肾囊性病变良恶性征象影像学研究

Imaging Study on Benign and Malignant Signs of Renal Cystic Lesions

摘要: 本研究回顾性分析50例肾囊性病变患者的影像学资料(女性32例，男性18例)，旨在系统评估良恶性病变的影像学特征差异及Bosniak分级的诊断价值。所有病例均经手术病理证实，采用多层螺旋CT (100%)、MRI (52%)及超声造影(CEUS, 38%)进行多模态评估。结果显示：恶性组(n = 19)以囊壁增厚(≥4 mm，84.2%)、分隔强化(78.9%)及壁结节(63.2%)为典型征象，Bosniak III~IV级占比89.5%；良性组(n = 31)以薄壁(≤2 mm, 93.5%)、无强化(96.8%)为主，Bosniak I~IIF级占比90.3%。Logistic回归证实实性成分强化是预测恶性的独立因素(OR = 8.72, p < 0.001)。女性患者中囊性血管平滑肌脂肪瘤(18.8%)及小肿瘤(<2 cm)误诊率达26.7%。研究表明，Bosniak分级联合CEUS可显著提升诊断准确性(AUC = 0.94)，未来需整合影像组学优化IIF/III级病变的鉴别策略。

Abstract: This study retrospectively analyzed the imaging data of 50 patients with renal cystic lesions (32 females and 18 males), aiming to systematically evaluate the differences in imaging characteristics between benign and malignant lesions and the diagnostic value of Bosniak grading. All cases were confirmed by surgical pathology and underwent multimodal evaluation using multi-slice spiral CT (100%), MRI (52%), and contrast-enhanced ultrasound (CEUS, 38%). The results showed that in the malignant group (n = 19), the typical features were thickening of the cyst wall (≥ 4 mm, 84.2%), enhanced septa (78.9%), and wall nodules (63.2%), with a proportion of 89.5% in the Bosniak III-IV grade; The benign group (n = 31) mainly consisted of thin-walled structures (≤ 2 mm, 93.5%) and no enhancement (96.8%), with Bosniak I-IIF grades accounting for 90.3%. Logistic regression confirmed that solid component enhancement is an independent factor in predicting malignancy (OR = 8.72, p < 0.001). The misdiagnosis rate of cystic angiomyolipoma (18.8%) and small tumors (<2 cm) in female patients is 26.7%. Research has shown that the combination of Bosniak grading and CEUS can significantly improve diagnostic accuracy (AUC = 0.94), and in the future, it is necessary to integrate radiomics to optimize the differentiation strategy of IIF/III grade lesions.