肾脏占位性病变的超声造影强化特征

目的 探讨肾脏占位病变的超声造影(CEUS)强化特征。 方法 对78例肾脏占位性病变患者行CEUS检查，观察CEUS增强特征、增强与减退情况及假包膜征等超声特点，分析良恶性占位病变超声造影时间-强度曲线(TIC)相关定量参数。 结果 78例肾脏占位性病变中，50例为恶性占位病变，另28例为良性占位。恶性占位病变均有不同程度增强，肾透明细胞癌主要表现为弥漫或厚环状增强并呈"快进快退"，乳头状细胞癌、嫌色细胞癌与肾盂癌则主要表现为弥漫性低增强并呈"慢进快退"。假包膜征主要出现于肾透明细胞癌。良性占位病变中，肾囊肿无增强，肾错构瘤主要为弥漫性低增强并呈"慢进慢退"，且均无假包膜征。恶性占位病灶达峰时间(TTP)早于良性占位组(P<0.05)，且峰值强度(PI)与曲线下面积(AUC)均高于良性占位(P<0.05)。 结论 不同性质的肾脏占位病变CEUS强化特征不同，CEUS有助于病变性质的确定。

Characteristics of Renal Occupying Lesions in Contrast-enhanced Ultrasonography

Objective To determine the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis of renal occupying lesions. Methods Seventy-eight patients with a preliminary diagnosis of renal masses in West China Hospital, Sichuan University were examined by CEUS. The characteristics of enhancement, phase of enhancement/decline, pseudocapsule sign, and time-intensity curve (TIC) were compared between the malignant and benign lesions. Results Of the 78 renal occupying lesions, 50 were malignant and 28 were benign. Malignant lesions showed enhanced signs to various degrees. The renal clear cell carcinoma mainly presented as “fast wash-in and fast wash-out”, while the other malignant lesions presented as “slow wash-in and fast wash-out”. Pseudocapsule signs were found mostly in renal clear cell carcinoma. No enhancement was found in renal cyst. Renal angiomyolipoma presented as diffuse hypo-enhancement characterized with “slow wash-in and slow wash-out”. The time-to-peak (TTP) in malignant lesions appeared earlier than benign lesions. Higher levels of peak intensity (PI) and area under the curve (AUC) were found in malignant lesions compared with the benign lesions (P<0.05). Conclusion CEUS plus time-intensity curve can provide evidence for identifying different kinds of renal occupying lesions.