Objective To evaluate the diagnostic performance of the features of cystic renal masses on contrast enhanced ultrasound (CEUS)for malignancy. Methods One hundred and three patients with 119 cystic renal masses(malignant 55,benign 64)were included in this study. The following features of each mass were recorded: the thickness of cyst walls and septa , poly-locule (≥5 ) , presence of thickened wall or septa ( > 2 mm) , presence of solid component, presence of contrast enhancement of the wall or septa or solid component. The diagnostic value of these features for malignant lesions was calculated respectively by using surgical pathology or follow-up as the gold standard. Results The wall thickness of benign and malignant cystic renal masses were 0. 22 (0. 10) cm and 0. 43 (0. 27) cm, there was significant difference between benign and malignant cystic renal masses (x2 =32. 2989, P < 0. 0001) , The septa thickness of benign and malignant masses were 0. 12(0. 12)cm and 0. 36(0. 25)cm,there was significant difference between benign and malignant cystic renal masses (x2 =36. 6528, P <0. 001 ). The sensitivity for malignant lesion of thick wall,thick septa,enhanced wall,enhanced septa,enhanced solid component,poly-locule were 90.91% ,78. 18% , 96.36% ,90.91% ,67.27% ,67. 27% respectively;The specificity for malignant lesion of thick wall,thick septa, enhanced wall,enhanced septa,enhanced solid component ,poly-eapsular were 34. 38% ,76. 56% ,1. 56% ,23.44% , 87. 50% , 79. 69% respectively; The accuracy for malignant lesion of thick wall , thick septa, enhanced wall, enhanced septa, enhanced solid component, poly-capsular space were 60. 50% ,77. 31% , 45.37% ,54. 62% ,78. 15% ,73. 95% respectively. Conclusions For the diagnosis of malignant cystic renal masses on CEUS, thick septa, enhanced solid component and poly -locule show good diagnostic performance. With 2 mm for a threshold of thickened speta ,has a good ability to identify malignant mass.%目的 探讨肾囊性肿物超声造影征象对恶性肾囊性肿物的诊断价值.方法 对103例患者119个肾囊性肿物行超声造影,测量肿物囊壁、分隔厚度,记录肿物有无囊壁增厚(＞2 mm)、分隔增厚(＞2 mm)、囊壁强化、分隔强化、实性成分强化、分隔较多(囊腔数≥5)等征象.手术病理和随诊结果证实119个肾囊性肿物中良性64个,恶性55个.以手术病理和随诊结果作为金标准,计算囊壁增厚、分隔增厚、囊壁强化、分隔强化、实性成分强化、分隔较多等征象诊断恶性肾囊性肿物的敏感度、特异度、准确性、阳性预测值和阴性预测值并进行比较.结果 良、恶性肾囊性肿物囊壁厚度的M(QR)分别为0.22(0.10)cm、0.43(0.27)cm,差异有统计学意义(χ2=32.2989,P＜0.0001),分隔厚度的M(QR)分别为0.12(0.12)cm、0.36(0.25)cm,差异也有统计学意义(χ2=36.6528,P＜0.001).囊壁增厚、分隔增厚、囊壁强化、分隔强化、实性成分强化、囊腔数≥5诊断恶性肾囊性肿物的敏感度分别为90.91%、78.18%、96.36%、90.91%、67.27%、67.27%,特异度分别为34.38%、76.56%、1.56%、23.44%、87.50%、79.69%,准确性分别为60.50%、77.31%、45.37%、54.62%、78.15%、73.95%,阳性预测值分别为54.38%、74.14%、45.69%、50.51%、82.22%、74.00%,阴性预测值分别为81.48%、80.83%、33.33%、75.00%、75.68%、73.91%.囊壁增厚、囊壁强化、分隔强化诊断恶性肾囊性肿物的敏感度较高,但特异度较低;分隔增厚、实性成分强化、分隔较多诊断恶性肾囊性肿物的准确性较高.结论 肾囊性肿物超声造影征象中分隔增厚、实性成分强化、分隔较多对恶性肾囊性肿物有较好的诊断价值.将分隔厚度＞2 mm定义为分隔增厚能较好地鉴别良、恶性肾囊性肿物.
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