1
|
Tian J, Xu T, Fan L, Sun H. Value of Contrast-Enhanced Ultrasound in the Diagnosis of Clear Cell Renal Cell Carcinoma: A Meta-Analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2025; 53:343-352. [PMID: 39400336 DOI: 10.1002/jcu.23861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/18/2024] [Indexed: 10/15/2024]
Abstract
This meta-analysis aims to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in diagnosing clear cell renal cell carcinoma (ccRCC). Literature published in five databases was searched. Twelve studies were included. The pooled results showed sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CEUS were 79% (95% CI: 75%-83%), 84% (95% CI: 80%-88%), 4.97 (95% CI: 3.86-6.39), 0.24 (95% CI: 0.20-0.30), and 20.32 (95% CI: 13.84-29.84), respectively. The area under the summary receiver operating characteristic curve was 0.86. In conclusion, CEUS demonstrates high sensitivity and specificity in diagnosing ccRCC, showing good diagnostic accuracy.
Collapse
Affiliation(s)
- Jiangke Tian
- Ultrasound Department, Beijing United Family Hospital, Beijing, China
| | - Tao Xu
- Ultrasound Department, Beijing United Family Hospital, Beijing, China
| | - Lijun Fan
- Ultrasound Department, Beijing United Family Hospital, Beijing, China
| | - Haiou Sun
- Ultrasound Department, Beijing United Family Hospital, Beijing, China
| |
Collapse
|
2
|
Li C, Qi L, Geng C, Xiao H, Wei X, Zhang T, Zhang Z, Wei X. Comparative Diagnostic Performance of Color Doppler Flow Imaging, MicroFlow Imaging and Contrast-enhanced Ultrasound in Solid Renal Tumors. Acad Radiol 2025:S1076-6332(24)01044-4. [PMID: 39826999 DOI: 10.1016/j.acra.2024.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Revised: 12/16/2024] [Accepted: 12/26/2024] [Indexed: 01/22/2025]
Abstract
RATIONALE AND OBJECTIVES Accurate distinguish malignant from benign renal masses remains a challenge for radiologists. The purpose of this study was to evaluate the value of Color Doppler Flow Imaging (CDFI), MicroFlow Imaging (MFI) and Contrast-enhanced Ultrasound (CEUS) in diagnosing solid renal tumors. MATERIALS AND METHODS A total of 291 patients with 300 solid renal tumors pathologically confirmed were retrospectively analyzed between January 2020 and December 2022. Each patient underwent CDFI, MFI, and CEUS examinations before surgery. The diagnostic efficacy of CDFI, MFI and CEUS in assessing renal tumors was compared based on blood flow grade, vascular morphology and CEUS characteristics. RESULTS MFI identified 243 renal lesions (81%) with blood flow grade (2, 3) and vascular morphology (IV, V), significantly outperforming CDFI, which detected 147 cases (49%). MFI demonstrated statistically significant differences in detecting blood flow signals and predicting renal malignancy compared to CDFI (p < 0.001). In CEUS examination, significant differences were observed in wash-in, enhancement intensity, wash-out, and perilesional rim-like enhancement of the contrast agent between malignant and benign renal lesions (all p < 0.001). The areas under the receiver operating characteristic curves (AUCs) for MFI and CEUS were 0.838 and 0.788, respectively, both higher than that for CDFI (0.695). In diagnosing solid renal tumors, MFI and CEUS showed significant differences compared to CDFI (p < 0.05), although no significant difference was found between MFI and CEUS (p = 0.075). The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CDFI, MFI and CEUS were as follows: 0.600 vs.0.893 vs.0.920; 0.554 vs. 0.920 vs.0.984; 0.837 vs. 0.755 vs.0.592; 0.946 vs. 0.951 vs.0.925; 0.268 vs. 0.649 vs.0.879. CONCLUSION MFI demonstrates higher sensitivity in detecting microvascular signs of renal tumors compared to CDFI. Moreover, MFI exhibits comparable diagnostic performance to CEUS in distinguishing malignant from benign renal masses.
Collapse
Affiliation(s)
- Chunxiang Li
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (C.L., X.W., T.Z., X.W.); National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.)
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (L.Q., C.G.); National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.)
| | - Changyu Geng
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (L.Q., C.G.); National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.)
| | - Huiting Xiao
- National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Department of Gynecologic Oncology,Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (H.X.)
| | - Xueqing Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (C.L., X.W., T.Z., X.W.); National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.)
| | - Tan Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (C.L., X.W., T.Z., X.W.); National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.)
| | - Zhenting Zhang
- National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Department of Urologic Oncology,Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (Z.Z.)
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China (C.L., X.W., T.Z., X.W.); National Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Key laboratory of Cancer Prevention and Therapy, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.); Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.L., L.Q., C.G., H.X., X.W., T.Z., Z.Z., X.W.).
| |
Collapse
|
3
|
Zhang H, Guo G, Zhu R, Wang H, Chen P, Qin C, Gao Y. Evaluation of Renal Masses Using Contrast-Enhanced Ultrasound with Sonovue and Sonazoid. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:128-137. [PMID: 39426844 DOI: 10.1016/j.ultrasmedbio.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/26/2024] [Accepted: 09/22/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVE To explore the differences between SonoVue and Sonazoid contrast-enhanced ultrasound (CEUS) in evaluating enhancement features of renal masses and determine the diagnostic value of CEUS in clear cell renal cell carcinoma (ccRCC). METHODS A total of 57 eligible patients were enrolled and divided into the ccRCC, papillary renal cell carcinoma (pRCC), non-ccRCC and non-pRCC malignancy groups, and benign mass groups based on their postsurgical histopathologic diagnosis. The enhancement features of renal masses following SonoVue and Sonazoid CEUS in each group were analyzed. Diagnostic efficiencies of SonoVue and Sonazoid CEUS for ccRCC and non-ccRCC were determined. RESULTS There were no significant differences in the enhancement features of renal masses with SonoVue and Sonazoid imaging in the four groups (p > .05). Both SonoVue CEUS and Sonazoid CEUS showed good diagnostic performance for the differential diagnosis of ccRCC and non-ccRCC, with sensitivities of 88.6% and 85.7%, specificities of 76.5% and 88.2%, accuracies of 84.6% and 86.5%, positive predictive values of 88.6% and 93.8%, and negative predictive values of 76.5% and 75%, respectively. There were no statistically significant differences in any of the diagnostic performance indices between the two methods (p > .05). CONCLUSION The CEUS features of SonoVue and Sonazoid in evaluating renal masses were similar in the vascular phase. Both SonoVue and Sonazoid CEUS showed good diagnostic performance for the differential diagnosis of ccRCC and non-ccRCC.
Collapse
Affiliation(s)
- Haixiang Zhang
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China
| | - Gang Guo
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Run Zhu
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hua Wang
- Department of Urology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Chen
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chi Qin
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yongyan Gao
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
4
|
Elbanna KY, Krishna S, Finelli A, Atri M. Contrast-Enhanced Ultrasound of the Indeterminate Renal Mass, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024:1-12. [PMID: 38415576 DOI: 10.2214/ajr.24.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is distinguished from CT and MRI by the use of microbubble ultrasound contrast agents (UCAs) with intravascular blood pool distribution. When performing CEUS, low-intensity ultrasound allows real-time tissue subtraction imaging, whereas high-intensity ultrasound leads to microbubble destruction, enabling visualization of the contrast inflow pattern. CEUS has exceptional contrast resolution that enables the detection of even minimal blood flow, achieving very high NPV for ruling out vascular perfusion and providing high frame rates in the evaluation of tissue perfusion dynamics. UCAs undergo hepatic metabolism and pulmonary clearance, ensuring safety in patients with renal impairment. CEUS excels in distinguishing solid from cystic renal masses, with higher sensitivity than CT or MRI for detection of lesion enhancement. CEUS can aid the further characterization of both solid and cystic lesions and may have particular applications in the surveillance of cystic masses and surveillance after renal cell carcinoma ablation. This review describes the use of CEUS to help characterize indeterminate renal masses, based on the authors' institutional experience. The article highlights key differences between CEUS and CT or MRI and provides practical insights for performing and interpreting CEUS of renal masses.
Collapse
Affiliation(s)
- Khaled Y Elbanna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Satheesh Krishna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Antonio Finelli
- Departments of Surgery and of Surgical Oncology, Division of Urology, Princess Margaret Hospital and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| |
Collapse
|
5
|
Zhang W, Wang J, Chen L. Characteristics of high frame frequency contrast-enhanced ultrasound in renal tumors. BMC Med Imaging 2024; 24:71. [PMID: 38528467 DOI: 10.1186/s12880-024-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE This study aims to analyze the characteristics of high frame rate contrast-enhanced ultrasound (H-CEUS) in renal lesions and to improve the ability for differential diagnosis of renal tumors. METHODS A total of 140 patients with renal lesions underwent contrast-enhanced ultrasound (CEUS) examination in the First Affiliated Hospital of Nanchang University from July 2022 to July 2023. Based on the tumor pathology and the results of enhanced CT, tumor patients were divided into malignant and benign groups. All subjects were examined using gray-scale ultrasound, conventional contrast-enhanced ultrasound (C-CEUS), and H-CEUS, and their dynamic images were recorded. Two radiologists independently analyzed and recorded the results of ultrasound, C-CEUS, and H-CEUS images and statistically analyzed the features of C-CEUS and H-CEUS images. The independent sample t-test was used to compare the difference in age and maximum diameter of nodules between the benign and malignant groups. The χ2 test was used to compare the sex, mode of operation, gray-scale ultrasound characteristics, and enhancement characteristics of the two CEUS modes (enhancement mode, regression mode, enhancement degree, enhancement uniformity, enhancement or not, enhancement direction, post-enhancement boundary and range, and pseudocapsule) between the benign and malignant groups. The difference in vascular morphology of malignant nodules of varying sizes under two angiographic modes. RESULTS There were significant differences in gender (χ2 = 10.408, P = 0.001), mode of operation (χ2 = 47.089, P < 0.001), nodule composition (χ2 = 7.481, P = 0.003), nodule echo (χ2 = 20.926, P < 0.001), necrosis (χ2 = 31.343, P < 0.001) and nodule blood flow (χ2 = 9.006, P = 0.029) between the benign and malignant groups. There were significant differences in the regression model (χ2 = 6.782, P = 0.034) and enhancement direction (χ2 = 13.771, P = 0.001) between the two radiographic techniques in the malignant group. There was a significant difference in the enhancement uniformity between the two CEUS techniques in the benign group (χ2 = 8.264, P = 0.004). There was a significant difference between the two CEUS techniques in displaying the vascular morphology in the malignant group with the maximum diameter of nodules ≤ 4.0 cm (χ2 = 11.421, P < 0.022). However, there was no significant difference between the two techniques in the malignant group with the maximum diameter of nodules > 4.0 cm. CONCLUSION Increasing the frame rate of ultrasound images is helpful to accurately display the enhanced features and vascular morphology of renal tumors, especially for malignant tumors with a maximum diameter of ≤ 4.0 cm. Thus, H-CEUS can make up for the limitation of CEUS with regard to the display of vascular morphology.
