Sonographic Appearances of Renal Cell Carcinoma: A Review of 78 Patients

腎細胞癌在超音波的表現：78名案例之回顧

楊境亦(Ching-Yih Yang) ； 刁翠美(Chui-Mei Tiu) ； 周宜宏(Yi-Hong Chou) ； 王信凱(Hsin-Kai Wang) ； 邱宏仁(Hong-Jen Chiou) ； 王家槐(Jia-Hwia Wang) ； 丘思穎(See-Ying Chiou) ； 許明輝(Ming-Huei Sheu) ； 張政彥(Cheng-Yen Chang) ； 陳光國(Kuang-Kuo Chen) ； 于俊(Ch)

《中華放射線醫學雜誌》 32卷4期 (2007/12) Pp. 177-183

摘要

腎細胞癌是成人最常見的腎臟惡性腫塊。絕大多數的腎臟，皆可利用即時性高解像力超音波作檢查。為歸納腎細胞癌超音波表現的徵象，我們回顧78例曾接受超音波檢查，並經病理證實為腎細胞癌的患者。
在5年中，總共收集了78例經上腹部超音波檢查發現腎臟腫塊，隨後並接受手術或切片檢查的病患。組織病理學檢驗證實這些病患皆有腎細胞癌。其中35名病患屬於無臨床症狀，但於例行超音波檢查中意外發現有腎臟腫瘤者。我們回顧相關超音波檢查結果，分析超音波型態與腫瘤大小的關係。病灶的回音強度在與腎臟髓質、腎臟皮質、肝臟或脾臟、和腎竇比較後，依序分為一至五級。
大多數腎細胞癌呈現實質性腫塊（33例，42%）或複合性腫塊（42例，54%）；僅有3例呈現囊性腫塊(4%)。第一級回音強度（不高於腎臟髓質）在所有腫瘤中佔5%；第二級回音強度（高於腎臟髓質，但不高於腎臟皮質）佔35%；第三級回音強度（高於腎臟皮質，但不高於肝臟或脾臟）佔50%；第四級回音強度（高於肝臟或脾臟，但不高於腎竇）佔10%。較小（小於或等於3公分）的腎細胞癌相對而言多呈現同質性(homogeneous)，且回音強度範圍多在第二至第三級之間。3-5公分的腎細胞癌呈現相對的異質性(heterogeneous)，且回音強度多在第二至第四級之間。至於5-7公分的腎細胞癌，則經常表現為複合性腫塊。第四級回音強度的腎細胞癌少見（佔10%），囊性腎細胞癌則僅只佔4%。
超音波檢查係具經濟效益、容易取得、可攜帶、且沒有游離輻射，並可作為篩檢腎臟癌症的檢查方式。對於超音波檢查後沒有定論的患者，或是臨床上高度懷疑局部腎臟腫瘤者，電腦斷層掃描，磁振造影檢查，或是甚至血管攝影檢查，則可用來作為補足的診斷檢查。

並列摘要

Renal cell carcinoma (RCC) is the most common malignant renal tumor in adults. The kidney can usually be adequately imaged with real-time ultrasound (US) scanners. To summarize the ultrasonographic manifestations of RCC, we reviewed 78 patients with pathologically proved RCC.
Within a period of 5 years, seventy-eight patients were found to have renal masses by ultrasonography (US) study of upper abdomen, and subsequently underwent surgical treatment and/or biopsy. Histopathological study confirmed the diagnosis of RCC in all patients. Thirty-five of them were asymptomatic and were found to have renal tumor incidentally at US examination. The US studies were reviewed to clarify the relationship between echopatterns and sizes of RCC. The echogenicity of the lesions was graded from I through V as compared to the echogenicity of renal medulla, renal cortex, liver/spleen and renal sinus.
Most RCCs were presented as solid masses (n=33; 42%) or complex masses (n=42; 54%). Only 3 patients were presented with cystic masses (4%). Grade I echogenicity (not higher than renal medulla) was noted in only 5% of renal tumors; grade II (higher than medulla but not higher than renal cortex) in 35%; grade III (higher than cortex but not higher than liver/spleen) in 50%; and grade IV (not higher than renal sinus) in 10%. Small RCCs (≦ 3cm) tended to be relatively homogeneous in echogenicity and ranged from grade II to III echogenicity. RCCs with a size between 3cm and 5 cm were relatively heterogeneous in echogenicity and had grade II to IV echogenicity. RCCs sized between 5cm and 7cm were frequently complex masses. RCCs with grade IV echogenicity were rare (10%), and cystic RCCs were noted in 4% of the patients.
US is a cost-effective, easily available, portable, and non-radiating examination for kidneys. It can be used as a screening modality for renal cancer. In patients with inconclusive US imaging finding or clinically high suspicion of focal renal tumor, CT, MRI, or even angiography should be utilized as complementary diagnostic modalities.