腺腺瘤超声造影增强模式,提高诊断水平。方法 经手术病理证实的33例肾上腺腺瘤患者,均经常规超声和超声造影检查,回顾性分析常见及少见的超声造影增强模式。结果33例肾上腺腺瘤常见的常规超声均表现为是单侧,最大径<4 cm,31例常规超声表现为低回声且回声均匀,1例伴囊变,1例回声不均匀;26例最大径<4cm;32例彩色多普勒超声成像（Colour Doppler flow imaging,CDFI）无血流信号;超声造影表现：增强均匀（31例）,增强不均匀（2例）;稍低-等增强（26例）,稀疏充填（5例）,高增强（2例）;整体增强（29例）,由周边向中央增强（4例）。为均匀,稍低-等的整体增强。少见的常规超声表现包括最大径≥4 cm,1例伴囊变,1例回声不均匀;超声造影表现：5例呈稀疏充填;2例呈高增强;4例增强方式由周边向中央;2例增强不均匀（1例伴囊变）。 结论 肾上腺腺瘤超声造影的常见表现为均匀、稍低-等的整体增强,少见表现包括稀疏充填、高增强、周围向中央增强、增强不均匀。根据超声造影表现大多可作出诊断或排除恶性;少数增强方式为周边向中央及增强不均匀的病例须结合增强CT或穿刺等检查排除恶性。     

能量多普勒和灰阶超声对肾实体占位的诊断及鉴别诊断

目的　探讨肾实体肿瘤的灰阶超声特征及其能量多普勒血供模式 ,并评价二者联合应用的诊断及鉴别诊断价值。方法　用灰阶超声及能量多普勒超声评价 4 2例肾实体肿瘤。在灰阶超声图上 ,观察肿块回声、均匀性、无回声边、肿瘤内无回声区及后方衰减。在能量多普勒超声上 ,肿块的血管分布被分成 5种模式。结果　 4 2例肾实体肿瘤 ,肾细胞癌 (RCC) 33例 ,肾血管平滑肌脂肪瘤 (AML ) 9例。在灰阶超声上 ,2 4例 (73% ) RCC可见无回声边和 /或肿瘤内无回声区 ;2 6例 (79% ) RCC肿块回声不均匀。 1例 AML (11% )出现声衰减。肿块回声强度不能提示病理诊断。在能量多普勒超声上 ,33例 RCC中 ,模式 3(边缘血流型 ) 4例 ,模式 4 (混合性边缘及穿入血流型 ) 2 9例。 9例 AML中 ,模式 4血流 1例 ,模式 0 (无血流信号型 ) 5例 ,模式 2 (穿入性血流型 ) 3例。在本组 RCC及 AML中均未见模式 1(肿瘤内局限性血流信号型 )。模式 0、模式 2对 AML有特异性。与单独灰阶超声 (6 0 % )及单独能量多普勒超声 (19% )的诊断率比较 ,二者联合诊断率 (79% )明显提高。结论　无回声边及肿瘤内无回声区提示 RCC的诊断。在灰阶超声发现的基础上 ,能量多普勒超声血管分布为 RCC及 AML的鉴别诊断提供了重要的依据     

超声造影对提高肾错构瘤诊断率的价值

目的探讨超声造影在肾错构瘤诊断中的价值。方法对37例患者37个经手术病理证实的肾错构瘤常规超声及超声造影声像图进行回顾性分析。常规超声观察肿瘤大小、边界、内部回声、有无彩色血流信号。超声造影观察病灶的增强时相和方式,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果常规超声显示肿块最大直径范围1.7～28.0cm,高回声团块19个,低回声为主团块11个,混合回声6个,无回声1个。19个肿块发现较丰富或丰富彩色血流信号,16个显示周边或内部少量血流信号,2例未见血流信号。术前常规超声诊断符合率为59.5%(22/37)。37个肿块超声造影平均增强起始时间为(13.57±3.34)s,达峰时间为(20.27±4.27)s,开始消退时间为(28.92±5.16)s。皮质期33个病灶呈缓慢向心增强,4个同步增强;达峰值呈高增强15个,等增强14个,低增强8个。其中28例均匀增强。实质期同步消退11个,缓慢消退19个,快速消退7个,发现假包膜2例。联合缓慢向心增强和达峰值均匀等增强或高增强的诊断符合率为75.7%(28/37)。结论造影时缓慢向心增强和均匀等增强或高增强是肾错构瘤的主要表现。     

CT negative attenuation pixel distribution and texture analysis for detection of fat in small angiomyolipoma on unenhanced CT

Purpose

The purpose of the paper is to evaluate if CT pixel distribution and texture analysis can identify fat in angiomyolipoma (AML) on unenhanced CT.

