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Tsili AC, Moulopoulos LA, Varakarakis IΜ, Argyropoulou MI. Cross-sectional imaging assessment of renal masses with emphasis on MRI. Acta Radiol 2021; 63:1570-1587. [PMID: 34709096 DOI: 10.1177/02841851211052999] [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: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Ioannis Μ Varakarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
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Tsili AC, Andriotis E, Gkeli MG, Krokidis M, Stasinopoulou M, Varkarakis IM, Moulopoulos LA. The role of imaging in the management of renal masses. Eur J Radiol 2021; 141:109777. [PMID: 34020173 DOI: 10.1016/j.ejrad.2021.109777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022]
Abstract
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Efthimios Andriotis
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Myrsini G Gkeli
- 1st Department of Radiology, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Miltiadis Krokidis
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Myrsini Stasinopoulou
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Ioannis M Varkarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, 15126, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece.
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Zhang F, Li R, Li G, Jin L, Shi Q, Du L. Value of Contrast-Enhanced Ultrasound in the Diagnosis of Renal Cancer and in Comparison With Contrast-Enhanced Computed Tomography: A Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:903-914. [PMID: 30203542 DOI: 10.1002/jum.14769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this meta-analysis was to assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in renal cancer and to compare it with contrast-enhanced computed tomography (CECT). METHODS A systematic search was performed to recruit eligible original studies published until December 2017. Two reviewers independently extracted data. A meta-analysis was performed, and the pooled sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, diagnostic odds ratio, summary receiver operating characteristic curve, and area under the curve were calculated. The extent and potential sources of heterogeneity were further explored. Moreover, a head-to-head comparison was also performed to compare the diagnostic value between CEUS and CECT in renal cancer. RESULTS Twenty-two studies were included in this meta-analysis. The summary sensitivity and specificity of CEUS for detecting renal cancer were 0.96 (95% confidence interval [CI], 0.94-0.97) and 0.82 (95% CI, 0.74-0.88), respectively. The summary diagnostic odds ratio was 102.04 (95% CI, 49.55-210.13). The area under the summary receiver operating characteristic curve was 0.97 (95% CI, 0.95-0.98). In the head-to-head comparison, CEUS showed higher diagnostic sensitivity than CECT (0.94 versus 0.85) for renal cancer, whereas the specificities were comparable between CEUS and CECT (0.77 versus 0.75). CONCLUSIONS Contrast-enhanced US has high sensitivity and moderate specificity in the differential diagnosis of renal cancer. The diagnostic sensitivity of CEUS in renal cancer was higher than that of CECT, suggesting that CEUS could be used as a preferred diagnostic tool for renal cancer.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Li
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Gang Li
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gaudiano C, Schiavina R, Vagnoni V, Busato F, Borghesi M, Bandini M, Di Carlo M, Brunocilla E, Martorana G, Golfieri R. Can the multiphasic computed tomography be useful in the clinical management of small renal masses? Acta Radiol 2017; 58:625-633. [PMID: 27599523 DOI: 10.1177/0284185116663042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Small renal masses (SRMs; ≤4 cm) represent a challenging issue. Computed tomography (CT) is widely used for investigating renal tumors even if its ability to differentiate among the different subtypes has not yet been definitively established. Purpose To assess the potential role of the morphological features and angiodynamic behavior on multiphasic CT in the preoperative evaluation of SRMs. Material and Methods The CT images of 80 patients with SRMs who underwent surgical resection at our institution were retrospectively reviewed. The morphological features, the pattern, and the quantitative analysis of enhancement were assessed for each lesion and were correlated with the histological subtypes. Results Overall, 81 SRMs were evaluated. Final pathological examination showed 30 (37%) oncocytomas, 22 (27.2%) clear cell renal cell carcinomas (ccRCCs), 16 (19.8%) papillary RCCs (pRCCs), and 13 (16%) chromophobe RCCs (chRCCs). Of the morphological features, only necrosis was significantly associated with ccRCC ( P = 0.047). The analysis of enhancement allowed the identification of two groups of lesions, based on arterial behavior: hypervascular (oncocytomas/ccRCC) and hypovascular (chRCC/pRCC) lesions. A significant difference between the two groups in terms of degree of enhancement on CT phases was found ( P < 0.05); this was also confirmed by the receiver operating characteristic (ROC) analysis. Conclusion Except for necrosis, the morphological features are not useful in making a correct diagnosis in the case of SRMs. The angiodynamic behavior on multiphasic CT showed high accuracy in differentiating between hypovascular and hypervascular tumors; this differentiation could be useful for deciding on the most appropriate clinical management of SRMs.
