CTU、增强MRI和CEUS在肾占位病变定性诊断中准确率的多维度分析

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

摘要

目的 多维度比较分析计算机体层成像尿路造影（CTU）、增强磁共振成像（MRI）及超声造影（CEUS）在肾占位性病变中定性诊断的准确率。方法 回顾性分析2019年1月-2024年5月武汉大学中南医院泌尿外科经手术病理证实的542例肾占位性病变患者的资料，结合患者临床及病理资料对其CTU、增强MRI及CEUS的检查结果进行分层多维度对比分析。结果 3项检查诊断肾占位性病变的准确率分别为CTU 84.50%、增强MRI 83.14%、CEUS 86.14%。同时行3项检查的161例患者中，CEUS对肾占位性病变定性诊断的准确率显著优于CTU（84.16% vs. 77.02%，P=0.018），而CTU或CEUS与增强MRI（79.81%）间定性诊断准确率的差异无统计学意义（P＞0.05）。分层分析发现，对于≤4 cm肾占位性病变的定性诊断，CEUS与CTU的准确率均为79.55%、增强MRI为76.14%，差异无统计学意义（P＞0.05）；对＞4 cm肾占位性病变的定性诊断，CEUS准确率为89.73%、增强MRI为84.25%、CTU为73.97%，CEUS和增强MRI的准确率明显优于CTU（P＜0.05）；对于透明细胞癌及良性肾占位的定性诊断，3项检查准确率之间的差异无统计学意义（P＞0.05）；CEUS对于非透明细胞癌定性诊断的准确率为83.87%、增强MRI为74.19%、CTU为56.45%，增强MRI和CEUS的诊断准确率显著大于CTU（P＜0.05）。结论 3项检查方法对于肾占位性病变的诊断均具有重要的临床价值，临床上应根据具体情况选择合适的影像学检查方法。CEUS和增强MRI对于肾占位性病变定性诊断的准确率高于CTU，特别是在诊断直径较大的肾占位性病变及非透明细胞癌时。

Abstract

Objective To compare the diagnostic accuracy of three imaging modalities, including 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 >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 (P<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 (P<0.05). Conclusion All of them have important diagnostic value, and the appropriate selection should be based on patients' specific 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.

关键词

计算机体层成像尿路造影 / 增强磁共振成像 / 超声造影 / 肾占位性病变 / 定性诊断

Key words

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

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