声辐射力脉冲成像技术鉴别诊断肾脏肿瘤

目的 评价声辐射力脉冲弹性成像（ARFI）技术诊断肾肿瘤的价值。方法 对86例肾肿瘤患者的86个病灶行常规超声及ARFI检查，比较肿瘤和周围肾实质、良恶性肾肿瘤的剪切波速度（SWV）、声触诊组织成像（VTI）评分的差异。结果 86例肾肿瘤患者中，良性肿瘤32例，均为血管平滑肌脂肪瘤；恶性肿瘤54例，包括肾透明细胞癌26例，肾嫌色细胞癌8例，肾乳头状细胞癌5例，浸润性尿路上皮癌15例；病灶与周围肾实质间SWV、VTI评分的差异均有统计学意义（P均<0.05），肾良性肿瘤的SWV及VTI评分低于肾恶性肿瘤（P均<0.05）。以SWV > 1.37 m/s或VTI评分 > 3.83判定良恶性肾肿瘤的曲线下面积分别为0.898、0.847（P均<0.05），敏感度分别为88.9%、83.3%，特异度分别为84.4%、78.1%；肾恶性肿瘤中，ccRCC的SWV及VTI评分明显高于其他恶性肿瘤，以SWV > 2.06 m/s或VTI评分 > 4.31鉴别ccRCC与肾其他肾恶性肿瘤的ROC曲线下面积分别为0.766、0.729（P均<0.05），敏感度分别为65.4%、57.7%，特异度分别为82.1%、78.6%。结论 ARFI技术在肾良恶性肿瘤的鉴别诊断中具有一定价值，并有助于区分ccRCC与其他肾恶性肿瘤。

Acoustic radiation force impulse imaging technique indifferential diagnosis of renal tumors

Objective To evaluate the value of acoustic radiation force impulse imaging (ARFI) technique in differential diagnosis of renal tumors. Methods Totally 86 patients with 86 renal tumors underwent conventional ultrasound and ultrasound with ARFI technique. The shear wave velocity (SWV), virtual touch tissue imaging (VTI) score between tumors and the surrounding renal parenchyma, benign and malignant tumors were compared. Results In 86 patients with renal tumors, 32 cases were renal benign tumors and all them were angiomyolipomas (AML), 54 cases were renal malignant tumors, inculding 26 cases of renal clear cell carcinoma (ccRCC), 8 cases of renal color cell carcinoma (cRCC), 5 cases of renal papillary carcinoma (pRCC), 15 cases of invasive urothelial carcinoma (IUC). The difference of SWV and VTI scores between lesions and the surrounding renal parenchyma were statistically significant (both P<0.05). The SWV and VTI score renal benign tumors were lower than those of malignant tumors (both P<0.05). The area under the ROC curve with SWV > 1.37 m/s or VTI score > 3.83 to distinguish benign and malignant renal tumors were 0.898, 0.847, sensitivity were 88.9%, 83.3%, specificity were 84.4%, 78.1%, respectively (P<0.05). Among renal malignant tumors, SWV and VTI score of ccRCC significantly higher than those of other malignant tumors, and the area under the ROC curve with SWV > 2.06 m/s or VTI score > 4.31 to distinguish ccRCC and other renal malignant renal tumors were 0.766, 0.729, sensitivity were 65.4%, 57.7%, specificity was 82.1%, 78.6%, respectively (P<0.05). Conclusion ARFI has important value in differential diagnosis of renal tumors, and can help to distinguish ccRCC with other renal malignant tumors.