Evaluation of renal masses with contrast-enhanced ultrasound: initial experience.
Evaluation of renal masses with contrast-enhanced ultrasound: initial experience.
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DOI：
10.2214/ajr.10.6330
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发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Russo P
中科院分区：
文献类型：
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作者：
Gerst S;Hann LE;Li D;Gonen M;Tickoo S;Sohn MJ;Russo P
近25%的实体性肾肿瘤是惰性癌或良性肿瘤，在选定的患者中可以保守治疗。这项前瞻性研究旨在确定术前IV微泡造影超声是否可用于区分惰性和良性肾肿瘤与更具侵袭性的透明细胞癌。34例肾肿瘤患者接受术前灰阶、彩色、能量多普勒和八氟丙烷微泡IV造影超声检查。三位盲法放射科医师阅读一致比较了对比剂洗入率、增强等级和模式以及与邻近实质相比的对比剂洗出率。对比超声检查结果与手术病理结果进行了比较。34例患者中有23例透明细胞癌，3例1型乳头状癌，1例嫌色细胞癌，1例透明罕见多房低度恶性肿瘤，2例未分类病变，3例嗜酸细胞瘤和1例良性血管平滑肌脂肪瘤。异质性病灶回声纹理和延迟病灶洗脱相结合，预测病灶是传统透明细胞癌还是其他肿瘤的阳性预测值为85%，阴性预测值为43%，敏感性为48%，特异性为82%。病灶强化程度降低对非透明细胞组织学特征（良性或低度恶性）的阳性预测值为75%，阴性预测值为81%，敏感性为55%，特异性为91%。结合延迟洗脱和定量病变峰值强度至少为肾脏峰值强度的20%，预测透明细胞组织学特征的阳性预测值为91%，阴性预测值为40%，敏感性为63%，特异性为80%。灰阶不均匀性、病灶洗脱、对比增强分级和峰值强度的定量测量等超声特征可能有助于区分肾透明细胞癌和非透明细胞肿瘤。
Nearly 25% of solid renal tumors are indolent cancer or benign and can be managed conservatively in selected patients. This prospective study was performed to determine whether preoperative IV microbubble contrast-enhanced ultrasound can be used to differentiate indolent and benign renal tumors from more aggressive clear cell carcinoma. Thirty-four patients with renal tumors underwent preoperative gray-scale, color, power Doppler, and octafluoropropane microbubble IV contrast-enhanced ultrasound. Three blinded radiologists reading in consensus compared rate of contrast wash-in, grade and pattern of enhancement, and contrast washout compared with adjacent parenchyma. Contrast ultrasound findings were compared with surgical histopathologic findings for all patients. The 34 patients had 23 clear cell carcinomas, three type 1 papillary carcinomas, one chromophobe carcinoma, one clear rare multilocular low-grade malignant tumor, two unclassified lesions, three oncocytomas, and one benign angiomyolipoma. The combination of heterogeneous lesion echotexture and delayed lesion washout had 85% positive predictive value, 43% negative predictive value, 48% sensitivity, and 82% specificity for predicting whether a lesion was conventional clear cell carcinoma or another tumor. Diminished lesion enhancement grade had 75% positive predictive value, 81% negative predictive value, 55% sensitivity, and 91% specificity for non–clear cell histologic features, either benign or low-grade malignant. Combining delayed washout with quantitative lesion peak intensity of at least 20% of kidney peak intensity had 91% positive predictive value, 40% negative predictive value, 63% sensitivity, and 80% specificity in the prediction of clear cell histologic features. Ultrasound features of gray-scale heterogeneity, lesion washout, grade of contrast enhancement, and quantitative measure of peak intensity may be useful for differentiating clear cell carcinoma and non–clear cell renal tumors.