目的 比较CEUS及增强CT(CECT)对小肾癌(SRCC)的诊断价值.方法 对132例患者进行实时CEUS及CECT检查,以手术和穿刺病理结果为标准比较两种检查方法对SRCC的诊断价值.结果 132例患者中,恶性肿瘤119例(透明细胞癌95例,嫌色细胞癌9例,乳头状细胞癌13例,肾囊性细胞癌2例),良性肿瘤13例(均为肾错构瘤).CEUS图像显示SRCC多呈富血供表现,有假包膜者占76.47％(91/119).时间-强度曲线显示SRCC病灶的造影剂到达时间及曲线达峰时间低于肾皮质(P＜0.05),达峰绝对值高于周围肾皮质(P＜0.05).CEUS确诊肾恶性肿瘤114例,误诊5例,确诊良性肿瘤6例,误诊7例.CECT确诊肾恶性肿瘤102例,误诊13例,漏诊4例,确诊良性病变6例,误诊7例.两种方法在SRCC的诊断方面差异无统计学意义(x2=2.74,P＞0.05).结论 CEUS与CECT对诊断SRCC可起到相互补充的作用.通过TIC分析,CEUS可定量分析SRCC的血流灌注特点,诊断SRCC更为准确、客观.%To compare the value of CEUS and contrast-enhanced computed tomography (CECT) in diagnosis of small renal cell carcinoma (SRCC). Methods Totally 132 patients with small renal tumors were examinated using CEUS and CECT respectively. Taking operation and pathology results as golden standards, the diagnostic value of SRCC with the two methods was compared. Results There were 119 patients with SRCC, including 95 clear cell carcinoma, 9 chromopho-bic cell renal carcinoma, 13 papillary cell carcinoma and 2 cystic renal cell carcinoma cases. Hamartoma was detected in 13 patients. Most of SRCC had rich blood supply, and pseudocapsule was found in 91 cases (91/119, 76.47%) by CEUS. Time-intensity curve showed the arrival time and the time to peak of SRCC were lower than those of the renal cortex (P< 0.05), and peak intensity was higher than that of the surrounding renal cortex (P<0.05). Correct diagnosis was obtained in 114 cases with SRCC and 6 cases with hamartoma using CEUS, while 102 SRCC and 6 hamartoma using CECT. CEUS misdiagnosed 5 cases of SRCC and 7 cases of hamartoma, while CECT misdiagnosed 13 cases of SRCC and 7 cases of hamartoma, and missed 4 cases of SRCC. No statistical difference was found between CEUS and CECT in differentiating of SRCC (x2=2. 74, P>0. 05). Conclusion CEUS and CECT complement each other in the diagnosis of SRCC. Through analyzing perfusion characteristics of SRCC quantitatively with TIC, CEUS can diagnose SRCC accurately and objectively.
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