能量多普勒和灰阶超声对肾实体占位的诊断及鉴别诊断

目的　探讨肾实体肿瘤的灰阶超声特征及其能量多普勒血供模式 ,并评价二者联合应用的诊断及鉴别诊断价值。方法　用灰阶超声及能量多普勒超声评价 4 2例肾实体肿瘤。在灰阶超声图上 ,观察肿块回声、均匀性、无回声边、肿瘤内无回声区及后方衰减。在能量多普勒超声上 ,肿块的血管分布被分成 5种模式。结果　 4 2例肾实体肿瘤 ,肾细胞癌 (RCC) 33例 ,肾血管平滑肌脂肪瘤 (AML ) 9例。在灰阶超声上 ,2 4例 (73% ) RCC可见无回声边和 /或肿瘤内无回声区 ;2 6例 (79% ) RCC肿块回声不均匀。 1例 AML (11% )出现声衰减。肿块回声强度不能提示病理诊断。在能量多普勒超声上 ,33例 RCC中 ,模式 3(边缘血流型 ) 4例 ,模式 4 (混合性边缘及穿入血流型 ) 2 9例。 9例 AML中 ,模式 4血流 1例 ,模式 0 (无血流信号型 ) 5例 ,模式 2 (穿入性血流型 ) 3例。在本组 RCC及 AML中均未见模式 1(肿瘤内局限性血流信号型 )。模式 0、模式 2对 AML有特异性。与单独灰阶超声 (6 0 % )及单独能量多普勒超声 (19% )的诊断率比较 ,二者联合诊断率 (79% )明显提高。结论　无回声边及肿瘤内无回声区提示 RCC的诊断。在灰阶超声发现的基础上 ,能量多普勒超声血管分布为 RCC及 AML的鉴别诊断提供了重要的依据

Power Doppler and Grey-Scale Ultrasound Used in Differential Diagnosis of Solid Renal Tumors

Objective To study the features of solid renal tumors on grey-scale ultrasound(US) and their vascular patterns on power Doppler US,and to evaluate the differential diagnostic value on ultrasound.Methods Grey-scale and power Doppler US were performed in 42 solid renal tumors.On grey-scale US,the echos,homogenecity,an anechoic rim,intratumoral cysts and shadowing were found in the lesions.On power Doppler US,the vascular distribution was divided into five patterns:pattern 0,no vasculature;1,intratumoral pattern;2,penetrated pattern from outside into the tumor;3,peripheral pattern;4,mixed-peripheral and penetrated.Results Totally 42 patients with solid renal tumors including 33 cases with renal cell carcinoma (RCC) and 9 cases with angiomyolipoma (AML).Findings on grey-scale US included:an anechoic rim and/or intratumoral cysts were in 24 of 33(73%)renal cell carcinoma(RCC)cases;heterogeneous echoes in 26 of 33(79%)RCC cases;shadowing was seen in 1 case (11%) of AML.Echogenicity could not define pathologic diagnosis.On power Doppler US:pattern 3 was seen in 4 RCCs,pattern 4 in 29 RCCs;pattern 0 in 5 AMLs,pattern 2 in 3 AMLs and pattern 4 in 1 AML.Pattern 1 was not seen in either RCC or AML.Pattern 0 or 2 was characteristic of AML.The rate of correct diagnosis was increased with combination of US and grey scale(79%)as compared to that with grey-scale(60%)or power Doppler only(19%).Conclusions An anechoic rim or intratumoral cysts suggests the diagnosis of RCC.The vascular distribution on power Doppler US could provide important information to grey-scale US helpful for differential diagnosis of RCC from AML.