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Affiliation(s)
- Caterina Gaudiano
- Department of Radiology, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Valerio Vagnoni
- Department of Urology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Fiorenza Busato
- Department of Radiology, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Bandini
- Department of Urology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Martorana
- Department of Urology, University of Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, Sant’Orsola-Malpighi Hospital, Bologna, Italy
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Skakić A, Stojanov D, Bašić D, Dinić L, Potić M, Tasić A. DIAGNOSTIC IMAGING OF SMALL RENAL MASSES. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tsili AC, Argyropoulou MI. Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma. World J Radiol 2015; 7:110-127. [PMID: 26120380 PMCID: PMC4473304 DOI: 10.4329/wjr.v7.i6.110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/18/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography (CT) is considered the examination of choice for the detection and staging of RCC. Multidetector CT (MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and three-dimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.
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Oh TH, Lee YH, Seo IY. Diagnostic efficacy of contrast-enhanced ultrasound for small renal masses. Korean J Urol 2014; 55:587-92. [PMID: 25237460 PMCID: PMC4165921 DOI: 10.4111/kju.2014.55.9.587] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/01/2014] [Indexed: 12/13/2022] Open
Abstract
Purpose Ultrasound (US) is highly sensitive in the detection of renal masses. However, it may not be able to differentiate benign and malignant lesions in smaller masses. The purpose of this study was to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) for small renal masses. Materials and Methods From January 2011 to December 2013, a total of 85 patients underwent CEUS for evaluation of renal masses. Of these patients, CEUS findings were retrospectively analyzed for small renal cell carcinoma (RCC) cases (n=38) and angiomyolipoma (AML) cases (n=11). The tumor echogenicity and enhancement patterns and degrees were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was compared. Results On CEUS, the findings of diffuse heterogeneous enhancement (observed in 78.9% of RCCs and 27.3% of AMLs, p=0.003), washout from hyperenhancement or iso-enhancement to hypoenhancement in late phase (73.7% of RCCs and 18.2% of AMLs, p=0.001), and perilesional rim-like enhancement (57.9% of RCCs and 9.1% of AMLs, p=0.006) were significantly different between AML and RCC cases. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.8% (33/38), 63.6% (7/11), 89.2% (33/37), 58.3% (7/12), and 81.6% (40/49), respectively. Conclusions Our results suggest that the characteristic CEUS features could have diagnostic value in the evaluation of small renal mass. CEUS showed a higher diagnostic efficacy than conventional US for differentiating RCC and AML.
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Affiliation(s)
- Tae Hoon Oh
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Hwan Lee
- Department of Radiology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Ill Young Seo
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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Brunocilla E, Borghesi M, Schiavina R, Della Mora L, Dababneh H, La Manna G, Monti C, Martorana G. Small Renal Masses Initially Managed Using Active Surveillance: Results From a Retrospective Study With Long-Term Follow-Up. Clin Genitourin Cancer 2014; 12:178-81. [DOI: 10.1016/j.clgc.2013.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/11/2013] [Accepted: 11/08/2013] [Indexed: 12/01/2022]
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Borghesi M, Della Mora L, Brunocilla E, Schiavina R, Rizzi S, La Manna G, Martorana G. Warm ischemia time and postoperative complications after partial nephrectomy for renal cell carcinoma. Actas Urol Esp 2014; 38:313-8. [PMID: 24565512 DOI: 10.1016/j.acuro.2013.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/17/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the correlations between PADUA and RENAL scores, WIT and postoperative complications in a cohort of patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma. MATERIAL AND METHODS We analyzed 96 consecutive patients who underwent partial nephrectomy for renal cell carcinoma between 2004 and 2013 at our Institution. The Spearman test was used to compare categorical variables. For all statistical analyses, a two-sided P < .05 was considered statistically significant. RESULTS The median (IQR) PADUA score was 7 (7-8) and the median (IQR) RENAL score was 7 (6-8). The median (IQR) warm ischemia time was 14 min (8-20). Low grade and high grade postoperative complications were found in 27 (28.1%) and 6 (6.3%) patients, respectively. PADUA risk group categories significantly correlated with WIT > 20 minutes and high grade postoperative complications, respectively (P = .04), regardless of the surgical approach. RENAL risk group categories significantly predicted longer hilar clamping time in our cohort (P = .04), but no statistically significant correlations with high grade postoperative complications were found. CONCLUSIONS In our retrospective series nephrometric scores demonstrated to significantly predict longer warm ischemia time and higher postoperative complications, especially in those patients with more challenging and complex renal tumors. Therefore, when planning to perform partial nephrectomy, urologists should widely use these comprehensive tools.