Methods

Thirty-seven patients with 38 AMLs and 75 patients with 83 renal cell carcinomas (RCCs) were evaluated. Region of interest (ROI) was manually placed over renal mass on unenhanced CT. In-house software generated multiple overlapping small-ROIs of various sizes within whole-lesion-ROI. Maximal number of pixels under cutoff attenuation values in the multiple small-ROIs was calculated. Skewness of CT attenuation histogram was calculated from whole-lesion-ROI. Presence of fat in renal mass was also evaluated subjectively. Performance of subjective evaluation and objective methods for identifying fat was compared using McNemar test.

Results

Macroscopic fat was identified in 15/38 AMLs and 1/83 RCCs by both subjective evaluation and by CT negative pixel distribution analysis (p = 1.0). Optimal threshold was ≥6 pixels below ?30 HU within 13-pixel-ROI. Skewness of < ?0.4 in whole-lesion-ROI identified fat in 10/38 AMLs and 0/83 RCCs. By combining CT negative pixel distribution analysis and skewness, fat was identified in 20/38 AMLs and 1/83 RCCs, but the difference to the subjective method was not statistically significant (p = 0.07).

Conclusion

CT negative attenuation pixel distribution analysis does not identify fat in AML beyond subjective evaluation. Addition of skewness by texture analysis may help improve identifying fat in AML.

     

Characterization and diagnostic confidence of contrast-enhanced ultrasound for solid renal tumors

The objective was to determine whether contrast-enhanced ultrasound (CEUS) could improve the diagnostic confidence of solid renal masses. CEUS examinations were performed on 51 patients with renal tumors. Histologic findings from surgical specimens (n = 24) or magnetic resonance imaging follow-up (n = 27) were used as reference procedures for definitive diagnosis. Diffuse heterogeneous/homogeneous enhancement and quick peripheralnodularenhancement were found to be characteristic patterns in renal cell carcinoma (RCC). Dotlike or diffuse heterogeneous/homogeneous enhancement and slow peripheral nodular enhancement were observed as typical enhancement patterns in angiomyolipoma. The results show that CEUS combined with conventional ultrasound significantly improves diagnostic confidence. The sensitivity for RCC diagnosis with this imaging approach was 86% and the specificity was 93%. Both positive and negative predictive values of detection were 90% and the overall accuracy was 90%.     

Diagnostic efficacy of contrast-enhanced ultrasonography in solid renal parenchymal lesions with maximum diameters of 5 cm.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) using a sulfur hexafluoride contrast agent and the cadence contrast pulse sequencing mode in differentiating solid renal parenchymal lesions (SRPLs) with a maximum diameter of 5 cm. METHODS: Seventy-one patients with 72 SRPLs with a maximum diameter of 5 cm underwent conventional ultrasonographic and CEUS examinations in our department. The final diagnoses were 44 renal cell carcinomas (RCCs; confirmed by pathologic examination), 24 renal angiomyolipomas (4 by pathologic examination and 20 by computed tomography, magnetic resonance imaging, and follow-up studies), 1 oncocytoma (by pathologic examination), 2 hypertrophied columns of Bertin, and 1 renal abscess (both by computed tomography, magnetic resonance imaging, and follow-up studies). Three observers who were blinded to other results and the final diagnoses reviewed the conventional ultrasonographic and CEUS images. RESULTS: Hyperenhancement in the late phase (30-90 seconds after agent injection) was the most important finding for predicting SRPLs with a maximum diameter of 5 cm to be RCCs. With this criterion, the specificity and sensitivity for diagnosing solid RCCs (相似文献   

超声造影鉴别诊断肾透明细胞癌和肾血管平滑肌脂肪瘤

目的 比较肾透明细胞癌(CCRCC)和肾血管平滑肌脂肪瘤(AML)的超声造影声像图表现,探讨超声造影对二者的鉴别诊断价值.方法 回顾106个CCRCC和25个AML的超声造影声像图表现,观察指标包括肿瘤的增强程度、增强均匀度、包膜增强、增强消退情况以及增强方式,分析超声造影声像图特征对肾癌的鉴别诊断价值.结果 肿瘤的增强程度和增强消退时间在CCRCC与AML之间差异无统计学意义(P>0.05),而增强均匀度、包膜增强以及增强方式差异有统计学意义(P<0.01).表现为不均匀增强、包膜增强以及弥漫性增强的肿瘤具有恶性倾向,其阳性预测值分别为97.26%、100%、94.74%.如将肿瘤同时具有这3种声像图特征作为CCRCC的诊断标准,其阳性预测值和阴性预测值达100%及95.00%.结论 CCRCC和AML具有不同的超声造影声像图特征,超声造影有助于二者的鉴别诊断.     

