常规超声联合超声造影在肾脏良恶性肿瘤中的鉴别价值

Value of conventional ultrasound combined with contrast-enhanced ultrasound in differentiating benign from malignant renal tumors

摘要:

目的 探讨常规超声联合超声造影在肾脏良恶性肿瘤中的鉴别价值。方法 选取2020年3月—2023年2月就诊于中国科学技术大学附属第一医院的141例（145个病灶）肾脏占位性病变患者。患者均接受常规彩色多普勒超声与超声造影检查，将超声引导性穿刺活检或手术取病理组织行病理检查的结果作为金标准，分析常规超声、超声造影鉴别诊断肾脏良恶性肿瘤的一致性、诊断效能（敏感性、特异性、准确性、阳性预测值、阴性预测值）。按照金标准将患者分为良性组、恶性组，对比两组常规超声参数［Finkler超声评分、血流阻力指数（RI）］与超声造影参数［曲线下面积（AUC）、达峰时间（TTP）、峰值强度（PI）、对比剂未到达时的基本强度（BI）、始增时间（AT）］，绘制受试者工作特征（ROC）曲线，分析常规超声联合超声造影对良恶性肾脏肿瘤的鉴别价值。结果 常规超声鉴别诊断肾脏良恶性肿瘤与病理检查结果的一致性较好（κ =0.581，P <0.05）。超声造影鉴别诊断肾脏良恶性肿瘤与病理检查结果的一致性极好（κ =0.804，P <0.05）。超声造影敏感性、准确度、阴性预测值高于常规超声。两种检查方法特异性、阳性预测值比较，差异均无统计学意义（P >0.05）。恶性组Finkler超声评分、AUC均高于良性组，RI水平和PI水平均低于良性组，TTP水平短于良性组（P <0.05）。两组BI、AT水平比较，差异无统计学意义（P >0.05）。ROC曲线结果显示，Finkler超声评分敏感性为82.8%（95% CI：0.784，0.923）、特异性为73.9%（95% CI：0.792，0.929）；RI敏感性为86.1%（95% CI：0.798，0.961）、特异性为73.9%（95% CI：0.802，0.958）；AUC敏感性为87.7%（95% CI：0.887，0.969）、特异性为82.6%（95% CI：0.873，0.946）；TTP敏感性为83.6%（95% CI：0.706，0.910）、特异性为69.6%（95% CI：0.713，0.915）；PI敏感性为85.2%（95% CI：0.802，0.936）、特异性为83.9%（95% CI：0.809，0.941）；联合检测敏感性为95.1%（95% CI：0.876，0.995）、特异性为89.6%（95% CI：0.864，0.986）。结论 常规超声联合超声造影可提升恶性肾脏肿瘤的检出率，且两者定量参数联合可有效鉴别肾脏良恶性肿瘤。

Abstract:

Objective To analyze the value of conventional ultrasound combined with contrast-enhanced ultrasound in differentiating benign from malignant renal tumors.Methods One hundred and forty-one patients (145 lesions) with renal space-occupying lesions who were admitted to the First Affiliated Hospital of University of Science and Technology of China from March 2020 to February 2023 were selected. They were all examined by conventional color Doppler ultrasound and contrast-enhanced ultrasound. The results of ultrasound-guided biopsy or pathological examination on tissues obtained from surgery were taken as the gold standard to analyze the consistency and efficiency (sensitivity, specificity, accuracy, positive predictive value and negative predictive value) of conventional ultrasound and contrast-enhanced ultrasound in the differential diagnosis of benign and malignant renal tumors. The patients were divided into benign group and malignant group according to the gold standard. The conventional ultrasound parameters [Finkler ultrasound score and blood flow resistance index (RI) ] and the contrast-enhanced ultrasound parameters [area under the curve (AUC), time to peak (TTP), peak intensity (PI), basic intensity (BI), and arrival time (AT) ]. The receiver operating characteristic (ROC) curve was plotted to analyze the value of the combination of conventional ultrasound parameters and contrast-enhanced ultrasound parameters in the differential diagnosis of benign and malignant renal tumors.Results The results of conventional ultrasound in differentiating benign and malignant renal tumors were in a great agreement with pathological findings (Kappa = 0.581, P < 0.05), while the results of contrast-enhanced ultrasound in differentiating benign and malignant renal tumors were in an excellent agreement with pathological findings (Kappa = 0.804, P < 0.05). The diagnostic sensitivity, accuracy and negative predictive value of contrast-enhanced ultrasound were higher than those of conventional ultrasound (P < 0.05). There was no difference in the specificity and positive predictive value between contrast-enhanced ultrasound and conventional ultrasound (P > 0.05). The Finkler ultrasound score and AUC of the malignant group were higher than those of the benign group, while the RI and PI of the malignant group were lower than those of the benign group (P < 0.05). The TTP of the malignant group was shorter than that of the benign group (P < 0.05). There was no difference in BI and AT between the malignant group and the benign group (P > 0.05). The ROC curve showed that the sensitivity of Finkler ultrasound score was 82.8% (95% CI: 0.784, 0.923) and the specificity was 73.9% (95% CI: 0.792, 0.929). The sensitivity of RI was 86.1% (95% CI: 0.798, 0.961) and the specificity was 73.9% (95% CI: 0.802, 0.958). The sensitivity of AUC was 87.7% (95% CI: 0.887, 0.969) and the specificity was 82.6% (95% CI: 0.873, 0.946). The sensitivity and specificity of TTP were 80.8% (95% CI: 0.706, 0.910) and 69.6% (95% CI: 0.713, 0.915). The sensitivity of PI was 85.2% (95% CI: 0.802, 0.936) and the specificity was 73.9% (95% CI: 0.809, 0.941). The sensitivity and specificity of the combined detection in differentiating benign and malignant renal tumors were 95.1% (95% CI: 0.876, 0.995) and 69.6% (95% CI: 0.864, 0.986).Conclusions Conventional ultrasound combined with contrast-enhanced ultrasound could increase the detection rate of malignant renal tumors, and the combination of quantitative parameters of the two approaches effectively aids in differentiating benign from malignant renal tumors.