探讨超声造影结合Bosniak分级对肾囊性病变的诊断价值。

回顾性分析2015年8月至2020年8月于兰州大学第二医院诊断为肾囊性病变的62例患者（共62个病灶，均经手术病理证实）的超声造影图像，并结合Bosniak分级标准对其进行分类，评价超声造影技术结合Bosniak分级对肾囊性病变的诊断及鉴别诊断价值。采用χ²检验比较良、恶性肾囊性病变的超声造影特征的差异；采用四格表计算超声造影结合Bosniak分级标准对病灶良恶性诊断的敏感度、特异度、阳性预测值和阴性预测值；采用χ²检验或Fisher确切概率检验比较不同病理类型囊性肾细胞癌的超声造影特征。

超声造影结合Bosniak分级标准，以Bosnaik分级≥Ⅲ级诊断恶性病灶的敏感度、特异度、阳性预测值、阴性预测值分别为83%、58%、73%、71%，其中，多房囊性肾细胞癌（MCRCC）多为Bosniak Ⅲ级（83%，5/6），超声造影表现为多囊结构，无实性增强结节；囊性肾透明细胞癌（CCRCC）及囊性乳头状肾细胞癌（PRCC）Bosniak分级多为IV级（86%，6/7；76%，13/17），而囊性CCRCC超声造影常表现为多囊结构（65%，11/17），71%（12/17）囊性CCRCC囊内实性成分表现为高增强，囊性PRCC超声造影常为单囊（86%，6/7），囊性PRCC囊内实性成分多表现为低增强（71%，5/7）。

超声造影结合Bosniak分级对肾囊性病变的良恶性诊断及不同类型囊性肾细胞癌的鉴别诊断有重要意义。

To assess the value of contrast-enhanced ultrasonography (CEUS) combined with the Bosniak classification in the diagnosis of renal cystic lesions.

The CEUS manifestations of 62 patients diagnosed with renal cystic lesions by conventional ultrasound and confirmed by surgical pathology at Lanzhou University Second Hospital from August 2015 to August 2020 were retrospectively analyzed and categorized by the Bosniak classification system according to the CEUS features. The value of contrast-enhanced ultrasonography combined with Bosniak classification in the diagnosis and differential diagnosis of cystic renal carcinoma was evaluated. The CEUS features of benign and malignant renal cystic lesions were compared by the Chi-square test. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS combined with Bosniak classification in the diagnosis of benign and malignant lesions were calculated. The CEUS imaging features of different subtypes of malignant cystic renal masses were analyzed and compared by the Chi-square test or Fisher's exact test.

For predicting multilocular cystic renal cell carcinomas (MCRCC), Bosniak classification ≥ Ⅲ had a sensitivity, specificity, positive predictive value, and negative predictive value of 83%, 58%, 73%, and 71%, respectively. MCRCC were more likely to have Bosniak classification Ⅲ (83%, 5/6), and CEUS often showed a multilocular cystic tumor without any enhancing solid nodule. Cystic clear cell renal cell carcinomas (CCRCC) and cystic papillary renal cell carcinomas (PRCC) were more likely to have Bosniak classification Ⅳ (86%, 6/7; 76%, 13/17). Cystic CCRCC were significantly more likely to show a multilocular pattern (65%, 11/17), and the intracystic solid components demonstrated a higher frequency of hyperenhancement (71%, 12/17). Cystic PRCC were significantly more likely to show a unilocular cystic pattern (86%, 6/7), and the intracystic solid components demonstrated a higher frequency of hypoenhancement (71%, 5/7).

CEUS combined with the Bosniak classification system is of great value in the diagnosis of benign and malignant cystic renal lesions and in the differential diagnosis of different types of cystic renal carcinoma.