Collapse
Affiliation(s)
- WeiPing Zhang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - JingLing Wang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Chen
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
| |
Collapse
|
6
|
Fan X, Fu F, Liang R, Xue E, Zhang H, Zhu Y, Ye Q. Associations between contrast-enhanced ultrasound features and WHO/ISUP grade of clear cell renal cell carcinoma: a retrospective study. Int Urol Nephrol 2024; 56:1157-1164. [PMID: 37670195 DOI: 10.1007/s11255-023-03774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Clear cell renal cell carcinoma (CCRCC) comprises 70%-80% of RCCs. The World Health Organization/International Society of Urology Pathology (WHO/ISUP) classification is the most important prognostic factor for CCRCC. By evaluating the variations of tumor microvascular density, contrast-enhanced ultrasound (CEUS) can noninvasively predict the WHO/ISUP grade of CCRCC, and provide the appropriate treatment plan before clinical operation. METHODS In this study, we used CEUS features to analyze 116 CCRCC cases and assess the value of correlation between each indicator and CCRCC WHO/ISUP grading. RESULTS When compared to high-grade (WHO/ISUP grade III/IV) tumors, low-grade (WHO/ISUP grade I/II) tumors had reduced relative peak intensity (ΔPI) (P = 0.021), relative area under the curve (ΔAUC) (P = 0.019). However, the frequency of incomplete pseudocapsule (P = 0.021) was significantly higher in high-grade tumors. A cut-off value of mean diameter > 5.5 cm, ΔPI > 304 × 10-3, ΔAUC > 350 × 10-3 allowed identification of high-grade tumors with an area under the curve (AUC) of 74.6%, 71.7%, 70.7%, respectively (95% confidence interval). CONCLUSIONS The features of CEUS are effective for differentiating high-grade tumors from low-grade tumors, thus CEUS can be considered an acceptable method for the preoperative assessment of tumor grade.
Collapse
Affiliation(s)
- Xiaoqing Fan
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Fen Fu
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Rongxi Liang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Ensheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Huiping Zhang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Yifan Zhu
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Qin Ye
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China.
| |
Collapse
|
7
|
Dipinto P, Canale V, Minelli R, Capuano MA, Catalano O, Di Pierro GB, Anceschi U, Perdonà S, Tufano A. Qualitative and quantitative characteristics of CEUS for renal cell carcinoma and angiomyolipoma: a narrative review. J Ultrasound 2024; 27:13-20. [PMID: 38238503 PMCID: PMC10908740 DOI: 10.1007/s40477-023-00852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 03/03/2024] Open
Abstract
Incidental findings of renal masses are increasing. However, a substantial portion of surgically treated renal masses turn out to be benign on histopathological examination. Thus, there is a clear need for improved pre-surgical assessment to minimize unnecessary invasive procedures. The challenge intensifies when distinguishing between renal cell carcinoma (RCC) and angiomyolipoma (AML) in renal lesions smaller than 4 cm with minimal adipose tissue. In such cases, contrast-enhanced ultrasound (CEUS) has emerged as a valuable diagnostic tool, by utilizing both qualitative and quantitative parameters. Quantitative measures offer objectivity, reliability, and reproducibility compared to qualitative parameters, enabling the characterization of RCC subtypes and differentiation from AML. Qualitative features as enhancement pattern, degree, and peak were less helpful in distinguishing triphasic minimal fat AML (TAML) from epithelioid AML (EAML), with the pseudocapsule sign potentially being the only distinguishing qualitative feature. The pseudocapsule sign was more frequently observed in ccRCCs (38.0%) than in AMLs (15.6%). Moreover, it was detected in 40.0% of EAMLs and 34.5% of ccRCCs but not in TAMLs due to similar growth patterns between EAMLs and low-grade ccRCCs. Quantitative measures such as the time-to-peak (TTP) ratio can further enhance diagnostic accuracy and also TOC ratio should be considered, as it was higher in clear cell RCCs (ccRCCs) and in EAMLs compared to TAMLs, indicating behavior similar to ccRCCs. However, CEUS remains an operator-dependent exam.
Collapse
Affiliation(s)
- Piervito Dipinto
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy.
| | - Rocco Minelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, CB, Italy
| | - Marco Alex Capuano
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, CB, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, 80126, Naples, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144, Rome, Italy
| | | | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162, Rome, Italy
| |
Collapse
|
8
|
Chen X, Feng X, Chen Y, Huang F, Long L. CT findings and clinical characteristics in distinguishing renal urothelial carcinoma mimicking renal cell carcinoma from clear cell renal cell carcinoma. BMC Urol 2024; 24:4. [PMID: 38172791 PMCID: PMC10765735 DOI: 10.1186/s12894-023-01393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to characterize the clinical and multiphase computed tomography (CT) features, which can distinguish renal urothelial carcinoma (RUC) mimicking renal cell carcinoma (RCC) from clear cell renal cell carcinoma (ccRCC) with collecting system invasion (CSI). METHODS Data from 56 patients with RUC (46 men and 10 women) and 366 patients with ccRCC (262 men and 104 women) were collected and assessed retrospectively. The median age was 65.50 (IQR: 56.25-69.75) and 53.50 (IQR: 42.25-62.5) years, respectively. Univariate and multivariate logistic regression analyses were performed on clinical and CT characteristics to determine independent factors for distinguishing RUC and ccRCC, and an integrated predictive model was constructed. Differential diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS The independent predictors for differentiating RUC from ccRCC were infiltrative growth pattern, hydronephrosis, heterogeneous enhancement, preserving reniform contour, and hematuria. The differential diagnostic performance of the integrated predictive model-1 (AUC: 0.947, sensitivity: 89.07%, specificity: 89.29%) and model-2 (AUC: 0.960, sensitivity: 92.1%, specificity: 89.3%) were both better than that of the infiltrative growth pattern (AUC: 0.830, sensitivity: 71.9%, specificity: 92.9%), heterogeneous enhancement (AUC: 0.771, sensitivity: 86.3%, specificity: 67.9%), preserving reniform contour (AUC = 0.758, sensitivity: 85.5%, specificity: 66.1%), hydronephrosis (AUC: 0.733, sensitivity: 87.7%, specificity: 58.9%), or hematuria (AUC: 0.706, sensitivity: 79.5%, specificity: 51.8%). CONCLUSION The CT and clinical characteristics showed extraordinary discriminative abilities in the differential diagnosis of RUC and ccRCC, which might provide helpful information for clinical decision-making.
Collapse
Affiliation(s)
- Xin Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China
- Department of Radiology, Jiangjin Hospital of Chongqing University, No.725, Jiangzhou Avenue, Dingshan Street, Chongqing, 402260, China
| | - Xiao Feng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China
| | - Yidi Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, Sichuan, 610041, China
| | - Fulin Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong road, Nanning, Guangxi, 530021, China.
| |
Collapse
|
9
|
Liang M, Qiu H, Ou B, Wu J, Zhao X, Luo B. Evaluation of contrast-enhanced ultrasound for predicting tumor grade in small (≤4 cm) clear cell renal cell carcinoma: Qualitative and quantitative analysis. Clin Hemorheol Microcirc 2024; 88:351-362. [PMID: 39031342 DOI: 10.3233/ch-231990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVE The study aimed to evaluate the utility of qualitative and quantitative analysis employing contrast-enhanced ultrasound (CEUS) in predicting the WHO/ISUP grade of small (≤4 cm) clear cell renal cell carcinoma (ccRCCs). METHODS Patients with small ccRCCs, confirmed by histological examination, underwent preoperative CEUS and were classified into low- (grade I/II) and high-grade (grade III/IV) groups. Qualitative and quantitative assessments of CEUS were conducted and compared between the two groups. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 72 patients were diagnosed with small ccRCCs, comprising 23 individuals in the high-grade group and 49 in the low-grade group. The low-grade group exhibited a significantly greater percentage of hyper-enhancement compared to the high-grade group (79.6% VS 39.1%, P < 0.05). The low-grade group showed significantly higher relative index values for peak enhancement, wash-in area under the curve, wash-in rate, wash-in perfusion index, and wash-out rate compared to the high-grade group (all P < 0.05). The AUC values for qualitative and quantitative parameters in predicting the WHO/ISUP grade of small ccRCCs ranged from 0.676 to 0.756. CONCLUSIONS Both qualitative and quantitative CEUS analysis could help to distinguish the high- from low-grade small ccRCCs.
Collapse
Affiliation(s)
- Ming Liang
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haolin Qiu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinbao Zhao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
10
|
Huang X, Wang N, Liu L, Zhu J, Wang Z, Wang T, Nie F. Pre-operative Prediction of Invasiveness in Renal Cell Carcinoma: The Role of Conventional Ultrasound and Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00204-1. [PMID: 37451952 DOI: 10.1016/j.ultrasmedbio.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE It is known that in patients with renal cell carcinoma (RCC), the invasiveness of the tumor is closely related to the treatment and prognosis. Currently, histologic diagnosis of RCC is typically established after surgical removal of tumors or after biopsy. The use of non-invasive imaging modalities to predict the invasiveness of RCC is of great clinical value, particularly before surgery. In this study, the differences in conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) features between invasive and non-invasive RCC were analyzed with the aim of providing more accurate and valuable information for diagnosis and treatment to clinically optimize the treatment plan in a non-invasive manner and improve the prognosis of patients. METHODS Conventional US and CEUS features of 163 patients (total of 164 RCCs), obtained from the Lanzhou University Second Hospital in the period ranging from March 2021 to September 2022, were retrospectively analyzed. Patients were categorized into two groups: invasive group (n = 44) and non-invasive group (n = 120), with surgical pathology as reference standard. Receiver operating characteristic curves were drawn to evaluate the feasibility of differentiation. RESULTS The possibility of an intrarenal lesion/kidney ratio >50% in the invasive group (13/44, 29.5%) was significantly higher than that in the non-invasive group (8/120, 6.7%) (p < 0.001). The absence of perilesional rim-like enhancement was more likely to imply invasive RCC (30/44, 68.2%) than non-invasive RCC (100/120, 83.3%) (p = 0.049) and was an independent predictor of invasive RCC. As for CEUS quantitative features, there were statistically significant differences in peak intensity (p = 0.009) or peak enhancement (p = 0.010), taking the largest range of lesion as the region of interest. CONCLUSION Conventional US and CEUS features may help in the differentiation of invasive RCC from non-invasive RCC and have potential application value in the pre-operative prediction of RCC invasiveness.
Collapse
Affiliation(s)
- Xiao Huang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Nan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Luping Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Ju Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Zhen Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Ting Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
| |
Collapse
|
11
|
Chen X, Feng X, Chen Y, Huang F, Long L. CT findings and clinical characteristics in distinguishing renal urothelial carcinoma mimicking renal cell carcinoma from clear cell renal cell carcinoma.. [DOI: 10.21203/rs.3.rs-2655480/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Background: We aimed to characterize the clinical and multiphase computed tomography (CT) features, which can distinguish renal urothelial carcinoma (RUC) mimicking renal cell carcinoma (RCC) from clear cell renal cell carcinoma (ccRCC) with collecting system invasion (CSI).
Methods: Data from 56 patients with RUC (46 men and 10 women) and 366 patients with ccRCC (262 men and 104 women) were collected and assessed retrospectively. The median age was 65.50 (IQR: 56.25–69.75) and 53.50 (IQR: 42.25–62.5) years, respectively. Univariate and multivariate logistic regression analyses were performed on clinical and CT characteristics to determine independent factors for distinguishing RUC and ccRCC, and an integrated predictive model was constructed. Differential diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC).
Results: The independent predictors for differentiating RUC from ccRCC were infiltrative growth pattern, hydronephrosis, heterogeneous enhancement, preserving reniform contour, and hematuria. The differential diagnostic performance of the integrated predictive model (AUC: 0.960, sensitivity: 92.1%, specificity: 89.3%) was better than that of the infiltrative growth pattern (AUC: 0.830, sensitivity: 71.9%, specificity: 92.9%), heterogeneous enhancement (AUC: 0.771, sensitivity: 86.3%, specificity: 67.9%), preserving reniform contour (AUC=0.758, sensitivity: 85.5%, specificity: 66.1%), hydronephrosis (AUC: 0.733, sensitivity: 87.7%, specificity: 58.9%), or hematuria (AUC: 0.706, sensitivity: 79.5%, specificity: 51.8%).
Conclusion: The CT and clinical characteristics showed extraordinary discriminative abilities in the differential diagnosis of RUC and ccRCC, which might provide helpful information for clinical decision-making.
