本文選題：腎細(xì)胞癌 + 時(shí)間-強(qiáng)度曲線　； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的探討腎透明細(xì)胞癌(clear cell renal cell carcinoma,ccRCC)的超聲造影特征與其侵襲性的關(guān)系并分析超聲造影在ccRCC及嫌色細(xì)胞癌(chromophobe renal cell carcinoma,chRCC)鑒別診斷中的應(yīng)用價(jià)值,進(jìn)一步評估超聲造影對腎癌的診斷效能。方法收集2012年5月~2015年6月期間行術(shù)前腎臟超聲造影檢查并經(jīng)術(shù)后病理證實(shí)為ccRCC的患者75例,根據(jù)病理結(jié)果,將ccRCC分為未侵犯組(41例)、侵犯組(34例),其中侵犯組分為侵犯腎被膜組(12例)和穿透腎被膜組(22例),后又以同樣方式收集2013年5月~2016年5月期間的ccRCC患者86例及chRCC患者31例,對所有腫瘤的超聲造影動(dòng)態(tài)資料以回顧性的方式進(jìn)行研究和分析,觀察腫瘤的增強(qiáng)程度、增強(qiáng)和消退時(shí)相、增強(qiáng)均勻性以及周圍假包膜征,隨后通過儀器內(nèi)Q-Lab軟件對腫瘤和周圍正常腎實(shí)質(zhì)分別選取一個(gè)感興趣區(qū)制作時(shí)間-強(qiáng)度曲線,從曲線中獲得相關(guān)的定量分析參數(shù),包括始增時(shí)間(AT)、上升時(shí)間(RT)、達(dá)峰時(shí)間(TTP)、曲線尖度(sharpness)、曲線下面積(AUC)及峰值強(qiáng)度(PI),并通過計(jì)算獲得校正的AT(?AT)、TTP(?TTP)、PI(?PI),然后進(jìn)行對比統(tǒng)計(jì)分析。結(jié)果1.超聲造影上ccRCC的增強(qiáng)、消退時(shí)相和增強(qiáng)程度,未侵犯組與侵犯組間比較差異無統(tǒng)計(jì)學(xué)意義(P=0.121,P=0.16,P=0.085);但ccRCC的不均勻增強(qiáng)特征多見于侵犯組(P0.001),而ccRCC的假包膜征及長徑≤3cm的腫塊多見于未侵犯組(P0.001,P=0.005);2.侵犯組ccRCC的sharpness、AUC及?PI均高于未侵犯組(P0.001,P=0.001,P0.001),穿透腎包膜組ccRCC的sharpness及?PI均高于侵犯腎被膜組(P=0.008,P=0.004)。3.ccRCC多表現(xiàn)為高增強(qiáng)(46/86,53.49%)、彌漫性增強(qiáng)(58/86,67.44%)和不均勻增強(qiáng)(65/86,75.58%),54.65%(47/86)有假包膜征,chRCC多表現(xiàn)為低增強(qiáng)(22/31,70.97%)、向心性增強(qiáng)(17/31,54.83%)和均勻增強(qiáng)(20/31,64.52%),61.29%(19/31)有假包膜征,ccRCC和chRCC增強(qiáng)程度、增強(qiáng)方式及增強(qiáng)形態(tài)的差異均有統(tǒng)計(jì)學(xué)意義(P0.001,P=0.012,P0.001),假包膜征檢出率的差異無統(tǒng)計(jì)學(xué)意義(P=0.523)。4.ccRCC的?AT和?TTP與chRCC相比,差異無統(tǒng)計(jì)學(xué)意義(P=0.068,P=0.077),而ccRCC的?PI明顯高于chRCC(P0.001),以?PI=0.05%為閾值鑒別診斷ccRCC和chRCC的準(zhǔn)確率最高,其敏感度為84.9%,特異度為100%,AUC為0.97,ccRCC出現(xiàn)腎周和(或)腎竇脂肪組織受累、腎門和(或)腹膜后淋巴結(jié)轉(zhuǎn)移的百分率均高于chRCC(P=0.025,P=0.027)。結(jié)論ccRCC是否對周圍組織發(fā)生了侵犯在超聲造影上具有不用的表現(xiàn),超聲造影可用于ccRCC侵襲性的初步評估;ccRCC和chRCC在超聲造影定性觀察指標(biāo)及定量參數(shù)上也均具有不同的特征,超聲造影對二者具有鑒別診斷價(jià)值。
[Abstract]:Objective to investigate the relationship between the characteristics of clear cell renal cell carcinoma and its invasiveness, and to analyze the value of contrast-enhanced ultrasonography in differential diagnosis of ccRCC and chromophobe renal cell carcinoma RCCs. To further evaluate the diagnostic efficacy of contrast-enhanced ultrasonography for renal cell carcinoma. Methods from May 2012 to June 2015, 75 patients with ccRCC were examined by preoperative contrast-enhanced ultrasonography and confirmed by pathology. CcRCC was divided into non-invasive group (n = 41) and invading group (n = 34). The invading group was divided into two groups: the invading group (n = 12) and the penetrating group (n = 22). From May 2013 to May 2016, 86 cases of ccRCC and 31 cases of chRCC were collected in the same way. The contrast-enhanced dynamic data of all tumors were studied and analyzed in a retrospective manner. The enhancement degree, the phase of enhancement and regression, the enhancement of uniformity and the surrounding pseudocapsule sign were observed. Then the time-intensity curves of tumor and surrounding normal renal parenchyma were selected by Q-Lab software, and the quantitative analysis parameters were obtained. It includes the beginning time, the rising time, the peak time, the sharp degree of the curve, the area under the curve, the peak intensity and the peak intensity, and the corrected ATT TTP is obtained by calculation, and then the comparative statistical analysis is carried out. Result 1. Enhancement, phase and degree of enhancement of ccRCC on contrast-enhanced ultrasonography, There was no significant difference between the non-invasive group and the invading group, but the non-uniform enhancement of ccRCC was more common in the invading group than in the invading group, while the pseudomembrane sign of ccRCC and the mass with long diameter 鈮，

本文編號(hào)：1890205