【作者】 王晓；

【导师】 黄备建；

【作者基本信息】 复旦大学 ， 影像医学与核医学， 2013， 硕士

【摘要】 第一部分超声造影技术在肾盂癌诊断中的临床应用及价值探讨目的探讨超声造影(Contrast-enhanced Ultrasonography, CEUS)诊断肾盂癌的潜在价值。方法对61例经手术及病理证实为肾盂癌患者的常规超声及超声造影声像图进行回顾性分析。常规超声观察肾盂占位大小、回声、边界、有无彩色血流信号。超声造影观察肿块的增强时相和增强方式,包括肿块的增强、消退时间和灌注表现。结果本组61个肿块直径范围1.5～12.7cm。常规超声显示扁平样肿块18个,不规则团块样肿块43个；伴同侧肾脏积水32例。13个肿块内发现较丰富彩色血流信号,20个仅周边少量彩色血流信号,28个未显示彩色血流信号。超声造影显示皮质期61个肿块均增强；同步增强22个,缓慢增强39个；达峰值呈低回声48个,高回声6个,等回声7个；实质期快速消退51个,同步消退5个,缓慢消退5个。常规超声和超声造影的诊断准确率分别为54.10%(33/61)和78.69%(48/61)。结论超声造影可改善肾盂癌的血供显示,提高诊断率。第二部分超声造影技术在输尿管癌诊断中的临床应用及价值探讨目的探讨超声造影诊断输尿管癌的可行性及表现。方法对21例经手术病理证实为输尿管癌患者的常规超声及超声造影声像图进行回顾性分析。常规超声观察输尿管占位大小、回声、边界、有无彩色血流信号。超声造影观察病灶的增强方式和增强时相,包括起始时间、达峰值时间、消退时间及病灶内部结构的增强表现。结果本组21个肿块最大长径范围1.8-7.7cm,常规超声显示低回声肿块11个,等回声肿块8个,高回声肿块1个,显示欠清1个；8个病灶内发现彩色血流信号,5个仅周边见彩色血流信号,8个未显示彩色血流信号。超声造影显示21例病灶早期均见增强,同步增强10个,缓慢增强11个；达峰值时呈稍高回声11个,稍低回声4个,等回声6个；增强晚期快速消退16个,同步消退2个,稍慢消退2个,不能比较1个。常规超声和超声造影的诊断准确率分别为38.10%(8/21)和80.95%(17/21)。结论超声造影可改善输尿管癌的血供和边界显示,提高诊断率。第三部分超声造影和增强CT技术在肾盂及输尿管恶性肿瘤诊断中的应用价值及对比分析目的对比分析超声造影和增强CT显示肾盂及输尿管肿瘤的血流灌注特点的异同点,探讨超声造影的临床应用价值。方法对82例行超声造影和增强CT检查并经手术病理证实的肾盂及输尿管肿瘤病例进行回顾性分析。对超声造影和增强CT诊断肾盂及输尿管肿瘤的异同点进行对比研究。结果超声造影显示82个肿块全部增强；同步增强32个,缓慢增强50个；达峰值呈低回声52个,高回声17个,等回声13个；实质期快速消退57个,同步消退7个,缓慢消退7个；显示最小病灶为1.5cm。增强CT显示79个肿块增强,多呈轻、中度均匀强化,增强程度低于肾实质。超声造影诊断准确率为79.27%(65/82),增强CT诊断准确率为87.80%(72/82),两者比较差异无统计学意义(P>0.05)。结论超声造影和增强CT对肾盂及输尿管肿瘤均有较高的诊断准确率,联合检测可提高早期诊断的检出率。更多还原