Collapse
Affiliation(s)
| | - Xiao Feng
- First Affiliated Hospital of GuangXi Medical University
| | - Yidi Chen
- West China Hospital of Sichuan University
| | - Fuling Huang
- First Affiliated Hospital of GuangXi Medical University
| | - Liling Long
- First Affiliated Hospital of GuangXi Medical University
| |
Collapse
|
12
|
Comparative diagnostic performance of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for differentiating clear cell and non-clear cell renal cell carcinoma. Eur Radiol 2023; 33:3766-3774. [PMID: 36725722 DOI: 10.1007/s00330-023-09391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the differential diagnosis of clear and non-clear cell renal cell carcinoma, as confirmed by subsequent pathology. METHODS A total of 181 patients with 184 renal lesions diagnosed by both CEUS and DCE-MRI were enrolled in the study, including 136 clear cell renal cell carcinoma (ccRCC) and 48 non-clear cell renal cell carcinoma (non-ccRCC) tumors. All lesions were confirmed by histopathologic diagnosis after surgical resection. Interobserver agreement was estimated using a weighted kappa statistic. Diagnostic efficiency in evaluating ccRCC and non-ccRCC was compared between CEUS and DCE-MRI. RESULTS The weighted kappa value for interobserver agreement was 0.746 to 0.884 for CEUS diagnosis and 0.764 to 0.895 for DCE-MRI diagnosis. Good diagnostic performance in differential diagnosis of ccRCC and non-ccRCC was displayed by both CEUS and DCE-MRI: sensitivity was 89.7% and 91.9%, respectively; specificity was 77.1% and 68.8%, respectively; and area under the receiver operating curve was 0.834 and 0.803, respectively. No statistically significant differences were present between the two methods (p = 0.54). CONCLUSIONS Both CEUS and DCE-MRI imaging are effective for the differential diagnosis of ccRCC and non-ccRCC. Thus, CEUS could be an alternative to DCE-MRI as a first test for patients at risk of renal cancer, particularly where DCE-MRI cannot be carried out. KEY POINTS • CEUS and DCE-MRI features can help differentiate ccRCC and non-ccRCC. • The differential diagnosis of ccRCC and non-ccRCC by CEUS is comparable to that of DCE-MRI. • Interobserver agreement is generally high using CEUS and DCE-MRI.
Collapse
|
13
|
He M, Gao Q, Xiang J, Mao Q, Jiang T. Diagnostic Value of Qualitative and Quantitative Contrast-Enhanced Ultrasound for Pathological Subtypes of Small Solid Renal Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36591796 DOI: 10.1002/jum.16169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To assess the diagnostic value of qualitative and quantitative contrast-enhanced ultrasound (CEUS) for pathological subtypes of small solid renal masses (sSRMs). METHODS Patients with sSRMs confirmed by surgical pathology from January 2019 to November 2021 were retrospectively identified. All patients were divided into 3 groups: clear cell renal cell carcinoma (ccRCC) group, none-ccRCC group (renal cell carcinoma other than ccRCC), and angiomyolipoma (AML) group. The mass position, size, echogenicity and blood flow signals were compared. The speed of wash-in, wash-out, the degree of peak enhancement and the homogeneity at peak enhancement, the presence of pseudocapsule sign in CEUS imaging were qualitatively evaluated. Peak enhancement, wash-in area under the curve (WiAUC), rise time, time to peak, wash-in rate (WiR), wash-in perfusion index (WiPI) and tumor-to-cortex enhancement ratio of the above parameters in CEUS imaging were quantitatively evaluated. RESULTS Of 105 patients, 105 sSRMs (66 ccRCC, 18 none-ccRCC, 21 AML) were enrolled in this study. No significant differences were found on location, size and echogenicity among 3 groups (all P > .05). The proportion of fast-washout and hypo-enhancement were highest in none-ccRCC group. Heterogeneous enhancement was detected in 87.88% in ccRCC group which is significantly higher than other 2 groups. Hundred percent of the AML showed no pseudocapsule sign, which is the highest among the 3 groups. Peak enhancement, WiAUC, WiR, WiPI of ccRCC group were the highest among the 3 groups. CONCLUSIONS Qualitative and quantitative CEUS not only has the diagnostic value in distinguishing AML from malignant sSRMs, but also helps to differentiate the pathological subtypes of sSRMs.
Collapse
Affiliation(s)
- Mengna He
- Department of Ultrasound, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Gao
- Department of Ultrasound, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjian Xiang
- Department of Ultrasound, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiqi Mao
- Department of Urinary Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
14
|
Li N, Hu Z, Liu Y, Ding J, Han P, Jing X, Kan Y. Dynamic contrast-enhanced ultrasound characteristics of renal tumors: VueBox™ quantitative analysis. Clin Hemorheol Microcirc 2023; 85:341-354. [PMID: 37742629 DOI: 10.3233/ch-231750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND VueBoxtrademark has been used for contrast analysis in DCE-US-based quantitative research. OBJECTIVE Aim of this study was to use the enhancement-mode and VueBoxtrademark parameters to further evaluate the differential diagnostic value of DCE-US for renal tumors. METHODS 24 patients with renal tumors, including 7 benign and 17 malignant, were retrospectively analyzed.The DCE-US enhancement-mode and VueBoxtrademark parameters correlated with the histological analyses of tumors were obtained and analyzed. RESULTS The benign and malignant renal tumors showed significant differences in enhancement degree (P = 0.017) and presence of a pseudocapsule (P = 0.009) and in the VueBoxtrademark parameters FT (P = 0.045) and RT (P = 0.039). Receiver operating characteristic analysis for differential diagnosis of benign and malignant renal tumors showed that AUC for a combination of enhancement degree and presence of a pseudocapsule was greater (AUC = 0.815) than the values for either parameter of enhancement mode alone. Similarly, the AUC for a combination of RT and FT was greater (AUC = 0.798) than the values for RT or FT alone. A comprehensive index obtaining by combining the enhancement-mode and VueBoxtrademark parameters showed the largest AUC (AUC = 0.916) with relatively high accuracy (87.50%), sensitivity (76.50%), and specificity (85.70%). CONCLUSIONS DCE-US with enhancement mode and quantitative analysis can facilitate preoperative differential diagnosis of benign and malignant renal tumors.
Collapse
Affiliation(s)
- Ning Li
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Ziyue Hu
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yang Liu
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Jianmin Ding
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Pengcheng Han
- College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yanmin Kan
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| |
Collapse
|
15
|
Ma W, Zhang F, Huang H, Wang W, Zhu Y, Lu Y, Guo H, Gan W. Contrast-Enhanced Ultrasound Features of Adult Xp11.2 Translocation Renal Cell Carcinoma: Differential Diagnosis With Three Main Renal Cell Carcinoma Subtypes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2673-2685. [PMID: 35103338 PMCID: PMC9788209 DOI: 10.1002/jum.15951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the sonographic features in Xp11.2 translocation renal cell carcinoma (Xp11.2 tRCC) using both conventional ultrasound (US) and contrast-enhanced US (CEUS) and evaluate the usefulness of sonographic imaging characteristics to differentiate between Xp11.2 tRCC and the three common RCC subtypes. METHODS Thirty-four adult Xp11.2 tRCC patients who preoperatively underwent both conventional US and CEUS and had solitary renal lesions and pathological confirmation after surgery were enrolled. Control matched patients included 131 with clear cell RCC (ccRCC), 48 with papillary RCC (pRCC), and 35 with chromophobe RCC (chRCC). Conventional US and CEUS data of all patients were retrospectively analyzed and compared. RESULTS Xp11.2 tRCC was more common in young women. The echogenicity of Xp11.2 tRCC lesions was hypo- and isoechoic relative to the adjacent renal cortex. A higher frequency of calcification within tumors was detected in Xp11.2 tRCC, but the presence of color flow signal (26.5%, 9/34) was much lower. Regarding CEUS features relative to the adjacent renal cortex, synchronous wash-in (61.8%, 21/34), iso-enhancement at peak (55.9%, 19/34), and fast wash-out (50.0%, 17/34) were more common in Xp11.2 tRCC. Moreover, an integrated variables model based on these features could differentiate Xp11.2 tRCC from ccRCC, pRCC, and chRCC (area under the curve, sensitivity, and specificity: 0.934, 92.0%, and 86.0%; 0.907, 88.0%, and 87.0%; and 0.808, 65.0%, and 99.0%, respectively). CONCLUSIONS Combining conventional US and CEUS lesion features with clinical information may provide a feasible and effective method to differentiate Xp11.2 tRCC from ccRCC, pRCC, and chRCC.
Collapse
Affiliation(s)
- Wenliang Ma
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Fan Zhang
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Department of Urogenital UltrasoundNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Haifeng Huang
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Department of Urogenital UltrasoundNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Wei Wang
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Department of Urogenital UltrasoundNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Yiqi Zhu
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Yanwen Lu
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Hongqian Guo
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
- Department of Urogenital UltrasoundNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Weidong Gan
- Department of UrologyNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| |
Collapse
|
16
|
Tufano A, Antonelli L, Di Pierro GB, Flammia RS, Minelli R, Anceschi U, Leonardo C, Franco G, Drudi FM, Cantisani V. Diagnostic Performance of Contrast-Enhanced Ultrasound in the Evaluation of Small Renal Masses: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12102310. [PMID: 36291999 PMCID: PMC9600471 DOI: 10.3390/diagnostics12102310] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Ultrasound (US) is a highly sensitive imaging tool in the detection of renal masses. However, the detection rate of small renal masses (SRMs) (<4 cm) is still limited. In this scenario, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized, diagnostic modality which aims to increase the overall diagnostic ability in the identification of SRMs. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of SRMs confirmed by pathology. A SR up to April 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on malignant vs. benign SMRs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled, and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, five qualified studies were deemed suitable for this meta-analysis. Finally, diagnostic performance of CEUS showed an accuracy of 0.93 in detecting malignant masses (sensitivity of 0.94, PPV of 0.95, specificity of 0.78, and NPV of 0.73). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of SMRs, since it allows clinicians to identify malignant lesions.
Collapse
Affiliation(s)
- Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
- Correspondence: (A.T.); (V.C.)
| | - Luca Antonelli
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Rocco Minelli
- Department Life and Health “V. Tiberio”, University of Molise, Francesco De Sanctis 1, 86100 Campobasso, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Francesco Maria Drudi
- Department of Radiological, Oncological and Pathobiological Sciences, Sapienza University of Rome, 00144 Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathobiological Sciences, Sapienza University of Rome, 00144 Rome, Italy
- Correspondence: (A.T.); (V.C.)
| |
Collapse
|
17
|
Zhu J, Li N, Zhao P, Wang Y, Song Q, Song L, Li Q, Luo Y. Contrast-enhanced ultrasound (CEUS) of benign and malignant renal tumors: Distinguishing CEUS features differ with tumor size. Cancer Med 2022; 12:2551-2559. [PMID: 36057970 PMCID: PMC9939203 DOI: 10.1002/cam4.5101] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is now a guideline-recommended strategy for diagnosing renal lesions. Tumor size is related to the risk of the treatment and prognosis in renal tumors. Thus, we aim to analyze the CEUS features of solid renal tumors in relation to tumor size. METHODS The CEUS appearance of 156 pathologically diagnosed solid renal tumors were retrospectively analyzed. Three groups were stratified according to the tumor size (≤2 cm [group I], 2.1-4 cm [group II] and 4.1-7 cm [group III]). For each group, the features of wash-in type, enhancement degree, enhancement homogeneity, and the presence of a pseudocapsule sign were compared between benign and malignant tumors. RESULTS All 156 included lesions were detected by CEUS. The proportion of benign tumors in three size groups was 37.1%, 19.4%, and 20.4%, respectively. The proportion of malignant tumors was highest (80.6%) in group II, followed by group III (79.6%) and group I (62.9%). In group I, malignant and benign tumors differed significantly in the presence of a pseudocapsule sign (p = 0.015) and homogeneity (p = 0.007). In group II, the degree of enhancement differed (p = 0.02) between tumor types. In group III, the two tumor types differed in both the wash-in pattern (p = 0.015) and enhancement degree (p = 0.024). The weighted and Cohen's kappa values for the concordance between inter-observer agreement ranged from 0.31 (95% CI: 0.36-0.57) to 0.90 (95% CI: 0.77-1.00). CONCLUSIONS CEUS features of malignant and benign renal tumors change along with the tumor size. The use of CEUS features in the diagnosis of benign and malignant tumors requires consideration of tumor size.
