Dong Xiao-qiu, Shen Yi, Xu Li-wei, Xu Chun-mei, Bi Wei, Wang Xiao-min
School of Astronautics, Harbin Institute of Technology, Harbin, Heilongjiang, China.
Chin Med J (Engl). 2009 May 20;122(10):1179-83.
Renal clear cell carcinoma (RCCC) is the most common malignant renal tumor. It is highly malignant, does not cause clinical symptoms in its early stages, and cannot be diagnosed using conventional ultrasound. This study was aimed to investigate the contrast-enhanced ultrasound (CEUS) mode and characteristics of the time-intensity curve for RCCC and its pathological basis.
Forty-two patients with pathologically diagnosed RCCC underwent CEUS examination before surgery. The patients' kidneys were visualized after injection of contrast agents using the Technos MPX DU8. We analyzed the CEUS mode, time-intensity curve, and pathological findings.
The detection rate of RCCC with conventional ultrasound was about 71%, while the rate using CEUS was 100%. Larger tumors (33 cases) showed non-uniform enhancement with defective filling. CEUS modes were divided into 4 types: type I, "quick in and out" (26.19%, 11/42); type II, "quick in and slow out" (40.48%, 17/42); type III, "Simultaneous in and out" (16.67%, 7/42); and type IV "slow in and out" (16.67%, 7/42). All types had a close correlation to the pathological basis. Time-intensity curve of CEUS consisted of 3 phases, the perfusion phase, regression phase, and lag phase. Cases of types I and III only had a perfusion and regression phase, those of type II and IV had a perfusion phase, regression phase, and lag phase. Quantitative analysis of the time-intensity curve showed that the time-to-peak (TTP) of the lesions was shorter than that of normal renal parenchyma (P < 0.0001), the mean value of the up slope rate of the absolute value of lesions was higher than that of the ipsilateral normal renal parenchyma (P < 0.0001), and that the mean value of descent slope rate of the absolute value of lesions was lower than that of the ipsilateral normal renal parenchyma (P < 0.0001).
CEUS is useful in detecting small vessels in tumors. Although there are several different CEUS modes, type I "quick in and out" and type II "quick in and slow out" accounted for the most cases that had a close correlation to pathologic angiogenesis. Time-intensity curves also showed some special characteristics. These data could provide valuable information for the clinical diagnosis of RCCC.
肾透明细胞癌（RCCC）是最常见的肾恶性肿瘤。其恶性程度高，早期无临床症状，常规超声难以诊断。本研究旨在探讨肾透明细胞癌的超声造影（CEUS）模式、时间强度曲线特征及其病理基础。
42例经病理确诊的肾透明细胞癌患者在手术前行CEUS检查。使用Technos MPX DU8超声仪注射造影剂后观察患者肾脏情况。分析CEUS模式、时间强度曲线及病理结果。
常规超声对肾透明细胞癌的检出率约为71%，而CEUS的检出率为100%。较大肿瘤（33例）表现为不均匀强化且充盈缺损。CEUS模式分为4种类型：I型，“快进快出”（26.19%，11/42）；II型，“快进慢出”（40.48%，17/42）；III型，“同进同出”（16.67%，7/42）；IV型，“慢进慢出”（16.67%，7/42）。所有类型均与病理基础密切相关。CEUS时间强度曲线由3个阶段组成，即灌注期、消退期和延迟期。I型和III型病例只有灌注期和消退期，II型和IV型病例有灌注期、消退期和延迟期。时间强度曲线的定量分析显示，病灶的达峰时间（TTP）短于正常肾实质（P < 0.0001），病灶绝对值上升斜率的平均值高于同侧正常肾实质（P < 0.0001），病灶绝对值下降斜率的平均值低于同侧正常肾实质（P < 0.0001）。
CEUS有助于检测肿瘤内的小血管。虽然有几种不同的CEUS模式，但I型“快进快出”和II型“快进慢出”占大多数病例，且与病理性血管生成密切相关。时间强度曲线也显示出一些特殊特征。这些数据可为肾透明细胞癌的临床诊断提供有价值的信息。
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