中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
5期
329-332
,共4页
李春香%忻晓洁%姚欣%张晟%徐勇
李春香%忻曉潔%姚訢%張晟%徐勇
리춘향%흔효길%요흔%장성%서용
肾细胞癌%超声造影%病理%时间-强度曲线
腎細胞癌%超聲造影%病理%時間-彊度麯線
신세포암%초성조영%병리%시간-강도곡선
Renal cell carcinoma%Contrast-enhanced ultrasound%Pathological%Time-intensity curve
目的 探讨超声造影检查对肾癌病理分型诊断的价值.方法 2012年6月至2014年6月经手术病理确诊的肾癌患者206例,男113例,女93例.年龄23～80岁,平均54岁.肿瘤直径1.4～ 10.4 cm,平均(3.8±1.6)cm.其中透明细胞癌147例,乳头状肾细胞癌32例,嫌色细胞癌27例.206例术前均行超声造影检查,观察造影剂灌注模式、增强程度、液性坏死区情况,分析其时间-强度曲线,测量造影前后肿瘤直径变化情况.比较3种病理类型肿瘤各项检查参数的差异.结果 灌注模式方面,透明细胞癌主要表现为“快进快退”(94/147,63.9％),乳头状肾细胞癌和嫌色细胞癌主要表现为“慢进快退”[(19/32,59.4％)和(14/27,51.9％)],差异有统计学意义(P＜0.05).增强程度方面,透明细胞癌主要表现为高增强(127/147,86.4％),乳头状肾细胞癌和嫌色细胞癌主要表现为低增强[(22/32(68.8％)和15/27(55.6％)],差异有统计学意义(P＜0.05).透明细胞癌、乳头状肾细胞癌、嫌色细胞癌分别有92例(62.6％)、19例(59.4％)、5例(18.5％)出现液性坏死区,差异有统计学意义(P＜0.05).时间-强度曲线分析结果显示,肾皮质的起始时间、达峰时间、达峰强度、曲线下面积分别为(11.06±2.75)s、(23.42±2.79)s、(27.47±3.02) dB、(35.01±2.94) dB;透明细胞癌分别为(8.01±1.89)s、(20.05±3.01)s、(30.03±2.98)dB、(37.64±4.01) dB,与肾皮质比较差异均有统计学意义(P＜0.05);乳头状肾细胞癌分别为(11.12±2.43)s、(27.29±3.54)s、(20.13±2.67)dB、(34.67±3.24)dB,与肾皮质比较达峰时间和达峰强度差异有统计学意义(P＜0.05);嫌色细胞癌分别为(11.32±2.90)s,(22.21±3.62)s、(22.02±2.52)dB、(28.67±3.65) dB,与肾皮质比较达峰强度、曲线下面积差异有统计学意义(P＜0.05).造影后透明细胞癌直径平均增加(0.35±0.11)cm,非透明细胞癌平均增加(0.23±0.10)cm,两者比较差异有统计学意义(P＜0.05).结论 超声造影检查对肾透明细胞癌、乳头状肾细胞癌和嫌色细胞癌的病理分型诊断具有一定价值.
目的 探討超聲造影檢查對腎癌病理分型診斷的價值.方法 2012年6月至2014年6月經手術病理確診的腎癌患者206例,男113例,女93例.年齡23～80歲,平均54歲.腫瘤直徑1.4～ 10.4 cm,平均(3.8±1.6)cm.其中透明細胞癌147例,乳頭狀腎細胞癌32例,嫌色細胞癌27例.206例術前均行超聲造影檢查,觀察造影劑灌註模式、增彊程度、液性壞死區情況,分析其時間-彊度麯線,測量造影前後腫瘤直徑變化情況.比較3種病理類型腫瘤各項檢查參數的差異.結果 灌註模式方麵,透明細胞癌主要錶現為“快進快退”(94/147,63.9％),乳頭狀腎細胞癌和嫌色細胞癌主要錶現為“慢進快退”[(19/32,59.4％)和(14/27,51.9％)],差異有統計學意義(P＜0.05).增彊程度方麵,透明細胞癌主要錶現為高增彊(127/147,86.4％),乳頭狀腎細胞癌和嫌色細胞癌主要錶現為低增彊[(22/32(68.8％)和15/27(55.6％)],差異有統計學意義(P＜0.05).透明細胞癌、乳頭狀腎細胞癌、嫌色細胞癌分彆有92例(62.6％)、19例(59.4％)、5例(18.5％)齣現液性壞死區,差異有統計學意義(P＜0.05).時間-彊度麯線分析結果顯示,腎皮質的起始時間、達峰時間、達峰彊度、麯線下麵積分彆為(11.06±2.75)s、(23.42±2.79)s、(27.47±3.02) dB、(35.01±2.94) dB;透明細胞癌分彆為(8.01±1.89)s、(20.05±3.01)s、(30.03±2.98)dB、(37.64±4.01) dB,與腎皮質比較差異均有統計學意義(P＜0.05);乳頭狀腎細胞癌分彆為(11.12±2.43)s、(27.29±3.54)s、(20.13±2.67)dB、(34.67±3.24)dB,與腎皮質比較達峰時間和達峰彊度差異有統計學意義(P＜0.05);嫌色細胞癌分彆為(11.32±2.90)s,(22.21±3.62)s、(22.02±2.52)dB、(28.67±3.65) dB,與腎皮質比較達峰彊度、麯線下麵積差異有統計學意義(P＜0.05).造影後透明細胞癌直徑平均增加(0.35±0.11)cm,非透明細胞癌平均增加(0.23±0.10)cm,兩者比較差異有統計學意義(P＜0.05).結論 超聲造影檢查對腎透明細胞癌、乳頭狀腎細胞癌和嫌色細胞癌的病理分型診斷具有一定價值.