Collapse
Affiliation(s)
- Jianing Zhu
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina,Medical School of Chinese PLABeijingChina
| | - Nan Li
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina
| | - Ping Zhao
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina
| | - Yanjie Wang
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina,Medical School of Chinese PLABeijingChina
| | - Qing Song
- Department of Ultrasound, the Seventh Medical CentreChinese PLA General HospitalBeijingChina
| | - Luda Song
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina,Medical School of Chinese PLABeijingChina
| | - Qiuyang Li
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina
| | - Yukun Luo
- Department of Ultrasound, the First Medical CentreChinese PLA General HospitalBeijingChina
| |
Collapse
|
18
|
Tao L, Fan J, Zhan W, Li W, Lu J, Yang N, Ma B, Zhou W. Contrast-enhanced ultrasound manifestations of renal masses undetectable on conventional ultrasound. Front Oncol 2022; 12:943960. [PMID: 35957888 PMCID: PMC9357941 DOI: 10.3389/fonc.2022.943960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to retrospectively analyze the features of contrast-enhanced ultrasound (CEUS) of renal masses that cannot be detected by conventional ultrasound (CUS). The data of 264 patients who underwent CEUS for renal lesions from January 2016 to December 2019 were retrieved. Of these, 16 patients with renal masses which were not detected by CUS were included in the final analysis. The corresponding characteristics of CEUS were evaluated, including intensity of enhancement, homogeneity, wash-in and wash-out patterns, and perilesional rim-like enhancement. Of the 16 patients, 10 patients had clear cell renal cell carcinoma (ccRCC) and 6 patients had urothelial carcinoma of the renal pelvis (UCRP). Compared with the location on non-enhanced computed tomography (CT) scan, all tumors were detected on CEUS. Most (7/10) of the ccRCCs appeared as hyperenhancement, homogeneous enhancement, synchronous-in, and no perilesional rim-like enhancement. Most (4/6) of the UCRPs appeared as isoenhancement, slow-in, fast-out, and no perilesional rim-like enhancement. CEUS may be helpful in the diagnosis and differential diagnosis of renal tumors which were not observed on CUS, and it might be an alternative method for some patients when contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) cannot be performed.
Collapse
Affiliation(s)
- Lingling Tao
- Department of Ultrasound, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinfang Fan
- Department of Ultrasound, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Li
- Department of Ultrasound, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Lu
- Department of Interventional Radiology, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nanan Yang
- Department of Interventional Radiology, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Binbin Ma
- Department of Urology, Ruijin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Wei Zhou,
| |
Collapse
|
19
|
Bu Z, Xiang T, Lei Z, Yang Q, Wu Y, Ye E, He B, Zheng M, Ali K. A new option for the treatment of condyloma acuminatum in the male urethra: Multimodal ultrasound image-guided scraping and photodynamic therapy (USP). Photodiagnosis Photodyn Ther 2022; 39:102985. [PMID: 35753674 DOI: 10.1016/j.pdpdt.2022.102985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Condyloma acuminatum (CA) is a sexually transmitted disease with a high recurrence rate due to the rapid replication of human papillomavirus (HPV) and its subtle immune escape mechanism, which makes the diagnosis and treatment of CA in the male urethra particularly difficult. This study aims to evaluate the efficacy of comprehensive treatments for male urethral CA after accurate localization of warts under ultrasound guidance. METHODS The study included 15 men with intraurethral CA. Before treatment, the urethra was examined by ultrasonography and HPV-PCR. After examination of the invisible urethral warts, wart curettage (penetrating operation with a special stainless steel medical curettage tool) combined with ALA-PDT was used for treatment. The ultrasound and HPV load were reviewed 1 week after treatment, and again at 1, 3, and 6 months after treatment. RESULTS All patients achieved satisfactory results 1 week after the last treatment. The viral load of human papilloma was significantly reduced or turned negative, ultrasound imaging exploration showed no neoplasm in the urethra, and no obvious intraoperative or postoperative complications were observed. The side effects in patients included a mild burning or tingling sensation confined to the treated area. After a 6 month follow-up period, only 2 patient relapsed. CONCLUSION The combined diagnosis and treatment of CA in the male urethra under the guidance of multi-mode ultrasound imaging is an effective, economical, safe, and well-tolerated treatment method.
Collapse
Affiliation(s)
- Zhangyu Bu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, hangzhou,310006,China.
| | - Tingkai Xiang
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - Zhikai Lei
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine,hangzhou, 310006,China
| | - QingYun Yang
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - YangFan Wu
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - EnYi Ye
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - BeiLei He
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University,hangzhou, 310053,China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine,hangzhou,310001
| | - Kamran Ali
- Department of Dermatology,International Education College of Zhejiang Chinese Medical University,hangzhou,310053,China
| |
Collapse
|
20
|
Cao H, Fang L, Chen L, Zhan J, Diao X, Liu Y, Lu C, Zhang Z, Chen Y. The Value of Contrast-Enhanced Ultrasound in Diagnosing Small Renal Cell Carcinoma Subtypes and Angiomyolipoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1415-1423. [PMID: 34499770 DOI: 10.1002/jum.15824] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To retrospectively explore the value of contrast-enhanced ultrasound (CEUS) in differentiating small renal cell carcinomas (RCCs) from angiomyolipomas (AMLs), and distinguishing between clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). METHODS A total of 151 patients with small renal masses (110 ccRCCs, 12 pRCCs, 9 chRCCs, and 20 AMLs) were enrolled between August 2016 and October 2019. RESULTS There were significant differences in terms of enhancement intensity (EI), enhancement homogeneity, perilesional rim-like enhancement (PRE), wash in, and wash out (WO) between RCC and AML (P = .000, .011, .000, .001, .000, respectively). Although there was no significant difference in EI between pRCC and chRCC (P = .272), EI of ccRCC was higher than that of pRCC (P = .000) and chRCC (P = .010). Multivariate regression analysis showed PRE and fast WO were related to RCC (OR = 18.189, 15.141, respectively). Although there were no significant differences in the sensitivity and area under the curve (AUC) between PRE and fast WO (95.0% vs. 95.0%, P = 1.000 and .880 vs. 0.799, P = .123, respectively), the specificity of PRE in predicting RCC was higher than that of fast WO (80.92% vs. 64.89%, P = .011). The sensitivity, specificity, and AUC of the two characteristics combination for differentiating RCC from AML were 95.0%, 90.8%, and 0.920, respectively, and that of EI for differentiating between ccRCC, pRCC, and chRCC were 81.0%, 78.2%, and 0.796, respectively. CONCLUSIONS CEUS has value in differentiating small RCCs from AMLs and distinguishing ccRCC, a subtype associated with a greater likelihood of malignant behavior from pRCC and chRCC.
Collapse
Affiliation(s)
- Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Chen Lu
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhengwang Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Department of Urology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| |
Collapse
|
21
|
Zhao S, Shi J, Yang R, Zhang X, Zhao W, Sun Z. Ultrasonography findings for the diagnosis of renal oncocytoma. J Med Ultrason (2001) 2022; 49:211-216. [PMID: 35083534 DOI: 10.1007/s10396-021-01179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Renal oncocytomas are rare benign epithelial tumors of the kidney. However, they are easily misdiagnosed as renal cancers, resulting in unnecessary radical nephrectomy. This review summarizes the use of ultrasound for the diagnosis of renal oncocytomas. On two-dimensional grayscale ultrasound, renal oncocytomas appear as solid, well-defined, round or oval, and relatively isoechoic or slightly hyperechoic masses. On color Doppler flow imaging, the "spoke-wheel" sign is evident. On power Doppler flow imaging, renal oncocytomas show mixed penetrating and peripheral patterns. Renal oncocytomas usually appear as highly enhanced on contrast-enhanced ultrasound images, and irregular nonenhanced areas in larger tumors. This review will help sonographers recognize renal oncocytomas.
Collapse
Affiliation(s)
- Shengnan Zhao
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Jiahong Shi
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Ran Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Xiujuan Zhang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Wei Zhao
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Zhixia Sun
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China.
| |
Collapse
|
22
|
Liu H, Cao H, Chen L, Fang L, Liu Y, Zhan J, Diao X, Chen Y. The quantitative evaluation of contrast-enhanced ultrasound in the differentiation of small renal cell carcinoma subtypes and angiomyolipoma. Quant Imaging Med Surg 2022; 12:106-118. [PMID: 34993064 DOI: 10.21037/qims-21-248] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Background Contrast-enhanced ultrasound (CEUS) has been widely used for renal lesion diagnosis and differential diagnosis. However, qualitative analysis of CEUS is subject to examinations with low reproducibility. This study aims to investigate the diagnostic value of CEUS quantitative parameters in differentiating small renal cell carcinoma (RCC) subtypes and angiomyolipoma (AML). Methods A retrospective analysis was performed on 97 cases of a small renal mass undergoing a CEUS before a radical or partial nephrectomy procedure. A region of interest (ROI) was placed in the tumor's maximum enhanced region (ROImax) as much as possible, and adjacent renal cortex (ROIrefer) was selected from normal renal tissue around a mass of the same depth. The time-intensity curve (TIC) was used to analyze the ROImax and the ROIrefer of the tumors quantitatively. Then the parameters of the ROImax and the ROIrefer, including the differences between the parameters of the ROImax and the ROIrefer, were analyzed statistically. Results In RCC and clear cell renal cell carcinoma (ccRCC), the peak intensity (PI), slope (SL), area under the curve (AUC), area under the wash-in curve (AWI), area under the wash-out curve (AWO), time to peak intensity (TTP) and the mean transit time (MTT) were statistically significant between ROImax and ROIrefer (all P=0.000). The △PI (△PI = PImax - PIrefer), △SL (△SL = SLmax - SLrefer), △AUC (△AUC = AUCmax - AUCrefer), △AWI (△AWI = AWImax - AWIrefer) and △AWO (△AWO = AWOmax - AWOrefer) of RCC were significantly higher than in AML (P=0.007, 0.000, 0.003, 0.048, 0.009, respectively), while the TTP (△TTP = TTPmax - TTPrefer) and △MTT (△MTT = MTTmax - MTTrefer) of RCC were significantly lower (both P=0.000). In comparison with papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC), the △PI, △SL, △AUC and △AWO of ccRCC were all larger (all P<0.05). The sensitivity, specificity, and AUC of the combination of parameter difference for differentiating RCC from AML were 100%, 81.2%, and 0.965, respectively, and for differentiating ccRCC from pRCC and chRCC, 85.71%, 85.92% and 0.911, respectively. Conclusions CEUS quantitative parameters have value in differentiating small RCC from AML and distinguishing ccRCC from pRCC and chRCC.