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Brunocilla E, Borghesi M, Schiavina R, Palmieri F, Pernetti R, Monti C, Martorana G. Active surveillance for small renal masses diagnosed in elderly or comorbid patients: looking for the best treatment strategy. Actas Urol Esp 2014; 38:1-6. [PMID: 24126193 DOI: 10.1016/j.acuro.2013.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Aim of this study is to provide our results after long-term active surveillance (AS) protocol for small renal masses (SRMs), and to report the outcomes of patients who remained in AS compared to those who underwent delayed surgical intervention. PATIENTS AND METHODS We retrospectively reviewed our database of 58 patients diagnosed with 60 contrast enhancing SRMs suspicious for renal cell carcinoma (RCC). All patients had clinical and radiological follow-up every 6 months. We evaluated the differences between patients who remained on AS and those who underwent surgical delayed intervention. RESULTS The mean age was 75 years, the mean follow-up was 88.5 months. The median initial tumor size at presentation was 2.6cm, and the median estimated tumor volume was 8.7cm(3). The median linear growth rate of the cohort was 0.7cm/year, and the median volumetric growth rate was 8.8 cm(3)/year. Death for metastatic disease occurred in 2 patients (3.4%). No correlation was found between initial tumor size and size growth rate. The mean linear and volumetric growth rates of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.9 vs. 0.4cm/year and 16.1 vs. 4.6 cm(3)/year, respectively; P<.001). CONCLUSIONS Most of SRMs demonstrate to have an indolent course and low metastatic potential. Malignant disease could have faster linear and volumetric growth rates, thus suggesting the need for a delayed surgical intervention. In properly selected patients with low life-expectancy, AS could be a reasonable option in the management of SRMs.
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Clinically localized renal cell carcinoma: which is the best treatment strategy? Clin Genitourin Cancer 2013; 12:e61. [PMID: 24331579 DOI: 10.1016/j.clgc.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/03/2013] [Indexed: 11/24/2022]
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Differing risk of cancer death among patients with pathologic T3a renal cell carcinoma: identification of risk categories according to fat infiltration and renal vein thrombosis. Clin Genitourin Cancer 2013; 11:451-7. [PMID: 23816525 DOI: 10.1016/j.clgc.2013.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/01/2013] [Accepted: 05/14/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The study objectives were to evaluate the prognostic impact of fat infiltration and renal vein thrombosis in patients with pT3a renal cell carcinoma (RCC) and to identify new prognostic groups. MATERIAL AND METHODS We analyzed 122 consecutive patients with pT3a who underwent radical nephrectomy for RCC between 2000 and 2011 at the University of Bologna. Cancer-specific survival (CSS) rates were estimated using Kaplan-Meier survival curves; univariable and multivariable analyses were performed with Cox analysis. RESULTS The mean follow-up was 41.7 ± 35.4 months. Patients with peritumoral/hilar fat infiltration (n = 63) and patients with renal vein thrombosis (n = 18) experienced comparable CSS rates, whereas patients with both fat infiltration plus renal vein thrombosis (n = 41) showed worse survival outcomes than the first group (P = .026). Patients were divided in 2 groups: group A, with fat invasion or renal vein thrombosis, and group B, with concomitant fat invasion and renal vein invasion. Group B showed worse cancer-specific survival than group A (P = .024). At multivariate analysis, this new risk-group stratification was found to be an independent prognostic predictor of CSS (P < .05). CONCLUSIONS Patients with T3a RCC with both fat invasion and renal vein thrombosis experience worse survival rates when compared with those patients with only 1 prognostic factor. The TNM classification should consider the concomitant presence of those parameters as a different prognostic predictor.
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Xu ZF, Xu HX, Xie XY, Liu GJ, Zheng YL, Lu MD. Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast-enhanced ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:709-717. [PMID: 20427782 DOI: 10.7863/jum.2010.29.5.709] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in differentiating renal cell carcinoma (RCC) from renal angiomyolipoma (RAML). METHODS One hundred nineteen patients with 126 renal lesions (33 RAMLs and 93 RCCs) who had undergone CEUS were retrospectively studied. All of the lesions were histopathologically or clinical proved. Contrast-enhanced ultrasonography was performed using low-acoustic power modes and a sulfur hexafluoride-filled microbubble contrast agent. The baseline sonograms and CEUS images were retrospectively analyzed in consensus by 2 radiologists. The tumor echogenicity, enhancement patterns, and degree of enhancement at different phases were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was computed and compared. RESULTS On CEUS, the features of wash-out from hyperenhancement or isoenhancement to hypoenhancement over time (observed in 3.0% of RAMLs and 71.0% of RCCs; P < .001), heterogeneous enhancement (observed in 12.1% of RAMLs and 74.2% of RCCs; P < .001), and an enhanced perilesional rim (observed in 3.0% of RAMLs and 79.6% of RCCs; P < .001) achieved significant difference between RCCs and RAMLs. Early wash-out and heterogeneous enhancement or peritumoral rim enhancement yielded the highest diagnostic capability in differentiating RCC from RAML. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88.2% (82 of 93), 97.0% (32 of 33), 98.8% (82 of 83), 74.4% (32 of 43), and 90.5% (114 of 126), respectively. CONCLUSIONS The CEUS features of early wash-out, heterogeneous enhancement, and an enhanced peritumoral rim highly suggest RCC, whereas homogeneous enhancement and prolonged enhancement are characteristic manifestations of RAML. Contrast-enhanced ultrasonography is valuable in differentiating RCC from RAML.
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Affiliation(s)
- Zuo-Feng Xu
- Department of Medical Ultrasonics, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-sen University, Guangzhou, China
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