肾细胞癌超声造影环状高增强的临床价值及病理基础

目的探讨CEUS检出肾细胞癌（RCCs）环状高增强（PHR）的临床价值及病理基础。方法分析53例患者54个肾常见肿瘤（27个RCCs,27个错构瘤）的CEUS图像,观察肿瘤PHR的检出及分布;对RCCs周边组织（TSR）行常规HE染色并免疫标记组织内血管内皮跨膜糖蛋白（CD34）,比较TSR假包膜、大血管及微血管分布与PHR检出的关系。结果 PHR仅在RCCs组中检出,PHR在RCCs与错构瘤间分布差异有统计学意义（P〈0.05）;用PHR诊断RCCs的敏感度、特异度、阳性及阴性预测值、假阳性及假阴性分别为44.44%（12/27）、100%（27/27）、100%（12/12）、64.29%（27/42）、0（0/27）、35.71%（15/42）;假包膜在检出与未检出PHR的RCCs中的分布差异无统计学意义（P〉0.05）;灌注期及全程检出PHR的TSR有丰富的大血管,消退期及未检出PHR的TSR有少量或无大血管分布;TSR中邻近边界癌组织（CTNB）微血管密度值（MVD）最大;不同TSR的MVD差值在灌注期与消退期检出PHR间、灌注期与全程检出PHR间、全程与未检出PHR间分布的差异有统计学意义（P〈0.05）,在消退与全程检出PHR间分布差异无统计学意义（P〉0.05）。结论 PHR是RCCs诊断的特异性、辅助性指标,病理上与RCCs TSB丰富的大血管和（或）CTNB较高的MVD值有关。

Clinical value and pathological basis of peritumoral hyperenhanced rim of renal cell carcinomas on contrast-enhanced ultrasound

Objective To investigate the clinical value and pathological basis of peritumoral hyperenhanced rim (PHR) of renal cell carcinomas (RCCs) on CEUS. Methods CEUS images of 53 patients with 54 renal tumors (27 RCCs, 27 renal angiomyolipomas) were analyzed, and the detection and distribution of PHR were evaluated. HE staining and immunohistochemistry of CD34 were performed in tissue surrounding RCCs (TSR) to observe distribution of psuedocapsule, large vessels, and microvasculars among TSR with different modes of PHR. Results PHR was found only in RCCs. PHR distribution between RCCs and angiomyolipomas was statistically different (P<0.05). Using PHR to diagnose RCC, the sensitivity, specificity, positive predictive value, negative predictive value, false positive and false negative was 44.44% (12/27), 100% (27/27), 100% (12/12), 64.29% (27/42), 0 (0/27) and 35.71% (15/42), respectively. Pseudocapsule distribution between RCCs with PHR and RCCs without PHR was not statistically different (P>0.05). There were rich large blood vessels in TSR with PHR in washin and both phases, and few or thimbleful large vessels were found in TSR without PHR in washout phase. Cancer tissue near the boundary (CTNB) of TSR had the highest microvessel density (MVD). MVD differences in different TSR with PHR were statistically different between washin and washout phases, washin and both phases, both phases with PHR and without PHR (P<0.05), but no statistical difference was found between washout and both phases (P>0.05). Conclusion PHR is a highly specific complementary indicator in diagnosing RCC, and it is correlated with rich blood vessels in TSR and (or) a higher MVD value in CTNB.