Collapse
Affiliation(s)
- Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| |
Collapse
|
23
|
Liu Y, Kan Y, Zhang J, Li N, Wang Y. Characteristics of contrast-enhanced ultrasound for diagnosis of solid clear cell renal cell carcinomas ≤4 cm: A meta-analysis. Cancer Med 2021; 10:8288-8299. [PMID: 34725960 PMCID: PMC8633224 DOI: 10.1002/cam4.4365] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022] Open
Abstract
Now solid renal tumors ≤4 cm is the most common, especially the subtype of clear cell renal cell carcinoma (ccRCC) of malignant kidney tumors in clinical. However, there is not specific characteristics of contrast‐enhanced ultrasound (CEUS) be recommended by the EFSUMB Guidelines in distinguish the essence of the kidney tumor with different sizes. Therefore, this meta‐analysis aimed to assess the ability of CEUS to diagnose solid ccRCC (sccRCC) ≤4 cm. We comprehensively searched the Cochrane Library, Embase, PubMed, and Web of Science databases from their inception to 28 July 2020, for studies reporting the CEUS features of sccRCC lesions ≤4 cm. Additional articles were identified through the Chinese National Knowledge Infrastructure database. Studies were selected independently by two investigators and the relevant data were extracted. Discrepancies were resolved via discussion with the senior author. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool, and the sensitivity and specificity of each study were determined and plotted as a receiver operating characteristic curve. Ten studies were included in this meta‐analysis. Hyperenhancement showed medium sensitivity (67%–89%) and specificity (42%–75%) for diagnosing sccRCC ≤4 cm, fast‐in contrast agent and heterogeneous enhancement showed high diagnostic abilities (area under curve (AUC) 0.74–0.84), but the presence of a pseudocapsule and fast‐out contrast agent had poor diagnostic ability (AUC <0.70). The combination of hyperenhancement and iso‐enhancement showed high sensitivity (98%) for diagnosing sccRCC ≤4 cm. Hyperenhancement, fast‐in contrast agent, and heterogeneous enhancement may be specific features that could help to identify sccRCC ≤4 cm, while the presence of a pseudocapsule and fast‐out of contrast agent may have low diagnostic values. The combination of multiple indexes may improve the diagnostic value of CEUS for sccRCC ≤4 cm.
Collapse
Affiliation(s)
- Yang Liu
- Department of Ultrasound, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, P.R. China
| | - Yanmin Kan
- Department of Ultrasound, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, P.R. China.,Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, P.R. China
| | - Jincun Zhang
- Department of Urological Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, P.R. China
| | - Ning Li
- Department of Ultrasound, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, P.R. China
| | - Yihua Wang
- Department of Ultrasound, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, P.R. China
| |
Collapse
|
24
|
Liang RX, Wang H, Zhang HP, Ye Q, Zhang Y, Zheng MJ, Xue ES, Zhu YF. The value of real-time contrast-enhanced ultrasound combined with CT enhancement in the differentiation of subtypes of renal cell carcinoma. Urol Oncol 2021; 39:837.e19-837.e28. [PMID: 34654644 DOI: 10.1016/j.urolonc.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/03/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to evaluate the value of real-time contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CECT) in the differential diagnosis of clear cell renal cell carcinoma (CCRCC), papillary renal cell carcinoma (PRCC), and chromophobe renal cell carcinoma (CRCC). MATERIALS AND METHODS In the present study, 82 patients with CCRCC, 24 patients with PRCC, and 19 patients with CRCC were confirmed by pathology of the resected tumor. All patients were evaluated by CEUS and CECT before the operation. In addition, the contrast enhancement mode of CEUS and CECT and the contrast parameters of the region of interest (ROI) time-intensity curve between the lesions and the surrounding normal renal parenchyma by CEUS were compared and analyzed. RESULTS Compared with the pathological results, the diagnostic accuracy of ultrasound in the 3 groups was 87.8% (72/82), 83.3% (20/24) and 73.7% (14/19). There was no significant difference between CEUS and CECT in the diagnostic accuracy of all groups (P>0.05). Meanwhile, compared with the surrounding renal parenchyma by CEUS, 82.5% (66/80) of CCRCC lesions showed "fast-forward and fast/slow-retrograde," while 83.3% (20/24) of PRCC, and 84.2% (16/19) showed "slow-forward and fast/slow-retrograde." Significant differences in the enhancement modes of CEUS were found among the CCRCC, PRCC, and CRCC lesions (P < 0.05). And the enhancement modes could be quantitatively analyzed by the ROI time-intensity curve of the lesion. Moreover, lesions enhanced by CECT and 74.4% (61/82) of CCRCC lesions showed "fast-forward and fast/slow-retrograde," while 66.7% (16/24) of PRCC and 84.2% (16/19) of CRCC showed "slow-forward and fast/slow-retrograde." The contrast modes and enhancement uniformity of CEUS and CECT showed no significant differences among the CCRCC, PRCC, and CRCC lesions (P > 0.05). CONCLUSION CEUS and quantitative analysis of ROI time-intensity curve can be used for differential diagnosis of the 3 RCC subtypes. The combination of CEUS and CECT can help us differentiate RCC subtypes and is of great significance for clinical treatment strategies and prognostication.
Collapse
Affiliation(s)
- Rong-Xi Liang
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hua Wang
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hui-Ping Zhang
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qin Ye
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Yu Zhang
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Mei-Juan Zheng
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - En-Sheng Xue
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yi-Fan Zhu
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| |
Collapse
|
25
|
Malone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics 2021; 40:562-588. [PMID: 32125955 DOI: 10.1148/rg.2020190183] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, transarterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymphangiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures. Online supplemental material is available for this article. ©RSNA, 2020.
Collapse
Affiliation(s)
- Christopher D Malone
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - David T Fetzer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Wayne L Monsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Philip A Velez
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Michalakis A Averkiou
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Raja S Ramaswamy
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| |
Collapse
|
26
|
Fang L, Bai K, Chen Y, Zhan J, Zhang Y, Qiu Z, Chen L, Wang L. A comparative study of contrast-enhanced ultrasound and contrast-enhanced CT for the detection and characterization of renal masses. Biosci Trends 2021; 15:24-32. [PMID: 33642452 DOI: 10.5582/bst.2021.01026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aims to compare the value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT (CECT) in the differential diagnosis of benign and malignant renal masses. Included in this retrospective study were 143 renal masses in 141 patients using histopathological findings as the gold standard. A comparison was made of the two modalities in image characteristics for their accuracy in the differential diagnosis of renal masses. CEUS and CECT were both used for 39 masses in 37 patients, with 31 (79.5%) being malignant and 8 (20.5%) benign. The differences between the benign and malignant groups in perfusion intensity, perfusion uniformity and entry and exit of the contrast agent were not statistically significant (P > 0.05). However, CEUS could better display the circular perfusion of renal cell carcinoma than CECT (P < 0.05). CECT alone detected 109 masses in 107 patients, with 93 (85.3%) being malignant and 16 (14.7%) benign. CEUS detected 73 masses in 71 patients, with 56 (76.7%) being malignant and 17 (23.3%) benign. No statistically significant differences were observed between CEUS and CECT in the diagnosis of renal cell carcinoma (92.8% vs. 90.3%), with a specificity of 52.9% vs. 31.2%, an accuracy of 83.5% vs. 81.6%, and a positive predictive value of 86.7% vs. 88.4% or a negative predictive value of 69.2% vs. 35.7% (P > 0.05 for all). These results suggested both CEUS and CECT are highly valuable in the differential diagnosis of renal masses, and CEUS can be used as an important supplement for CECT in diagnosis of renal cancer.
Collapse
Affiliation(s)
- Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Kun Bai
- Department of Ultrasound, Jiading Central Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Yinjia Zhang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Zhiying Qiu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Ling Wang
- Department of Reproductive Immunology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| |
Collapse
|
27
|
Zhang B, Li J, Wu Z, Li C, Sun T, Zhuo N, Liang J, Duan Q, Hu H, Tian J. Contrast-Enhanced Ultrasound Characteristics of Renal Pelvis Urothelial Carcinoma and Its Relationship with Microvessel Density. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:236-243. [PMID: 33158635 DOI: 10.1016/j.ultrasmedbio.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
We studied the characteristics of contrast-enhanced ultrasound (CEUS) in renal pelvic urothelial carcinomas and explored its performance in assessing microvessel density (MVD) of tumor tissues. We retrospectively analyzed the characteristics of 125 cases, which were confirmed pathologically to be renal pelvic urothelial carcinomas using CEUS. We performed CEUS and found that most tumors presented with an enhanced mode of "slow-in (mean = 16.7 ± 2.6 s, range: 12-25 s), hypo-enhancement and fast-out (mean = 69.3 ± 16.2 s, range: 42-113 s)." However, the wash-in pattern, homogeneity and wash-out pattern observed with CEUS was not correlated with pT stage and grade (p > 0.05). But advanced-pT-stage and high-grade tumors had a higher peak enhancement than early-pT-stage and low-grade tumors (p < 0.01). Peak enhancement obtained with CEUS can be used to evaluate the pT stage and grade of renal pelvic urothelial carcinomas more effectively. The MVD of those tissues was observed using immunohistochemical staining of cluster of differentiation 34 (CD34). MVD in the advanced-pT-stage and high-grade groups was significantly higher than that in the early-pT-stage and low-grade groups (p < 0.01). As tumor pT stage and grade improved, CEUS peak enhancement intensity and MVD of tumors also exhibited an upward trend. CEUS peak enhancement intensity has the potential to determine MVD of renal pelvic urothelial carcinomas.
Collapse
Affiliation(s)
- Bo Zhang
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jing Li
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhouliang Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chenyun Li
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Sun
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Na Zhuo
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jixiang Liang
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Duan
- Department of Ultrasound, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hailong Hu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jing Tian
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
| |
Collapse
|
28
|
Sun D, Lu Q, Wei C, Li Y, Zheng Y, Hu B. Differential diagnosis of <3 cm renal tumors by ultrasonography: a rapid, quantitative, elastography self-corrected contrast-enhanced ultrasound imaging mode beyond screening. Br J Radiol 2020; 93:20190974. [PMID: 32479108 DOI: 10.1259/bjr.20190974] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) <3 cm in size. METHODS The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. RESULTS In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. CONCLUSIONS This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. ADVANCES IN KNOWLEDGE In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.
Collapse
Affiliation(s)
- Di Sun
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Qijie Lu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Cong Wei
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| |
Collapse
|
29
|
Cao H, Fang L, Chen L, Zhan J, Diao X, Liu Y, Lu C, Zhang Z, Chen Y. The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound. BMC Med Imaging 2020; 20:32. [PMID: 32228606 PMCID: PMC7104488 DOI: 10.1186/s12880-020-00436-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
Background The value of contrast-enhanced ultrasound (CEUS) in differentiating between renal cell carcinoma (RCC) and angiomyolipoma (AML) was analyzed. The purpose of this study was to identify the independent indicators of CEUS for predicting RCC. Methods A total of 172 renal tumors (150 RCCs, 22 AMLs) in 165 patients underwent conventional ultrasound (CUS) and CEUS examinations before radical or partial nephrectomy, and the features on CUS and CEUS were analyzed. Results There were significant differences in echogenicity, blood flow signals in color Doppler flow imaging (CDFI), peak intensity, homogeneity of enhancement, wash in, wash out, and perilesional rim-like enhancement between RCC and AML (P < 0.05 for all). Multivariate analysis indicated that perilesional rim-like enhancement (P = 0.035, odds ratio [OR] = 9.907, 95% confidence interval [CI]: 1.169–83.971) and fast wash out (P = 0.001, OR = 9.755, 95%[CI]: 2.497–38.115) were independent indicators for predicting RCC. The area under the receiver operating characteristic (ROC) curve (AUC) for perilesional rim-like enhancement was 0.838 (95% CI: 0.774–0.890) with 76.7% sensitivity and 90.9% specificity, while the AUC of fast wash out was 0.833 (95% CI:0.768–0.885) with 74.7% sensitivity and 81.8% specificity. Conclusions This study indicated that CEUS has value in differentiating RCC and AML. Present perilesional rim-like enhancement and fast wash out may be important indicators for predicting RCC.
