CTU、增強MRI和CEUS在腎占位病變定性診斷中準確率的多維度分析

Multidimensional analysis of accuracy of CTU，contrast-enhanced MRI and CEUS in qualitative diagnosis of renal space-occupying lesions

WU Linjie，YU Ying，BAI Xiaojie，QI Zihao，ZHENG Hang，GUO Zhongqiang

（Department of Urology，Zhongnan Hospital of Wuhan University，Wuhan 430071，China）

ABSTRACT：Objective To compare the diagnostic accuracy of three imaging modalities，inlducing CT urography （CTU），contrast-enhanced MRI （CE-MRI），and contrast-enhanced ultrasound （CEUS） in the qualitative diagnosis of renal space-occupying lesions.Methods A retrospective analysis was performed on 542 patients with renal lesions confirmed by surgical pathology in our hospital during Jan.2019 and May 2024.The diagnostic results of CTU，CE-MRI and CEUS were compared and analyzed based on the patients clinical and pathological data.Results The diagnostic accuracy rate of CTU，CE-MRI and CEUS were 84.50%，83.14% and 86.14%，respectively.For the 161 patients who underwent all three examinations，CEUS was significantly more accurate than CTU （84.16% vs. 77.02%，P=0.018），while there was no significant difference between CTU or CEUS and CE-MRI （79.81%） （P＞0.05）.Further analysis found that for lesions ≤4 cm，the accuracy of the three examinations was as follows：CEUS=CTU 79.55%，CE-MRI 76.14%，with no significant difference （P＞0.05）.However，for lesions gt;4 cm，CEUS ranked the first，followed by CE-MRI and CTU （89.73% vs. 84.25% vs. 73.97%），and CEUS and CE-MRI were better than CTU （Plt;0.05）.Additionally，for the diagnosis of clear cell renal carcinoma and benign renal space-occupying lesions，there was no statistically significant difference among the three imaging modalities （P＞0.05），while for the qualitative diagnosis of non-clear cell renal carcinoma，CEUS ranked the first，followed by CE-MRI and CTU （83.87% vs. 74.19% vs. 56.45%），and CE-MRI and CEUS were better than CTU （Plt;0.05）.Conclusion All of them have important diagnostic value，and the appropriate selection should be based on patients specifc conditions.CEUS and CE-MRI are more accurate in the qualitative diagnosis of renal space-occupying lesions than CTU，especially for large lesions and non-clear cell carcinoma.

KEY WORDS：

computed tomography urography；magnetic resonance imaging；contrast-enhanced ultrasound;renal space-occupying lesions;qualitative diagnosis

摘要：目的 多維度比較分析計算機體層成像尿路造影（CTU）、增強磁共振成像（MRI）及超聲造影（CEUS）在腎占位性病變中定性診斷的準確率。方法 回顧性分析2019年1月—2024年5月武漢大學中南醫(yī)院泌尿外科經(jīng)手術病理證實的542例腎占位性病變患者的資料，結合患者臨床及病理資料對其CTU、增強MRI及CEUS的檢查結果進行分層多維度對比分析。結果 3項檢查診斷腎占位性病變的準確率分別為CTU 84.50%、增強MRI 83.14%、CEUS 86.14%。同時行3項檢查的161例患者中，CEUS對腎占位性病變定性診斷的準確率顯著優(yōu)于CTU（84.16% vs. 77.02%，P=0.018），而CTU或CEUS與增強MRI（79.81%）間定性診斷準確率的差異無統(tǒng)計學意義（P＞0.05）。分層分析發(fā)現(xiàn)，對于≤4 cm腎占位性病變的定性診斷，CEUS與CTU的準確率均為79.55%、增強MRI為76.14%，差異無統(tǒng)計學意義（P＞0.05）；對＞4 cm腎占位性病變的定性診斷，CEUS準確率為 89.73%、增強MRI為84.25%、CTU為73.97%，CEUS和增強MRI的準確率明顯優(yōu)于CTU（P＜0.05）；對于透明細胞癌及良性腎占位的定性診斷，3項檢查準確率之間的差異無統(tǒng)計學意義（P＞0.05）；CEUS對于非透明細胞癌定性診斷的準確率為83.87%、增強MRI為 74.19%、CTU 為56.45%，增強MRI和CEUS的診斷準確率顯著大于CTU（P＜0.05）。結論 3項檢查方法對于腎占位性病變的診斷均具有重要的臨床價值，臨床上應根據(jù)具體情況選擇合適的影像學檢查方法。CEUS和增強MRI對于腎占位性病變定性診斷的準確率高于CTU，特別是在診斷直徑較大的腎占位性病變及非透明細胞癌時。

關鍵詞：計算機體層成像尿路造影；增強磁共振成像；超聲造影；腎占位性病變；定性診斷

中圖分類號：R699.2"" 文獻標志碼：A

DOI：10.3969/j.issn.1009-8291.2025.01.010

收稿日期：2024-06-28""" 修回日期：2024-09-21

通信作者：

郭中強，碩士研究生導師，副主任醫(yī)師。……