【Abstract】 Part one Clinical application and value of diagnosis of renal pelvic carcinoma with contrast-enhanced ultrasonographyObjective To explore the potential value of diagnosis of renal pelvic carcinoma with contrast-enhanced ultrasonography (CEUS).Methods The ultrasonogram of conventional ultrasound and CEUS were analyzed retrospectively in61patients with pathologically proved renal pelvic carcinoma. The size, echo, boundary and color flow signal of renal pelvic lesions were observed by conventional ultrasound. The enhancement pattern and phases of tumors were also observed by CEUS, including wash-in and wash-out time, as well as the perfusion appearances.Results The maximum diameter of61renal pelvic tumors ranged from1.5cm to12.7cm. Conventional ultrasound detected flat mass in18tumors, irregular mass in43tumors and the same side hydronephrosis in32patients. Color Doppler flow imaging (CDFI) disclosed fairly rich flow signal of13tumors, a small amount of flow signal around tumor in20tumors and no-flow signal in the rest tumors. CEUS detected the cortical phase enhancement in all renal pelvic tumors, including synchronously enhancement in22tumors and delayed enhancement in39tumors. At the time of peak enhancement, hypoechogenicity compared to the normal renal cortex was showed in48tumors, hyperechogenicity in6tumors and isoechogenicity in7tumors. Fast wash-out in parenchymal phase was displayed in51tumors, isochronously wash-out in5tumors and delayed wash-out in5tumors. The diagnostic accuracy of the conventional ultrasound and CEUS was54.10%(33/61) and78.69%(48/61), respectively.Conclusion CEUS can depict blood flow supply better than conventional US and improve the diagnostic rate of renal pelvic carcinoma.Part two Clinical application and value of diagnosis of ureteral carcinoma with contrast-enhanced ultrasonographyObjective To study the diagnostic value of contrast-enhanced ultrasonography (CEUS) in ureteral carcinoma.Methods We retrospectively analyzed the ultrasonogram of conventional ultrasound and CEUS in21patients with pathologically proved ureteral carcinoma. The size, inner echoes, boundary and color blood signal of ureteral lesions were observed by conventional ultrasound. The pattern and phases of enhancement, including arrival time, peak time, washout time and appearance of internal structure, were observed by CEUS.Results The maximum length of21ureteral tumors ranged from1.8cm to7.7cm. Conventional ultrasound showed11hypoechoic masses,8isoechoic masses,1hyperechoic mass and1unclear mass. Color Doppler flow imaging (CDFI) showed fairly rich blood signal in8tumors, a small amount of blood signal around tumor in5tumors and no blood signal in the rest. In early phase, CEUS showed enhancement in all21ureteral lesions, including synchronously enhancement in10tumors and delayed enhancement in11tumors. At the time of peak enhancement, hypoechogenicity compared to the normal renal cortex was shown in4tumors, hyperechogenicity in11tumors and isoechogenicity in6tumors. In late phase, fast wash-out was displayed in16tumors, isochronously wash-out in2tumors, delayed wash-out in2tumors and unclear in1tumor. The diagnostic accuracy of the conventional ultrasound and CEUS was38.10%(8/21) and80.95%(17/21) respectively.Conclusion CEUS can improve blood supply and boundary display, as well as the diagnostic rate of ureteral carcinoma.Part three Comparative analysis of diagnosis of renal pelvis and ureter carcinoma by contrast-enhanced ultrasonography and contrast-enhanced computed tomographyObjective To compare and analyze the similarities and differences of the blood perfusion characteristics of renal pelvis and ureter carcinoma displayed by contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography (CECT), and explore the clinical value of contrast-enhanced ultrasonography in renal pelvis and ureter carcinoma.Methods To retrospectively analyze the ultrasonogram of contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography(CECT) in82renal pelvis and ureter carcinoma cases confirmed by operation and pathology. We compared the appearance and characteristics of renal pelvis and ureter carcinoma by these two methods.Results CEUS detected the cortical phase enhancement in all renal pelvis and ureter tumors, including synchronously enhancement in32tumors and delayed enhancement in50tumors. At the time of peak enhancement, hypoechogenicity compared to the normal renal cortex was shown in52tumors, hyperechogenicity in17tumors and isoechogenicity in13tumors. Fast wash-out in parenchymal phase was displayed in57tumors, isochronously wash-out in7tumors and delayed wash-out in7tumors. The minimum diameter of82renal pelvis and ureter carcinoma tumors is1.5cm. CECT showed the enhancement in79tumors, mostly mild to moderate homogeneous enhancement. The enhanced intensity of tumors was lower than those of renal parenchyma. The diagnostic accuracy of CEUS was79.27%(65/82), and the diagnostic accuracy of CECT was87.80%(72/82). The difference was not statistically significant between CEUS and CECT (P>0.05)Conclusion Both CEUS and CECT have higher diagnostic accuracy of renal pelvis and ureter carcinoma, so combining the two methods can increase the detection rate of the renal pelvis and ureter carcinoma.更多还原