Collapse
Affiliation(s)
- Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Chen Lu
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhengwang Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Department of Urology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| |
Collapse
|
30
|
Wei S, Tian F, Xia Q, Huang P, Zhang Y, Xia Z, Wu M, Yang B. Contrast-enhanced ultrasound findings of adult renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion: comparison with clear cell renal cell carcinoma and papillary renal cell carcinoma. Cancer Imaging 2019; 20:1. [PMID: 31892340 PMCID: PMC6938633 DOI: 10.1186/s40644-019-0268-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the contrast-enhanced ultrasound (CEUS) findings of renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusion (Xp11.2/TFE3) in adult patients by comparison with those of clear cell RCC (ccRCC) and papillary RCC (pRCC). METHODS In total, 110 patients (110 renal masses) who underwent CEUS examinations were enrolled in this study. The cases included 18 Xp11.2/TFE3 RCCs, 60 ccRCCs and 32 pRCCs. All masses were confirmed by operative pathology. The CEUS imaging data of these patients were retrospectively analysed by two readers. The conventional US and CEUS features of Xp11.2/TFE3 RCC were compared with those of ccRCC and pRCC. RESULTS The age of the patients with Xp11.2/TFE3 RCC ranged from 20 to 68 years, with a mean age of 38.3 ± 16.3 years and a slight female predominance. The weighted kappa value that interprets the concordance between the interobserver agreement of the US and CEUS features ranged from 0.61 to 0.89. On conventional US and CEUS imaging of Xp11.2/TFE3 RCCs, the tumours were hypoechoic (6/18, 33.3%), isoechoic (8/18, 44.4%), and hyperechoic (4/18, 22.2%). The cystic component was present in 5 cases (27.8%), calcification was present in 9 cases (50.0%), and colour flow signal was present in 7 cases (38.9%). Most cases showed simultaneous wash-in (11/18, 61.1%); the peak enhancement showed hypoenhancement (6/18, 33.3%), isoenhancement (10/18, 55.6%), and hyperenhancement (2/18, 11.1%); most cases exhibited heterogeneous enhancement (12/18, 66.7%) and fast- or simultaneous-out (16/18, 88.9%); and a pseudocapsule was present in 6 cases (33.3%). In the multivariate logistic regression analysis, calcification and lower peak enhancement were more likely to be present in Xp11.2/TFE3 RCC than in ccRCC (P < 0.05), and younger age and relatively high peak enhancement were more likely to be present in Xp11.2/TFE3 RCC than in pRCC (P < 0.05). The calcification combined peak enhancement model differentiated Xp11.2/TFE3 RCC from ccRCC, and the age combined peak enhancement model differentiated Xp11.2/TFE3 RCC from pRCC with an AUC, a sensitivity and a specificity of 0.896, 94.4% and 73.3% and 0.786, 50.0% and 100.0%, respectively. CONCLUSIONS The specific CEUS features combined with demographic information and clinical symptoms may be helpful for differentiating Xp11.2/TFE3 RCC from ccRCC and pRCC.
Collapse
Affiliation(s)
- Shuping Wei
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Fuli Tian
- Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Qiuyuan Xia
- Department of Pathology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Pengfei Huang
- Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Yidan Zhang
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Zhichao Xia
- Department of Domestic clinical application, Mindray Bio-Medical Electronics Co. Ltd, Shenzhen, Guangdong, China
| | - Min Wu
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Bin Yang
- Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
| |
Collapse
|
31
|
Shen L, Li Y, Li N, Zhao Y, Zhou Q, Li Z. Clinical utility of contrast-enhanced ultrasonography in the diagnosis of benign and malignant small renal masses among Asian population. Cancer Med 2019; 8:7532-7541. [PMID: 31642189 PMCID: PMC6912038 DOI: 10.1002/cam4.2635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022] Open
Abstract
We assessed the clinical utility of contrast-enhanced ultrasonography (CEUS) in the diagnosis of benign and malignant small renal masses using a meta-analysis of diagnostic test. We performed a comprehensive online search in the following database including PubMed, Embase, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure from the inception to August 25, 2019. the following index were calculated for assessing the diagnostic ability, including sensitivity, specificity, diagnostic odds ratio (DOR), negative likelihood ratio (NLR), positive likelihood ratio (PLR), area under the curve (AUC) with 95% confidence intervals (CIs). Seventeen studies were included in the qualitative and quantitative analyses. The overall sensitivity was 0.93 with 95% CI of 0.88-0.95. The specificity was 0.71 and the 95% CI was 0.60-0.80. The pooled AUC was 0.91 (95% CI: 0.88-0.93). The diagnostic odds ratio was 31 (95% CI: 21-45). The NLR and PLR were 0.10 (95% CI: 0.07-0.15) and 3.2(95% CI: 2.3-4.4), respectively. There is a slight heterogeneity within studies. The subgroup analysis was also performed. For retrospective and perspective, the sensitivity and specificity were 0.93, 0.92 and 0.71, 0.73; For different diameter lesions, the sensitivity and specificity were 0.93, 0.94 and 0.64, 0.74; For sample size (≤median vs. >median), the sensitivity and specificity were 0.94, 0.93 and 0.67, 0.77. The Deek's funnel plot asymmetry test in indicated no publication bias. The CEUS have a high diagnostic ability in differentiating benign and malignant small renal masses among Asian population.
Collapse
Affiliation(s)
- Lin Shen
- Department of OncologyXiangya HospitalCentral South UniversityChangshaHunanChina
| | - Yanyan Li
- Department of NursingXiangya HospitalCentral South UniversityChangshaHunanChina
| | - Na Li
- Department of OncologyXiangya HospitalCentral South UniversityChangshaHunanChina
| | - Yajie Zhao
- Department of Nuclear MedicineCentral South UniversityChangshaHunanChina
| | - Qin Zhou
- Department of OncologyXiangya HospitalCentral South UniversityChangshaHunanChina
| | - Zhanzhan Li
- Department of OncologyXiangya HospitalCentral South UniversityChangshaHunanChina
| |
Collapse
|
32
|
Stock KF, Slotta-Huspenina J, Kübler H, Autenrieth M. Innovative Ultraschalldiagnostik bei Nierentumoren. Urologe A 2019; 58:1418-1428. [DOI: 10.1007/s00120-019-01066-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
33
|
Tedesco G, Sarno A, Rizzo G, Grecchi A, Testa I, Giannotti G, D’Onofrio M. Clinical use of contrast-enhanced ultrasound beyond the liver: a focus on renal, splenic, and pancreatic applications. Ultrasonography 2019; 38:278-288. [PMID: 31230431 PMCID: PMC6769197 DOI: 10.14366/usg.18061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 12/11/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly used, diagnostic imaging modality. In recent years, due to its safety, quickness, and repeatability, several studies have demonstrated the accuracy, specificity, and sensitivity of CEUS. The European Federation of Societies for Ultrasound in Medicine and Biology has recently updated the previous guidelines from 2012 for the use of CEUS in non-hepatic applications. This review deals with the clinical use and applications of CEUS for the evaluation of non-hepatic abdominal organs, focusing on renal, splenic, and pancreatic applications.
Collapse
Affiliation(s)
- Giorgia Tedesco
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Alessandro Sarno
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giulio Rizzo
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Annamaria Grecchi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Ilaria Testa
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Gabriele Giannotti
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Mirko D’Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| |
Collapse
|
34
|
Wei Z, Wu B, Wang L, Zhang J. A large‐scale transcriptome analysis identified
ELANE
and
PRTN3
as novel methylation prognostic signatures for clear cell renal cell carcinoma. J Cell Physiol 2019; 235:2582-2589. [PMID: 31490025 DOI: 10.1002/jcp.29162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Zhongheng Wei
- Department of Oncology Affiliated Hospital of Youjiang Medical University for Nationalities Baise Guangxi China
| | - Bo Wu
- Department of Clinical Laboratory Hospital of Chengdu University of Traditional Chinese Medicine Chengdu China
| | - Li Wang
- Fudan University School of Medicine Shanghai China
| | - Juan Zhang
- Department of Rehabilitation, Huai'an Second People's Hospital The Affiliated Huai'an Hospital of Xuzhou Medical University Huai'an Huai'an China
| |
Collapse
|
35
|
Dai WB, Yu B, Diao XH, Cao H, Chen L, Chen Y, Zhan J. Renal Masses: Evaluation with Contrast-Enhanced Ultrasound, with a Special Focus on the Pseudocapsule Sign. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1924-1932. [PMID: 31122812 DOI: 10.1016/j.ultrasmedbio.2019.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/01/2019] [Accepted: 03/28/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to analyze the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differentiating between benign and malignant renal masses, with a special emphasis on the value of the pseudocapsule sign. A total of 163 consecutive patients with 163 renal masses were involved. The conventional ultrasonography and CEUS features were assessed. Sensitivity, specificity and the area under the receiver operating characteristic curve (Az) were calculated for qualitative CEUS, and a multivariate analysis was performed to analyze the correlation between the sonographic features and malignancy. Time to peak (TTP) and peak intensity (PI) were compared between benign and malignant renal masses for quantitative CEUS analysis in 72 of 163 patients. Intraclass correlations were calculated for variability in intensity and time parameters between qualitative and quantitative evaluation. Among all qualitative CEUS features, the pseudocapsule sign showed the highest Az (0.777; 95% confidence interval: 0.701-0.853) and yielded the highest sensitivity (67.4%) and specificity (88.0%); multivariate logistic regression analysis showed that the pseudocapsule sign and color Doppler flow imaging patterns were the two strongest independent predictors for malignancy. For quantitative CEUS analysis, higher PI and shorter TTP were found in malignant renal masses than those in benign ones. The Intraclass correlation coefficient values among qualitative and the quantitative assessments were 0.00 for time and 0.03 for intensity. The pseudocapsule sign offered the most efficient performance among all the qualitative and quantitative CEUS features.
Collapse
Affiliation(s)
- Wen-Bin Dai
- Department of Urology Surgery, Huadong Hospital, Fudan University, Shanghai, P.R China
| | - Bo Yu
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, P.R China
| | - Xue-Hong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, P.R China
| | - Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, P.R China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, P.R China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, P.R China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, P.R China.
| |
Collapse
|
36
|
Nichtinvasive Phänotypisierung von Nierentumoren – aktueller Stand. Radiologe 2018; 58:900-905. [DOI: 10.1007/s00117-018-0432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
37
|
Villanueva LAA, Knust M, Quintella L, Suassuna JHR, Araújo NC. Renal oncocytoma in a kidney transplant patient: the imaging features on contrast-enhanced ultrasonography (CEUS): a case report. ACTA ACUST UNITED AC 2018; 40:86-90. [PMID: 29796579 PMCID: PMC6533961 DOI: 10.1590/1678-4685-jbn-3787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/18/2017] [Indexed: 01/20/2023]
Abstract
Renal oncocytoma is an infrequently reported renal neoplasm, often asymptomatic,
which usually behaves as a benign entity and is identified accidentally on
radiological imaging. Transplant patients under long-term immunosuppressive
drugs have a high prevalence of cancers, such as skin cancers,
lymphoproliferative disorders, and renal carcinomas. We present a case report of
an asymptomatic renal oncocytoma in a kidney transplant recipient presenting
persistent hematuria. The features of computed tomography and contrast-enhanced
ultrasound (CEUS) are presented. This was the first time we used CEUS in a
transplant kidney recipient presenting a renal mass, allowing the real-time
visualization of contrast-enhancement patterns during all vascular phases for
the differential diagnosis of renal tumors. Although the pattern of intense
vascularization could mislead to an early judgment as a malignant lesion, it
could help to exclude other renal lesions without inducing nephrotoxicity.