목적 탐토초성조영검사대신암병리분형진단적개치.방법 2012년6월지2014년6월경수술병리학진적신암환자206례,남113례,녀93례.년령23～80세,평균54세.종류직경1.4～ 10.4 cm,평균(3.8±1.6)cm.기중투명세포암147례,유두상신세포암32례,혐색세포암27례.206례술전균행초성조영검사,관찰조영제관주모식、증강정도、액성배사구정황,분석기시간-강도곡선,측량조영전후종류직경변화정황.비교3충병리류형종류각항검사삼수적차이.결과 관주모식방면,투명세포암주요표현위“쾌진쾌퇴”(94/147,63.9％),유두상신세포암화혐색세포암주요표현위“만진쾌퇴”[(19/32,59.4％)화(14/27,51.9％)],차이유통계학의의(P＜0.05).증강정도방면,투명세포암주요표현위고증강(127/147,86.4％),유두상신세포암화혐색세포암주요표현위저증강[(22/32(68.8％)화15/27(55.6％)],차이유통계학의의(P＜0.05).투명세포암、유두상신세포암、혐색세포암분별유92례(62.6％)、19례(59.4％)、5례(18.5％)출현액성배사구,차이유통계학의의(P＜0.05).시간-강도곡선분석결과현시,신피질적기시시간、체봉시간、체봉강도、곡선하면적분별위(11.06±2.75)s、(23.42±2.79)s、(27.47±3.02) dB、(35.01±2.94) dB;투명세포암분별위(8.01±1.89)s、(20.05±3.01)s、(30.03±2.98)dB、(37.64±4.01) dB,여신피질비교차이균유통계학의의(P＜0.05);유두상신세포암분별위(11.12±2.43)s、(27.29±3.54)s、(20.13±2.67)dB、(34.67±3.24)dB,여신피질비교체봉시간화체봉강도차이유통계학의의(P＜0.05);혐색세포암분별위(11.32±2.90)s,(22.21±3.62)s、(22.02±2.52)dB、(28.67±3.65) dB,여신피질비교체봉강도、곡선하면적차이유통계학의의(P＜0.05).조영후투명세포암직경평균증가(0.35±0.11)cm,비투명세포암평균증가(0.23±0.10)cm,량자비교차이유통계학의의(P＜0.05).결론 초성조영검사대신투명세포암、유두상신세포암화혐색세포암적병리분형진단구유일정개치.
Objective The purpose of this study was to evaluate the value of contrast-enhanced ultrasound in diagnosis of renal cell carcinoma subtyping.Methods 206 cases with renal tumors were confirmed by pathology and surgery from June 2012 to June 2014,including 113 male cases and 93 female cases.The mean age was 54 years (range 23-80 years).The subtype of renal tumor included clear cell carcinoma in 147 cases,papillary cell carcinoma in 32 cases,chromophobe cell carcinoma in 27 cases.All patients were received the CEUS before operation.The enhancement patterns,degree of enhancement,the appearance of necrosis and the time-intensity curve by contrast-enhanced ultrasound were analyzed.Results Enhancement patterns of CEUS were showed by fast in and fast out in 63.9％ (94/147)cases with clear cell carcinoma,59.4％ (19/32) cases with papillary cell carcinoma,51.9％ (14/27) cases with chromophobe cell carcinoma.Statistical significant diference was shown among those subtype groups (P ＜ 0.05).Most of the clear cell carcinomas (127/147,86.4％) showed hyperenhancing.While,the papillary renal cell carcinoma (22/32,68.8％) and chromophobe cell carcinoma (15/27,55.6％) showed hypoenhancing (P ＜ 0.05).The rate of necrosis in clear renal cell carcinoma was 62.6％ (92/147),and 59.4％ (19/32) in papillary cell carcinoma.necrosis area accounted for only 18.5％ (5/27)in chromophobe cell carcinoma (P ＜ 0.05).In the time-intensity curve analysis,the initial time,the average arrival time,the time to peak and area under the curve in renal cortex was (11.06 ± 2.75) s,(23.42 ± 2.79) s,(27.47 ± 3.02) dB,(35.01 ± 2.94)dB,respectively.Significant differences in those items were found in clear cell carcinoma,which was(8.01 ± 1.89) s,(20.05 ± 3.01) s,(30.03 ± 2.98) dB,(37.64 ± 4.01) dB respectively,compared with those in cortex (P ＜ 0.05).The arrival time,time to peak,peak intensity and area under the curve in papillary cell carcinoma were (1 1.12 ± 2.43) s,(27.29 ± 3.54) s,(20.13 ± 2.67) dB,(34.67 ±3.24) dB,respectively.The curve showed the time to peak was higher and the peak intensity were lower than those of renal cortex (P ＜0.05).The arrival time,time to peak,peak intensity and area under the curve in chromophobe cell carcinoma were (11.32 ± 2.90) s,(22.21 ± 3.62) s,(22.02 ± 2.52) dB,(28.67 ± 3.65) dB,respectively.The curve demonstrated peak intensity and area under the curve were lower than those of surrounding renal cortex (P ＜ 0.05).The increase of tumor diameter after contrast-enhanced ultrasound in clear cell carcinoma was about (0.35 ± 0.11)cm and in nonclear cell carcinoma was about (0.23 ± 0.10) cm (P ＜ 0.05).Conclusion The contrast-enhanced ultrasound played an important role in diagnosis and subtype renal cell carcinoma.
