Department of Clinical Radiology, University of Munich - Grosshadern Campus, Munich, Germany.
Clin Hemorheol Microcirc. 2009;43(1-2):95-107. doi: 10.3233/CH-2009-1224.
It was the aim of our study to combine the findings of contrast-enhanced ultrasound and ARFI-imaging in the evaluation of renal masses in comparison to the histological findings.
Fifteen patients with unclear kidney lesions were analyzed. We used a high-end ultrasound machine (Siemens ACUSON S2000, Siemens Healthcare, Erlangen, Germany) with a multifrequency curved array 4 MHz or linear 9 MHz transducer. Contrast-enhanced ultrasound (bolus injection 1.6-2.4 ml SonoVue was carried out. We obtained fifteen ARFI measurements from each patient with at least five values for quantification. The ARFI-ROI (region of interest) was placed in the ventral margin of the kidney tumor and the whole ROI was covered by the tumor. The "reference-ROI" was placed in the ventral kidney parenchyma of the patient at a distance of at least two centimeters from the tumor. All renal tumors were surgically resected. In cases of complex renal cysts or anatomic variations mimicking renal tumors ("pseudo-tumors"), constant results of ultrasound examinations and additional MRI or multiphase CT over 6 months were required.
Fifteen patients were included in the study and were examined using the diagnostic ultrasound tools of our study The kidney tumors of our patients had diameters ranging from 1.5 to 8 cm and were located at depths ranging from 2 to 5.5 cm. ARFI imaging was also performed in all patients. A field up to a depth of 10 cm could be visualized for diagnostic use. Performing ARFI quantification using Siemens Virtual Touch Tissue Quantification we obtained minimum and maximum tissue shear velocities ranging from 1.6 to 3.42 m/s. The reference tissue ROIs showed values from 1.31 to 4.4 m/s. 12 cases were accepted for surgical resection. The visualization of lesions with Virtual Touch Tissue Imaging confirmed the measurements of ARFI quantification and were able to depict the different areas of stiffness in the kidney tissue. No infiltration of kidney veins or vena cava was detected by contrast-enhanced ultrasound. Of the 12 cases two "complicated" renal cysts were examined, and both showed Bosniak-III findings.
ARFI imaging improves visualization of unclear renal masses in comparison to fundamental B-scan and adds new information about the tissue stiffness in a less time-consuming and more reproducible way. CEUS with SonoVue allows an early evaluation of renal masses or complex cysts.
本研究旨在将对比增强超声和 ARFI 成像的结果结合起来，用于评估肾脏肿块，并与组织学发现进行比较。
对 15 例肾脏病变不明确的患者进行分析。我们使用高端超声机（西门子 ACUSON S2000，西门子医疗，德国埃朗根），配备多频曲面探头 4 MHz 或线性探头 9 MHz。进行对比增强超声（弹丸注射 1.6-2.4 ml SonoVue）。从每位患者获得 15 次 ARFI 测量值，每个 ROI 至少进行 5 次定量测量。ARFI-ROI（感兴趣区）放置在肾脏肿瘤的腹侧边缘，整个 ROI 被肿瘤覆盖。“参考 ROI”放置在患者距离肿瘤至少 2 厘米的肾脏腹侧实质内。所有肾脏肿瘤均行手术切除。对于复杂的肾囊肿或模拟肾肿瘤的解剖变异（“假性肿瘤”），需要进行连续的超声检查和 6 个月以上的额外 MRI 或多期 CT 检查。
本研究共纳入 15 例患者，使用本研究的诊断超声工具进行检查。患者的肾脏肿瘤直径为 1.5-8 cm，深度为 2-5.5 cm。所有患者均进行 ARFI 成像。诊断用 ARFI 成像的可视深度可达 10 cm。使用西门子虚拟触诊组织量化技术进行 ARFI 定量分析，获得最小和最大组织剪切速度范围为 1.6-3.42 m/s。参考组织 ROI 显示值为 1.31-4.4 m/s。12 例患者接受手术切除。虚拟触诊组织成像（VTI）对病变的可视化证实了 ARFI 定量分析的测量结果，并能够描绘肾脏组织不同区域的硬度。对比增强超声未发现肾静脉或腔静脉浸润。在 12 例患者中，有 2 例“复杂”肾囊肿被检查，均显示 Bosniak-III 型表现。
与基本的 B 型扫描相比，ARFI 成像可改善对不明确的肾脏肿块的可视化，并以更省时、更可重复的方式提供关于组织硬度的新信息。SonoVue 增强超声允许对肾脏肿块或复杂囊肿进行早期评估。