Collapse
Affiliation(s)
| | - Maira Knust
- Hospital Universitário Pedro Ernesto, Vila Isabel, Rio de Janeiro, RJ, Brasil
| | - Leonardo Quintella
- Hospital Universitário Pedro Ernesto, Vila Isabel, Rio de Janeiro, RJ, Brasil
| | | | - Nordeval C Araújo
- Hospital Universitário Pedro Ernesto, Vila Isabel, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
38
|
Tuma J, Neugebauer F, Serra A. [CME Sonography 83/Answers: Incidental Finding]. PRAXIS 2018; 107:1231-1234. [PMID: 30376782 DOI: 10.1024/1661-8157/a003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jan Tuma
- 1 Ultrasound Learning Center (ULC) der European Federation of Ultrasound in Medicine and Biology (EFSUMB) am Institut für Allgemeine Innere Medizin und Nephrologie, Klinik Hirslanden, Zürich
| | - Felix Neugebauer
- 1 Ultrasound Learning Center (ULC) der European Federation of Ultrasound in Medicine and Biology (EFSUMB) am Institut für Allgemeine Innere Medizin und Nephrologie, Klinik Hirslanden, Zürich
| | - Andreas Serra
- 1 Ultrasound Learning Center (ULC) der European Federation of Ultrasound in Medicine and Biology (EFSUMB) am Institut für Allgemeine Innere Medizin und Nephrologie, Klinik Hirslanden, Zürich
| |
Collapse
|
39
|
Contrast-enhanced ultrasound of the kidney: a single-institution experience. Ir J Med Sci 2017; 187:795-802. [PMID: 29218489 DOI: 10.1007/s11845-017-1725-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Focal renal masses are typically evaluated by means of triphasic contrast-enhanced CT or MRI scan but use of iodinated contrast or gadolinium is unsuitable for some patients. Contrast-enhanced ultrasound (CEUS) is an imaging alternative in this scenario but has limited availability in Ireland. AIM The aim of the study was to retrospectively evaluate experience with selective use of CEUS for non-invasive characterization of focal renal masses in a tertiary referral institution in Ireland, with a particular focus on cystic renal lesions and the influence of CEUS on final Bosniak classification and treatment outcomes. METHODS All cases of renal CEUS between 2009 and 2017 were identified. Imaging history, patient records, histopathology reports, urology conference notes, clinical follow-up details, details of lesion progression or stability on surveillance, biopsy and/or resection details and pre- and post-CEUS Bosniak scores were recorded. RESULTS Thirty-one patients underwent renal CEUS (7 solid renal lesions, 21 cystic renal lesions and 3 'indeterminate' renal lesions). After CEUS, the CEUS-modified Bosniak score was upgraded in nine patients and downgraded in two patients. All three lesions upgraded from Bosniak III to IV were renal cell carcinomas. One of two lesions downgraded from Bosniak IV to III was resected (cystic nephroma) and the other showed no progression after 19 months of surveillance. CONCLUSION CEUS is a valuable alternative to CT in assessing complex cystic or solid renal lesions where iodinated CT contrast or gadolinium is inappropriate. CEUS can also refine the Bosniak category of atypical cystic renal lesions and help facilitate treatment decisions.
Collapse
|
40
|
Xu Y, Hou R, Lu Q, Deng Y, Hu B. Renal clear cell carcinoma metastasis to the breast ten years after nephrectomy: a case report and literature review. Diagn Pathol 2017; 12:76. [PMID: 29096639 PMCID: PMC5668985 DOI: 10.1186/s13000-017-0666-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background Renal cell carcinoma most commonly metastasizes to the lungs, skeleton or liver. Metastatic renal cell carcinoma to the breast is very rare, especially for clear cell carcinoma, and few cases regarding this condition have been reported. Case Presentation The case we presented was a 68-year-old Chinese female with metastatic renal clear cell carcinoma of the left breast 10 years after a nephrectomy. Identification of the metastatic renal clear cell carcinoma in the breast required multiple breast imaging modalities. Imaging showed a single, ovary-shaped, well-defined hypo-echoic mass, with abundant blood flow on ultrasound images. The mass was enhanced early on MRI, and it was hypointense on a T1-weighted image and hyperintense on a fat-saturated T2-weighted image. Following surgical excision of the tumor, a routine immunohistochemistry antibody panel on the tumor cells revealed negative staining for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (Her-2). Strong positive staining for the cluster of differentiation 10 (CD10) and vimentin was present. Conclusion This case is unusual because of the site of metastatic progression. It is important for physicians to be aware of this progression so early diagnoses can be made, and appropriate therapeutic planning can be initiated.
Collapse
Affiliation(s)
- Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Rui Hou
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Qijie Lu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Yifan Deng
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China
| | - Bin Hu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600th Yishan Road, Xuhui District, Shanghai, 200233, People's Republic of China.
| |
Collapse
|
41
|
Wei SP, Xu CL, Zhang Q, Zhang QR, Zhao YE, Huang PF, Xie YD, Zhou CS, Tian FL, Yang B. Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses: comparison with contrast-enhanced CT. Abdom Radiol (NY) 2017; 42:2135-2145. [PMID: 28331942 DOI: 10.1007/s00261-017-1111-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The study aimed to compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of contrast-enhanced computed tomography (CECT) in the evaluation of benign and malignant small renal masses (SRMs) (<4 cm) confirmed by pathology. METHODS A total of 118 patients with 118 renal masses smaller than 4 cm diagnosed by both CEUS and CECT were enrolled in this study, including 25 benign lesions and 93 malignant lesions. All lesions were confirmed by histopathologic diagnosis after surgical resection. The diagnostic imaging studies of the patients were retrospectively reviewed by two independent ultrasonologists and two independent radiologists blinded to the CT or ultrasound findings and final histological results. All lesions on both CEUS and CECT were independently scored on a 3-point scale (1: benign, 2: equivocal, and 3: malignant). The concordance between interobserver agreement was interpreted using a weighted kappa statistic. The diagnostic efficiency of the evaluation of benign and malignant lesions was compared between CEUS and CECT. RESULTS All the 118 included lesions were detected by both CEUS and CECT. In CEUS and CECT imaging evaluation of the 118 lesions, the weighted kappa value interpreting the concordance between interobserver agreement was 0.89 (95% CI 0.79-0.98) and 0.93 (95% CI 0.87-0.99), respectively. Both CEUS and CECT demonstrated good diagnostic performance in differential diagnosis of benign and malignant SRMs with sensitivity of 93.5% and 89.2%, specificity of 68% and 76%, PPV of 91.6% and 93.3%, NPV of 73.9% and 65.5%, and AUC of 0.808 and 0.826, respectively. There was no statistically significant difference in any of the diagnostic performance indices between these two methods (P > 0.05). However, the qualitative diagnosis of small papillary renal cell carcinoma (RCC) by CEUS was significantly better than that by CECT (P < 0.05), while there was no significant difference in qualitative diagnostic accuracy on other histotypes of SRMs between CEUS and CECT (P > 0.05). CONCLUSIONS Both CEUS and CECT imaging modalities are effective for the differential diagnosis of benign and malignant SRMs. Furthermore, CEUS may be more effective than CECT for the qualitative diagnosis of small papillary RCC.
Collapse
|
42
|
Galia M, Albano D, Bruno A, Agrusa A, Romano G, Di Buono G, Agnello F, Salvaggio G, La Grutta L, Midiri M, Lagalla R. Imaging features of solid renal masses. Br J Radiol 2017; 90:20170077. [PMID: 28590813 DOI: 10.1259/bjr.20170077] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The "classical angiomyolipoma" is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign diagnosis.
Collapse
Affiliation(s)
- Massimo Galia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Domenico Albano
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Alberto Bruno
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Francesco Agnello
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| |
Collapse
|
43
|
Reimann R, Rübenthaler J, Hristova P, Staehler M, Reiser M, Clevert DA. Characterization of histological subtypes of clear cell renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2017; 63:77-87. [PMID: 26484711 DOI: 10.3233/ch-152009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the histological subtypes of clear cell renal cell carcinoma (RCC) examined by means of contrast-enhanced ultrasound (CEUS) and a second generation blood pool agent (SonoVue®, Bracco, Milan, Italy) during the pre-operative phase. MATERIALS AND METHODS 29 patients with histologically proven subtypes of clear cell RCC were examined. A total of three patients were diagnosed with highly differentiated clear cell RCC, 21 out of 29 cases with moderately differentiated clear cell RCC and five out of 29 patients had insufficiently differentiated clear cell RCC. An experienced radiologist examined the patients with CEUS. The following parameters were analyzed: maximum signal intensity (PEAK), time elapsed until PEAK is reached (MTT), local blood flow (RBF), area under the time intensity curve (AUC) and the signal intensity (SI) during the course of time. For the groups all comparisons are made based on healthy renal parenchyma. RESULTS In the clear cell RCC significant differences (significance level p < 0.05) between cancerous tissue and the healthy renal parenchyma were noticed in all four parameters. Therefore, the clear cell RCC stands out due to its reduced blood volume. However, it reached the PEAK reading relatively rapidly and its signal intensity was always lower than that of the healthy renal parenchyma. In the arterial phase retarded absorption of the contrast agent was observed, followed by fast washing out of the contrast agent bubbles.In all three histological subgroups no significant differences were noticed in PEAK and SI. However, the diagrams showed the possible bias, that the group of the insufficiently differentiated clear cell RCC had the highest PEAK-value and the highest signal intensity when compared with highly and moderately differentiated clear cell RCC. CONCLUSION Our study suggests that CEUS may be an additional tool for non-invasive characterisation and differentiation of the three histological subtypes of clear cell RCC. Furthermore, it seems to have an additional diagnostic value in daily clinical.
Collapse
Affiliation(s)
- R Reimann
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - J Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - P Hristova
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Staehler
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - D A Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| |
Collapse
|
44
|
Xue LY, Lu Q, Huang BJ, Li CX, Yan LX, Wang WP. Differentiation of subtypes of renal cell carcinoma with contrast-enhanced ultrasonography. Clin Hemorheol Microcirc 2017; 63:361-371. [PMID: 26598999 DOI: 10.3233/ch-152024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We aimed to assess the difference of enhancement patterns among the three RCC subtypes with contrast-enhanced ultrasound (CEUS). Two hundreds cases of pathologically proved clear cell renal cell carcinomas (ccRCC), 58 papillary renal cell carcinomas (pRCC) and 51 chromophobe renal cell carcinomas (chRCC) underwent preoperative conventional ultrasound and CEUS. The wash-in and wash-out pattern, peak enhancement degree and homogeneity, and the presence of pseudocapsule were evaluated by two blinded observers respectively. The interreader agreement in the characterization of CEUS features between two observers was good (κ = 0.649-0.775). Compared with pRCCs and chRCCs, ccRCCs demonstrated higher frequency of simultaneous wash-in pattern, hyperenhancement and heterogeneity with necrotic areas. Most pRCCs and chRCCs manifested hypoenhancement, homogeneity, fast wash-out and presence of pseudocapsule. The only difference we obtained between pRCC and chRCC was the wash-in pattern, with slow wash-in in pRCC and simultaneous wash-in in chRCC. In small lesions with long diameter≤3 cm, the majority of the three subtypes of RCC showed homogeneous enhancement and there was no difference among them. CEUS was a useful method to preoperatively differentiate the ccRCC from non-ccRCC subtypes. There were no distinguishing features identifid on CEUS that allowed reliable differentiation of pRCC from chRCC.
Collapse
Affiliation(s)
- Li-Yun Xue
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qing Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Bei-Jian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Cui-Xian Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Li-Xia Yan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China
| |
Collapse
|
45
|
Sun D, Wei C, Li Y, Lu Q, Zhang W, Hu B. Contrast-Enhanced Ultrasonography with Quantitative Analysis allows Differentiation of Renal Tumor Histotypes. Sci Rep 2016; 6:35081. [PMID: 27725761 PMCID: PMC5057121 DOI: 10.1038/srep35081] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/20/2016] [Indexed: 02/08/2023] Open
Abstract
Totally 85 patients with 93 renal lesions who underwent contrast-enhanced ultrasound (CEUS) were retrospectively studied with quantitative analysis to evaluate its value in the differential diagnosis of renal tumor histotypes. CEUS characteristics were analysed including the enhancement patterns, peak intensity, homogeneity of enhancement, and pseudocapsule. Quantitative parameters of peak intensity (P) and time to peak (TP) were measured with QontraXt software, and the index “relative enhancement percentage” ΔP% and “difference in TP between tumor and cortex” ΔTP were used to quantify the CEUS features of renal tumors. There are significant difference in CEUS features between the 46 clear cell renal cell carcinoma (CCRCC) and other types of renal tumors, including 17 low malignant lesions, 11 urothelial carcinoma of the renal pelvis, and 19 renal angiomyolipoma. The differences lie in the peak intensity, the homogeneity, the time of wash-in, peak, clearance and presence of pseudocapsule. The ΔTP and ΔP% of the CCRCC is significantly different from other tumors. With “fast to peak + high peak intensity” as the main criterion, assisted with “heterogeneous enhancement” and “fast wash-in” as the secondary criteria, the diagnostic accuracy of CCRCC is 91.4%, demonstrating quantitative CEUS imaging is highly valuable in differentiating CCRCC from other tumors.
