超声造影与增强CT对小肾癌诊断价值及不同病理类型超声造影表现的研究

目的 通过对比超声造影与增强CT在小肾癌中的诊断准确率及不同病理类型超声造影的表现，探讨超声对小肾癌及不同病理类型的诊断价值，提高小肾癌的诊断水平。方法 回顾性分析2010年6月~2017年12月我院收治的60例直径小于4 cm肾占位性病变患者的超声造影和增强CT检查资料，并根据病理检查结果进行对比研究，比较两种检查方法对小肾癌的诊断准确率、灵敏度、阳性预测值和阴性预测值，同时对比不同病理类型的小肾癌在超声造影下的灌注特点。结果 超声造影诊断准确率为96.67%，高于增强CT的95.00%，差异无统计学意义（P＞0.05）。肾透明细胞癌主要以快进快退为主（42.86%），其次为快进慢退（36.73%）、等进等退（8.16%）和其他（8.16%）、慢进慢退（4.08%）；乳头状肾细胞癌主要以慢进慢退（57.14%），其次为快进快退为主（42.86%）；嫌色细胞癌均为快进快退（100.00%）；错构瘤为慢进慢退（100.00%）；嗜酸性粒细胞瘤为快进慢退（100.00%）。结论 肾癌的病理类型以透明细胞癌为主，透明细胞癌的超声造影表现主要以快进快退为主，乳头状肾细胞癌以慢进慢退为主，嫌色细胞癌以快进快退为主。通过超声造影提示基本可以评估小肾癌的病理类型，超声造影、增强CT对小肾癌的诊断都具有较高的价值，但增强CT可以为小肾癌精确定位诊断提供重要参考。若两者联合使用，有助于提高诊断准确率，为临床的诊断及临床手术方案的拟定提供更大的帮助。

The Value of Contrast-enhanced Ultrasonography and Contrast-enhanced CT inthe Diagnosis of Small Renal Cell Carcinoma and the Contrast-enhanced Ultrasonography

Objective To compare the diagnostic accuracy of contrast-enhanced ultrasonography and enhanced CT in small renal cell carcinoma and the contrast-enhanced ultrasound findings of different pathological types, to explore the diagnostic value of ultrasound for small renal cell carcinoma and different pathological types, and to improve the diagnosis of small renal cell carcinoma.Methods A retrospective analysis of 60 patients with renal occlusion lesions less than 4 cm in diameter from June 2010 to December 2017 was performed. The results of contrast-enhanced ultrasonography and contrast-enhanced CT examination were compared. The diagnostic method was used to diagnose the accuracy, sensitivity, positive predictive value and negative predictive value of small renal cell carcinoma, and to compare the perfusion characteristics of small renal cell carcinoma with different pathological types under contrast-enhanced ultrasound.Results The diagnostic accuracy of contrast-enhanced ultrasound was 96.67%, which was higher than that of enhanced CT 95.00%,the difference was not statistically significant (P>0.05). Renal clear cell carcinoma is mainly fast-forward and fast-recession (42.86%), followed by fast-forward and slow-recession (36.73%), equal-in and backward (8.16%) and other (8.16%), slow-in and slow-off (4.08%); papillary renal cell carcinoma mainly slowed down slowly (57.14%), followed by fast-forward and rapid retreat (42.86%); chromophobe cell carcinoma was fast-forward and retreat (100.00%); Slow progression and slow retreat (100.00%); eosinophilic tumor is fast-forward and slow-back (100.00%).Conclusion The pathological type of renal cell carcinoma is mainly clear cell carcinoma. The contrast-enhanced ultrasonography of clear cell carcinoma is mainly fast-forward and fast-return. Papillary renal cell carcinoma is mainly slow-moving and slow-returning. Retreat to the main. Ultrasound angiography can basically evaluate the pathological type of small renal cell carcinoma. Contrast-enhanced ultrasonography and enhanced CT have high value in the diagnosis of small renal cell carcinoma. However, enhanced CT can provide an important reference for accurate localization diagnosis of small renal cell carcinoma. If the two are used together, it will help to improve the diagnostic accuracy and provide greater help for clinical diagnosis and clinical surgical planning.