CT诊断肾少脂肪血管平滑肌脂肪瘤与透明细胞癌的临床分析

目的研究CT诊断肾少脂肪血管平滑肌脂肪瘤(AML)与透明细胞癌(CRCC)的临床特征,提高诊断的准确率。方法选择AML与CRCC患者各30例为研究对象,分为AML组和CRCC组。回顾性两组患者的CT检查情况以及相关特征指标。结果两组在肿瘤密度、强化程度方面无显著性差异,强化类型上AML组均匀强化显著多于CRCC组,差异有统计学意义(P0.05)。且AML组患者在病灶突出比、皮质掀起征两个方面均大于CRCC组,差异有统计学意义(P0.05)。结论 AML组与CRCC组在CT中表现出的差异较大,AML无论在肿瘤均匀性、病灶突出比还是皮质掀起证都明显大于CRCC,因此应用CT能够准确地鉴别二者。     

Point Shear Wave Elastography Using Machine Learning to Differentiate Renal Cell Carcinoma and Angiomyolipoma

The question of whether ultrasound point shear wave elastography can differentiate renal cell carcinoma (RCC) from angiomyolipoma (AML) is controversial. This study prospectively enrolled 51 patients with 52 renal tumors (42 RCCs, 10 AMLs). We obtained 10 measurements of shear wave velocity (SWV) in the renal tumor, cortex and medulla. Median SWV was first used to classify RCC versus AML. Next, the prediction accuracy of 4 machine learning algorithms—logistic regression, naïve Bayes, quadratic discriminant analysis and support vector machines (SVMs)—was evaluated, using statistical inputs from the tumor, cortex and combined statistical inputs from tumor, cortex and medulla. After leave-one-out cross validation, models were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Tumor median SWV performed poorly (AUC = 0.62; p = 0.23). Except logistic regression, all machine learning algorithms reached statistical significance using combined statistical inputs (AUC = 0.78–0.98; p < 7.1 × 10^–3). SVMs demonstrated 94% accuracy (AUC = 0.98; p = 3.13 × 10^–6) and clearly outperformed median SWV in differentiating RCC from AML (p = 2.8 × 10^–4).     

肾脏占位病变的超声造影诊断及鉴别诊断

目的 探讨超声造影对肾脏占位病变的诊断价值,提高其诊断及鉴别诊断水平.方法 对35例经穿刺或手术病理结果证实为肾脏占位病变患者的超声造影表现进行回顾分析,观察其增强程度、增强均匀度、假包膜征、增强、消退时间及增强方式.结果 超声造影示恶性肿瘤28例,良性病变7例.恶性肿瘤中肾癌17例,肾盂癌11例;良性病变中肾血管平滑肌脂肪瘤4例,肾囊肿3例.肾癌多表现为快进快出、弥漫性不均匀性明显增强及假包膜形成;肾盂癌多表现为慢进快出和弥漫性均匀性不明显增强;肾血管平滑肌脂肪多表现为快进慢出和向心性均匀性不明显增强;肾囊肿多表现为无增强.结论 超声造影对肾脏占位病变的诊断和良恶性病变的鉴别诊断有较高价值.     

术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值

目的探讨术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值。 方法选取2017年10月至2019年3月解放军总医院收治的发现肾肿瘤伴下腔静脉癌栓并行腹腔镜手术治疗的患者60例，所有患者均于术前及术中行超声造影检查，以典型增强模式判断癌栓是否合并血栓，并最终取得术后病理结果。以术后病理结果为"金标准"，计算术前及术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值和阴性预测值。 结果60例下腔静脉癌栓患者均接受了机器人辅助腹腔镜下根治性肾切除联合下腔静脉内癌栓切除术。根据病理结果，下腔静脉癌栓合并血栓者10例（16.7%），其中术前超声造影漏诊2例，另有2例癌栓头部坏死组织被术前及术中超声造影误诊为血栓。术前与术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、96.0%、93.3%、80.0%、96.0%和100.0%、96.0%、96.7%、83.3%、100.0%。 结论术前及术中超声造影对下腔静脉癌栓是否合并血栓有较好的鉴别诊断效能，可为手术方式的选择提供重要信息和依据，具有较高的临床应用价值。     

CEUS诊断肾脏占位性病变

目的 探讨CEUS在肾脏占位性病变中的应用价值。方法 对67例肾脏占位性病变患者术前行常规超声及CEUS检查,观察造影增强特征,并对其中40例肾透明细胞癌（CCRCC）和14例肾血管平滑肌脂肪瘤（AML）造影增强特征进行比较,并分析时间-强度曲线定量参数,包括峰值强度（IMAX）、上升时间（RT）、达峰时间（TTP）及平均渡越时间（mTT）。结果 CCRCC和AML的CEUS增强模式、增强强度、增强均匀度和假包膜征差异均有统计学意义（P均< 0.01）。CCRCC的IMAX高于AML,RT和mTT均早于AML （P < 0.05）。CEUS定性诊断恶性肾脏占位性病变的敏感度91.49%（43/47）,特异度75.00%（15/20）,准确率86.57%（58/67）。结论 CEUS结合造影定量分析软件有助于诊断和鉴别CCRCC与AML。