Collapse
Affiliation(s)
- Di Sun
- Department of Ultrasound in Medicine, Shanghai Jiao tong University Affiliated Sixth People's Hospital, China.,Shanghai Institute of Ultrasound in Medicine, China
| | - Cong Wei
- Department of Ultrasound in Medicine, Shanghai Jiao tong University Affiliated Sixth People's Hospital, China.,Shanghai Institute of Ultrasound in Medicine, China
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao tong University Affiliated Sixth People's Hospital, China.,Shanghai Institute of Ultrasound in Medicine, China
| | - Qijie Lu
- Department of Ultrasound in Medicine, Shanghai Jiao tong University Affiliated Sixth People's Hospital, China.,Shanghai Institute of Ultrasound in Medicine, China
| | - Wei Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao tong University Affiliated Sixth People's Hospital, China.,Shanghai Institute of Ultrasound in Medicine, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao tong University Affiliated Sixth People's Hospital, China.,Shanghai Institute of Ultrasound in Medicine, China
| |
Collapse
|
46
|
Qiu T, Ling W, Lu Q, Lu C, Luo Y. Contrast-enhanced ultrasound in diagnosis of epithelioid renal angiomyolipoma with renal vein and inferior vena cava extension. J Med Ultrason (2001) 2016; 43:427-430. [PMID: 26960715 DOI: 10.1007/s10396-016-0705-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
Epithelioid angiomyolipoma is considered to be a rare variant of angiomyolipoma and potentially malignant. Reported cases of renal epithelioid angiomyolipoma with extension into the renal vein and inferior vena cava are even rarer. Once it occurs, it is difficult to differentiate from renal cell carcinoma on imaging. In addition, very few of the reported cases presented contrast-enhanced ultrasound images. Here, we report a case of a renal epithelioid angiomyolipoma extending into the renal vein and inferior vena cava along with its contrast-enhanced ultrasonic information. Contrast-enhanced ultrasound provided valuable information for diagnosis in this case.
Collapse
Affiliation(s)
- Tingting Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Changli Lu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
47
|
Gulati M, King KG, Gill IS, Pham V, Grant E, Duddalwar VA. Contrast-enhanced ultrasound (CEUS) of cystic and solid renal lesions: a review. ACTA ACUST UNITED AC 2016; 40:1982-96. [PMID: 25588715 DOI: 10.1007/s00261-015-0348-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Incidentally detected renal lesions have traditionally undergone imaging characterization by contrast-enhanced computer tomography (CECT) or magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) of renal lesions is a relatively novel, but increasingly utilized, diagnostic modality. CEUS has advantages over CECT and MRI including unmatched temporal resolution due to continuous real-time imaging, lack of nephrotoxicity, and potential cost savings. CEUS has been most thoroughly evaluated in workup of complex cystic renal lesions, where it has been proposed as a replacement for CECT. Using CEUS to differentiate benign from malignant solid renal lesions has also been studied, but has proven difficult due to overlapping imaging features. Monitoring minimally invasive treatments of renal masses is an emerging application of CEUS. An additional promising area is quantitative analysis of renal masses using CEUS. This review discusses the scientific literature on renal CEUS, with an emphasis on imaging features differentiating various cystic and solid renal lesions.
Collapse
Affiliation(s)
- Mittul Gulati
- Department of Radiology, Keck USC School of Medicine, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033, USA,
| | | | | | | | | | | |
Collapse
|
48
|
Ragel M, Nedumaran A, Makowska-Webb J. Prospective comparison of use of contrast-enhanced ultrasound and contrast-enhanced computed tomography in the Bosniak classification of complex renal cysts. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 24:6-16. [PMID: 27433270 DOI: 10.1177/1742271x15626959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 12/13/2015] [Indexed: 11/15/2022]
Abstract
AIM To compare contrast-enhanced ultrasound and contrast-enhanced computed tomography in the evaluation of complex renal cysts using the Bosniak classification. METHODS Forty-six patients with 51 complex renal cysts were prospectively examined using contrast-enhanced ultrasound and contrast-enhanced computed tomography and images analysed by two observers using the Bosniak classification. Adverse effects and patients' preference were assessed for both modalities. RESULTS There was complete agreement in Bosniak classification between both modalities and both observers in six cysts (11.8%). There was agreement of Bosniak classification on both modalities in 21 of 51 cysts (41.2%) for observer 1 and in 17 of 51 cysts (33.3%) for observer 2. Contrast-enhanced ultrasound gave a higher Bosniak classification than corresponding contrast-enhanced computed tomography in 31 % of cysts by both observers. Histological correlation was available in three lesions, all of which were malignant and classified as such simultaneously on both modalities by at least one observer, with remaining patients followed up with US or CT for 6-24 months. No adverse or side effects were reported following the use of US contrast, whilst 63.6% of patients suffered minor side effects following the use of CT contrast. 81.8% of the surveyed patients preferred contrast-enhanced ultrasound to contrast-enhanced computed tomography. CONCLUSION Contrast-enhanced ultrasound is a feasible tool in the evaluation of complex renal cysts in a non-specialist setting. Increased contrast-enhanced ultrasound sensitivity to enhancement compared to contrast-enhanced computed tomography, resulting in upgrading the Bosniak classification on contrast-enhanced ultrasound, has played a role in at best moderate agreement recorded by the observers with limited experience, but this would be overcome as the experience grows. To this end, we propose a standardised proforma for the contrast-enhanced ultrasound report. The benefits of contrast-enhanced ultrasound over contrast-enhanced computed tomography include patients' preference and avoidance of ionising radiation or nephrotoxicity, as well as lower cost.
Collapse
Affiliation(s)
- Matthew Ragel
- Radiology Department, Aintree University Hospital, Liverpool, UK
| | - Anbu Nedumaran
- Radiology Department, Aintree University Hospital, Liverpool, UK
| | | |
Collapse
|
49
|
Lu Q, Li CX, Huang BJ, Xue LY, Wang WP. Triphasic and epithelioid minimal fat renal angiomyolipoma and clear cell renal cell carcinoma: qualitative and quantitative CEUS characteristics and distinguishing features. ACTA ACUST UNITED AC 2015; 40:333-42. [PMID: 25139641 DOI: 10.1007/s00261-014-0221-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To determine the contrast-enhanced ultrasonography (CEUS) characteristics of minimal fat renal angiomyolipoma (AML) (triphasic and epithelioid) and compare them to each other and to clear cell renal cell carcinoma (ccRCC) to explore their differential diagnostic clue. METHODS Qualitative and quantitative CEUS analyses were retrospectively conducted for epithelioid renal AMLs (EAMLs) (n = 15), triphasic minimal fat AMLs (TAMLs) (n = 25), and ccRCCs (n = 113). Enhancement patterns and features with CEUS were qualitatively evaluated. As for the quantitative parameters, rise times (RT), time to peak (TTP), and tumor-to-cortex enhancement ratio (TOC ratio) were compared among these renal tumor histotypes. RESULTS No significant differences were detected on conventional ultrasound in the three histotypes of renal tumor. On qualitative CEUS analysis, centripetal enhancement in cortical phase (73.3% in EAMLs, 84.0% in TAMLs vs. 18.6% in ccRCCs, p < 0.001 for both), homogeneous peak enhancement (100.0% in both EAMLs and TAMLs vs. 43.4% in ccRCCs, p < 0.001 for both), and iso-enhancement in parenchyma phase (53.3% in AMLs, 52.0% in TAMLs vs. 26.5% in ccRCCs, p = 0.034 and 0.013, respectively) were valuable traits for differentiating EAMLs and TAMLs from ccRCCs. Furthermore, with quantitative analysis, RT and TTP were much shorter in ccRCCs than those in EAMLs and TAMLs. However, all these qualitative and quantitative characteristics made no significant difference between EAMLs and TAMLs. In the differential diagnosis of EAMLs from TAMLs, pseudocapsule sign was valuable (40.0% in EAMLs vs. 0.0% in TAMLs, p < 0.001), and TOC ratio was much higher in EAMLs (166.01 ± 64.47%) than that in TAMLs (93.74 ± 46.56%)(p < 0.001), though they did make overlaps with ccRCCs. With either heterogeneous peak enhancement or the presence of pseudocapsule or TOC ratio >97.34% as the criteria to differentiate ccRCCs and EAMLs from TAMLs, the sensitivity and specificity were 80.0% and 87.5%, respectively. CONCLUSIONS Qualitative and quantitative CEUS analyses are helpful in the differential diagnosis of ccRCCs, EAMLs, and TAMLs.
Collapse
Affiliation(s)
- Qing Lu
- Department of Ultrasound, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China,
| | | | | | | | | |
Collapse
|
50
|
Harvey CJ, Alsafi A, Kuzmich S, Ngo A, Papadopoulou I, Lakhani A, Berkowitz Y, Moser S, Sidhu PS, Cosgrove DO. Role of US Contrast Agents in the Assessment of Indeterminate Solid and Cystic Lesions in Native and Transplant Kidneys. Radiographics 2015; 35:1419-30. [PMID: 26273994 DOI: 10.1148/rg.2015140222] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasonography (US) is often the initial imaging modality employed in the evaluation of renal diseases. Despite improvements in B-mode and Doppler imaging, US still faces limitations in the assessment of focal renal masses and complex cysts as well as the microcirculation. The applications of contrast-enhanced US (CEUS) in the kidneys have dramatically increased to overcome these shortcomings with guidelines underlining their importance. This article describes microbubble contrast agents and their role in renal imaging. Microbubble contrast agents consist of a low solubility complex gas surrounded by a phospholipid shell. Microbubbles are extremely safe and well-tolerated pure intravascular agents that can be used in renal failure and obstruction, where computed tomographic (CT) and magnetic resonance (MR) imaging contrast agents may have deleterious effects. Their intravascular distribution allows for quantitative perfusion analysis of the microcirculation, diagnosis of vascular problems, and qualitative assessment of tumor vascularity and enhancement patterns. Low acoustic power real-time prolonged imaging can be performed without exposure to ionizing radiation and at lower cost than CT or MR imaging. CEUS can accurately distinguish pseudotumors from true tumors. CEUS has been shown to be more accurate than unenhanced US and rivals contrast material-enhanced CT in the diagnosis of malignancy in complex cystic renal lesions and can upstage the Bosniak category. CEUS can demonstrate specific enhancement patterns allowing the differentiation of benign and malignant solid tumors as well as focal inflammatory lesions. In conclusion, CEUS is useful in the characterization of indeterminate renal masses and cysts.
Collapse
Affiliation(s)
- Chris J Harvey
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Ali Alsafi
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Siarhei Kuzmich
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - An Ngo
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Ioanna Papadopoulou
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Amish Lakhani
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Yaron Berkowitz
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Steven Moser
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - Paul S Sidhu
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| | - David O Cosgrove
- From the Departments of Imaging, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, England (C.J.H., A.A., A.N., I.P., A.L., Y.B., S.M., D.O.C.); Department of Imaging, Whipps Cross University Hospital, London, England (S.K.); and Department of Imaging, King's College Hospital, London, England (P.S.S.)
| |
Collapse
|