超声造影定性诊断肾癌的价值及其与病理分型的相关性

发布时间：2018-05-15 00:37

  本文选题：肾细胞癌 + 时间-强度曲线　； 参考：《兰州大学》2017年硕士论文

【摘要】：目的探讨肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)的超声造影特征与其侵袭性的关系并分析超声造影在ccRCC及嫌色细胞癌(chromophobe renal cell carcinoma,chRCC)鉴别诊断中的应用价值,进一步评估超声造影对肾癌的诊断效能。方法收集2012年5月~2015年6月期间行术前肾脏超声造影检查并经术后病理证实为ccRCC的患者75例,根据病理结果,将ccRCC分为未侵犯组(41例)、侵犯组(34例),其中侵犯组分为侵犯肾被膜组(12例)和穿透肾被膜组(22例),后又以同样方式收集2013年5月~2016年5月期间的ccRCC患者86例及chRCC患者31例,对所有肿瘤的超声造影动态资料以回顾性的方式进行研究和分析,观察肿瘤的增强程度、增强和消退时相、增强均匀性以及周围假包膜征,随后通过仪器内Q-Lab软件对肿瘤和周围正常肾实质分别选取一个感兴趣区制作时间-强度曲线,从曲线中获得相关的定量分析参数,包括始增时间(AT)、上升时间(RT)、达峰时间(TTP)、曲线尖度(sharpness)、曲线下面积(AUC)及峰值强度(PI),并通过计算获得校正的AT(?AT)、TTP(?TTP)、PI(?PI),然后进行对比统计分析。结果1.超声造影上ccRCC的增强、消退时相和增强程度,未侵犯组与侵犯组间比较差异无统计学意义(P=0.121,P=0.16,P=0.085);但ccRCC的不均匀增强特征多见于侵犯组(P0.001),而ccRCC的假包膜征及长径≤3cm的肿块多见于未侵犯组(P0.001,P=0.005);2.侵犯组ccRCC的sharpness、AUC及?PI均高于未侵犯组(P0.001,P=0.001,P0.001),穿透肾包膜组ccRCC的sharpness及?PI均高于侵犯肾被膜组(P=0.008,P=0.004)。3.ccRCC多表现为高增强(46/86,53.49%)、弥漫性增强(58/86,67.44%)和不均匀增强(65/86,75.58%),54.65%(47/86)有假包膜征,chRCC多表现为低增强(22/31,70.97%)、向心性增强(17/31,54.83%)和均匀增强(20/31,64.52%),61.29%(19/31)有假包膜征,ccRCC和chRCC增强程度、增强方式及增强形态的差异均有统计学意义(P0.001,P=0.012,P0.001),假包膜征检出率的差异无统计学意义(P=0.523)。4.ccRCC的?AT和?TTP与chRCC相比,差异无统计学意义(P=0.068,P=0.077),而ccRCC的?PI明显高于chRCC(P0.001),以?PI=0.05%为阈值鉴别诊断ccRCC和chRCC的准确率最高,其敏感度为84.9%,特异度为100%,AUC为0.97,ccRCC出现肾周和(或)肾窦脂肪组织受累、肾门和(或)腹膜后淋巴结转移的百分率均高于chRCC(P=0.025,P=0.027)。结论ccRCC是否对周围组织发生了侵犯在超声造影上具有不用的表现,超声造影可用于ccRCC侵袭性的初步评估;ccRCC和chRCC在超声造影定性观察指标及定量参数上也均具有不同的特征,超声造影对二者具有鉴别诊断价值。
[Abstract]:Objective to investigate the relationship between the characteristics of clear cell renal cell carcinoma and its invasiveness, and to analyze the value of contrast-enhanced ultrasonography in differential diagnosis of ccRCC and chromophobe renal cell carcinoma RCCs. To further evaluate the diagnostic efficacy of contrast-enhanced ultrasonography for renal cell carcinoma. Methods from May 2012 to June 2015, 75 patients with ccRCC were examined by preoperative contrast-enhanced ultrasonography and confirmed by pathology. CcRCC was divided into non-invasive group (n = 41) and invading group (n = 34). The invading group was divided into two groups: the invading group (n = 12) and the penetrating group (n = 22). From May 2013 to May 2016, 86 cases of ccRCC and 31 cases of chRCC were collected in the same way. The contrast-enhanced dynamic data of all tumors were studied and analyzed in a retrospective manner. The enhancement degree, the phase of enhancement and regression, the enhancement of uniformity and the surrounding pseudocapsule sign were observed. Then the time-intensity curves of tumor and surrounding normal renal parenchyma were selected by Q-Lab software, and the quantitative analysis parameters were obtained. It includes the beginning time, the rising time, the peak time, the sharp degree of the curve, the area under the curve, the peak intensity and the peak intensity, and the corrected ATT TTP is obtained by calculation, and then the comparative statistical analysis is carried out. Result 1. Enhancement, phase and degree of enhancement of ccRCC on contrast-enhanced ultrasonography, There was no significant difference between the non-invasive group and the invading group, but the non-uniform enhancement of ccRCC was more common in the invading group than in the invading group, while the pseudomembrane sign of ccRCC and the mass with long diameter 鈮，

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