Bladder Tumor Staging: Comparison of Contrast-Enhanced and Gray-Scale Ultrasound
Bladder Tumor Staging: Comparison of Contrast-Enhanced and Gray-Scale Ultrasound
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DOI：
10.2214/ajr.09.2741
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发表时间：
2010-01-01
影响因子：
5
通讯作者：
Lagalla, Roberto
中科院分区：
文献类型：
--
作者：
Caruso, Giuseppe;Salvaggio, Giuseppe;Lagalla, Roberto
目标。本研究的目的是评估对比增强超声与常规超声在鉴别膀胱肌肉浸润性和浅表性肿瘤方面的有效性。研究对象和方法。对连续登记的34例膀胱肿瘤患者行常规超声和增强超声检查。所有检查均由两名独立的超声医师复查。在灰度超声检查中，高回声膀胱壁的中断被认为是区分浅表性和浸润性肿瘤的主要诊断标准。在超声造影中，当膀胱壁低增强肌层完好时，肿瘤被认为是浅表性的；通过增强肿瘤组织破坏肌肉层被认为是浸润的诊断。对肌肉层肿瘤浸润诊断的置信度为5度。接受者工作特征分析用于评估常规超声和增强超声对肿瘤肌肉浸润诊断的总体置信度。所有患者均获得组织学诊断。最终病理分期显示25例浅表性肿瘤（Ta-T1疾病）和9例肌肉浸润性肿瘤（> T1）。常规超声显示了9个肌肉浸润性肿瘤中的5个，对比增强超声显示了所有9个。对比增强超声的诊断效能接近参考标准（受者工作特征曲线下面积，0.996），但灰度超声的诊断效能较差（曲线下面积，0.613）。我们的研究表明，对比增强超声检查在鉴别膀胱肌肉浸润性和浅表性肿瘤方面优于常规超声检查。
OBJECTIVE. The purpose of this study was to evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.SUBJECTS AND METHODS. Conventional and contrast-enhanced sonography were performed on 34 consecutively registered patients with bladder tumors. All examinations were reviewed by two independent sonologists. At gray-scale sonography, interruption of the hyperechoic bladder wall was considered the main diagnostic criterion for differentiating superficial and infiltrating tumors. At contrast-enhanced sonography, a tumor was considered superficial when the hypoenhancing muscle layer of the bladder wall was intact; disruption of the muscle layer by enhancing tumor tissue was considered diagnostic of infiltration. A level of confidence in the diagnosis of tumor infiltration of the muscle layer was assigned on a 5-degree scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle infiltration by tumor at both conventional and contrast-enhanced sonography. Histologic diagnosis was obtained for all patients.RESULTS. Final pathologic staging revealed 25 superficial tumors (Ta-T1 disease) and nine muscle-infiltrating tumors (> T1). Conventional sonography depicted five of nine muscle-infiltrating tumors, and contrast-enhanced sonography depicted all nine. The diagnostic performance of contrast-enhanced sonography approached that of the reference standard (area under the receiver operating characteristic curve, 0.996), but the diagnostic performance of gray-scale ultrasound was worse (area under curve, 0.613).CONCLUSION. Our study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.