声辐射力脉冲成像鉴别诊断肾肿瘤

目的 探讨声辐射力脉冲成像(ARFI)鉴别诊断肾良恶性肿瘤的价值,以及ARFI所示肿瘤硬度与CEUS反映的肿瘤灌注之间的关系。 方法 对经手术或穿刺病理证实的35例肾肿瘤患者依次行ARFI及CEUS检查,运用声触诊组织量化(VTQ)技术测量肿瘤组织的剪切波速度(SWV),采用ROC曲线评价SWV对肾良恶性肿瘤的鉴别诊断价值并确定界值,并将ARFI所示肿瘤硬度与CEUS反映的肿瘤灌注情况进行对比。 结果 35例肾肿瘤患者中,VTQ测量的肾良恶性肿瘤的SWV值分别为(2.25±0.33)m/s和(2.72±0.46)m/s(P<0.05);以SWV=2.355 m/s为界值,鉴别诊断肾良恶性肿瘤的敏感度为83.30%,特异度为72.70%。22例(22/35,62.86%)肾肿瘤SWV值高于肾皮质,其中CEUS表现为高强化19例,低强化3例;13例(13/35,37.14%)肾肿瘤SWV值低于肾皮质,其中CEUS表现为高强化5例,低强化8例。不同硬度的肾肿瘤血流灌注程度不同,质地硬者灌注较高,质地软者灌注较低(P<0.05)。 结论 ARFI技术有助于鉴别良恶性肾肿瘤,其所示肾肿瘤硬度与血流灌注有关。

Acoustic radiation force impulse imaging in differential diagnosis of renal tumors

Objective To explore the value of acoustic radiation force impulse imaging (ARFI) in differential diagnosis of benign and malignant renal tumors, and to explore the correlation between the elasticity of tumors obtained with ARFI and blood perfusion obtained with CEUS. Methods Thirty-five patients with renal tumors confirmed with surgical operation or pathology underwent ARFI and CEUS. Shear wave velocity (SWV) of tumors were measured with virtual touch tissue quantification (VTQ), the cut-off point for SWV was obtained with ROC curve analysis, and the elasticity of tumors obtained with ARFI was compared with the blood perfusion obtained with CEUS. Results SWV of benign and malignant renal tumors was (2.25±0.33)m/s and (2.72±0.46)m/s (P<0.05), respectively. Taking the cut-off point of 2.355 m/s for SWV in differential diagnosis of benign and malignant renal tumors, the sensitivity and specificity was 83.30% and 72.70%, respectively. SWV of renal tumors were higher than that of renal cortex in 22 (22/35, 62.86%) patients, among which 19 tumors appeared hyper-enhancement and 3 appeared hypo-enhancement. SWV of renal tumors were lower than that of renal cortex in 13 (13/35, 37.14%) patients, among which 5 tumors appeared hyper-enhancement and 8 appeared hypo-enhancement. Tumors with different elasticity had different enhancement, stiff tumors tended to appeared hyper-enhancement, and soft tumors tended to appeared hypo-enhancement (P<0.05). Conclusion ARFI is helpful to the differential diagnosis of benign and malignant renal tumors. There is correlation between elasticity obtained with ARFI and blood perfusion obtained with CEUS in renal tumors.