小肾癌的灰阶超声及能量多普勒特征与肿瘤大小的相关性研究

目的探讨小肾癌的灰阶超声及能量多普勒超声(PDI)特征与肿瘤大小的关系。方法回顾性分析我院近三年收治的经病理证实为小肾癌的58例患者的灰阶超声及PDI检查资料,按肿瘤最大直径(Dmax)分为四组:组1(Dmax≤1cm)8例、组2(Dmax1.1~2.0 cm)14例、组3(Dmax 2.1~3.0cm)20例及组4(Dmax 3.1~4.0cm)16例。观察四组不同大小肿瘤超声声像图特征及血流分布差异。结果 58例患者中,高回声51例(87.93%),低回声7例(12.07%);回声均匀44例(75.86%),回声不均匀14例(24.14%);肿瘤假包膜检出43例(74.14%),未检出15例(25.86%)。四组之间回声高低、均匀性及假包膜检出率比较差异均无统计学意义(P值分别为0.850、0.183及0.511)。而以Dmax=2.0 cm为界,Dmax≤2.0 cm组与Dmax 2.1~4.0 cm组回声高低比较差异无统计学意义(P=0.698),均匀性比较差异有统计学意义(P=0.003),假包膜检出率比较差异有统计学意义(P=0.043);PDI能检测出所有小肾癌内部不同的血流信号,以穿入型、边缘型及混合型(边缘及穿入共存)多见,分别占31.03%、41.38%和24.14%。肿瘤周边以环状血流(30/58,51.72%)或半环状血流(15/58,25.86%)多见,少数患者肿瘤周边未检测到血流信号(13/58,22.41%)。四组之间肿瘤内部血流比较差异有统计学意义(P=0.011),肿瘤周边血流比较差异无统计学意义(P=0.085)。结论小肾癌的灰阶超声特征因肿瘤大小不同而异,大多呈均匀高回声,假包膜检出率高,而PDI能清晰显示小肾癌血流分布特征,二者结合能为临床提供有效的诊断信息。

Correlation between tumor size and features of gray-scale ultrasound and power Doppler imaging of small renal carcinoma

Objective To explore the correlation between tumor size and gray-scale ultrasound and power Doppler imaging （PDI） features of small renal carcinoma. Methods The gray-scale ultrasound and PDI data of 58 patients with small renal carcinoma confirmed by pathology were reviewed retrospectively. The patients were divided into 4 groups according to the maximal diameter（Dmax） of the tumors： 8 cases in group 1 （Dmax≤ 1 cm） , 14 cases in group 2（Dmax 1.1-2.0 cm）, 20 cases in group 3（Dmax 2.1-3.0 cm） and 16 cases in group 4（Dmax 3.1-4.0 cm）. The two-dimensional ultrasonographic characteristics and blood flow distribution differences were observed and compared among the groups. Results In 58 patients, hyperechogenicity was shown in 51 cases（87.93%）, hypoechogenicity was shown in 7 cases（12.07%）, uniform echo was shown in 44 cases（75.86%）, uneven echo was shown in 14 cases（24.14%）, tumor pseudocapsule was detected in 43 cases（74.14%）, while not detected in 15 cases （25.86%）. The echo, uniformity and detection rate of pseudocapsules showed no significant difference between the four groups （P values were 0.850, 0.183 and 0.511, respectively）. When regarding Dmax=2.0 cm as a boundary, there was no significant difference of echo between the Dmax≤2.0 cm group and Dmax 2.1-4.0 cm group （P=0.698）, while there was significant difference of echo uniformity and detection rate of pseudocapsules （P=0.003 and P=0.043）. Different blood flow signals ws detected by PDI in all small renal carcinomas. The intratumoral blood flow patterns were mainly penetration type, edge and mixed type （edge and penetration coexistence）, they were respectively accounted for 31.03%, 41.38% and 24.14%. Peritumoral blood flow of tumors was primarily annular flow or semi-annular flow, 51.72% （30/58 ） and 25.86% （ 15/58 ） of totality, respectively. Only 22.41%（13/58） had no blood flow. Statistically significant differences were found in intratumoral blood flow patterns among the four groups （P=0.011 ）, but there were no differences in peritumoral blood flow among them （P=0.085）.Conclusion The gray-scale ultrasound features of small renal carcinoma differ from different tumor size, but it is given priority to be with uniform high echo and it has high pseudoeapsule detection rate. PDI can clearly shows blood flow distribution characteristics of small renal carcinoma, a combination of both can provides effective clinical diagnostic information.