目的探讨不同大小肾透明细胞癌(CCRCC)超声造影声像图特征及其在CCRCC诊断中的价值。方法对77例(80个肿瘤)经手术病理证实为CCRCC患者的常规超声及超声造影声像图进行回顾性分析,并按CCRCC最大瘤径,分为小肿瘤(≤30mm)、中等肿瘤(>30mm)、大肿瘤(>50mm)3组进行观察。常规超声观察肿块的血流显示程度、回声均匀度以及瘤周有无低回声晕。超声造影观察记录肿瘤的增强程度、增强均匀度以及有无包膜增强,并对3组肿瘤检查结果进行统计学分析。结果80个CCRCC中小肿瘤组32个,中等肿瘤组28个,大肿瘤组20个。常规超声显示小肿瘤组中回声呈不均匀者占18.8%(6/32),中等肿瘤组中占71.4%(20/28),大肿瘤组中为95%(19/20),3组间回声均匀度比较有显著性差异,但血流显示程度和假包膜征显示率在3组间差异无统计学意义。超声造影显示小肿瘤组中不均匀增强者占28.1%(9/32),中等肿瘤组中占85.7%(24/28),大肿瘤组中达100%(20/20);中等肿瘤组的假包膜征显示率高于小肿瘤组及大肿瘤组,分别为71.4%(20/28)、50%(16/32)、25%(5/20)。增强均匀度以及假包膜征显示率在3组之间有显著性差异,3组CCRCC的增强程度均以中等、明显增强为主,差异无统计学意义。与常规超声相比,超声造影将肿瘤内血流显示丰富者由51.3%(41/80)提高至87.5%(70/80),假包膜征显示率由22.5%(18/80)提高至51.3%(41/80),两者之间有显著差异。肿瘤呈回声不均匀者在常规超声中占56.3%(45/80),超声造影中占66.3%(53/80),但两者之间差异无统计学意义。结论不同大小CCRCC在增强均匀度和假包膜征显示率两方面有不同的超声造影声像图特征。超声造影能更清晰地显示肾癌的血流灌注特点,为肾癌的超声诊断提供更多信息。 Objective To investigate the echocardiographic features of different sizes of clear cell renal carcinoma (CCRCC) and its value in the diagnosis of CCRCC. Methods Totally 77 patients (80 tumors) were retrospectively analyzed by routine sonography and contrast echography of CCRCC. According to the largest diameter of CCRCC, they were divided into small tumors (≤30mm), middle tumors (> 30mm), large tumors (> 50mm) 3 groups were observed. Conventional ultrasonography was used to observe the extent of blood flow in the mass, the echo uniformity, and the presence or absence of hypoechoic halo around the tumor. Contrast-enhanced ultrasound was used to record the enhancement of tumor, enhancement of homogeneity and enhancement of encapsulation, and statistical analysis of the results of three groups of tumor examination. Results There were 32 small and medium tumors in 80 CCRCCs, 28 in medium tumors and 20 in large tumors. Conventional ultrasonography showed that echoes were uneven in 18.8% (6/32) of the small tumors, 71.4% (20/28) of the medium tumors, and 95% (19/20) of the large tumors. Among the 3 groups Echo uniformity was significantly different, but the degree of blood flow display and pseudocapsule sign showed no significant difference among the three groups. The contrast-enhanced ultrasound showed 28.1% (9/32) in the small tumor group, 85.7% (24/28) in the medium tumor group, 100% (20/20) in the large tumor group, and The incidence of pseudocapsule sign was higher than that of the small tumor group and the large tumor group (71.4% (20/28), 50% (16/32), 25% (5/20) respectively). There was a significant difference between the three groups in enhancement of evenness and the appearance rate of pseudocapsule sign. The enhancement of CCRCC in all three groups was moderately and obviously enhanced with no significant difference. Compared with conventional ultrasound, CEUS increased the tumor-rich blood flow from 51.3% (41/80) to 87.5% (70/80), and the rate of pseudocapsules increased from 22.5% (18/80) to 51.3% (41/80), there are significant differences between the two. Tumor non-uniform echo were 56.3% (45/80) in conventional ultrasound, ultrasound contrast accounted for 66.3% (53/80), but the difference between the two was not statistically significant. Conclusion Different sizes of CCRCC have different CEUS features in terms of enhancement of uniformity and indication of pseudocapsule sign. Contrast-enhanced ultrasound can clearly show the perfusion characteristics of renal cell carcinoma and provide more information for the ultrasound diagnosis of renal cell carcinoma.