Lu Qing, Li Cui-xian, Huang Bei-jian, Xue Li-yun, Wang Wen-ping
Department of Ultrasound, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China,
Abdom Imaging. 2015 Feb;40(2):333-42. doi: 10.1007/s00261-014-0221-y.
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.
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.
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.
Qualitative and quantitative CEUS analyses are helpful in the differential diagnosis of ccRCCs, EAMLs, and TAMLs.
确定微小脂肪肾血管平滑肌脂肪瘤（AML）（三相型和上皮样型）的超声造影（CEUS）特征，并将它们相互比较，同时与透明细胞肾细胞癌（ccRCC）进行比较，以探索其鉴别诊断线索。
对上皮样肾AML（EAML，n = 15）、三相型微小脂肪AML（TAML，n = 25）和ccRCC（n = 113）进行回顾性的定性和定量CEUS分析。对CEUS的增强模式和特征进行定性评估。至于定量参数，比较了这些肾肿瘤组织学类型之间的上升时间（RT）、达峰时间（TTP）和肿瘤与皮质增强比（TOC比）。
在这三种组织学类型的肾肿瘤中，常规超声未检测到显著差异。在定性CEUS分析中，皮质期向心性增强（EAML中为73.3%，TAML中为84.0%，而ccRCC中为18.6%，两者比较p均<0.001）、均匀的峰值增强（EAML和TAML中均为100.0%，而ccRCC中为43.4%，两者比较p均<0.001）以及实质期等增强（AML中为53.3%，TAML中为52.0%，而ccRCC中为26.5%，p分别为0.034和0.013）是将EAML和TAML与ccRCC区分开来的有价值特征。此外，通过定量分析，ccRCC的RT和TTP比EAML和TAML短得多。然而，所有这些定性和定量特征在EAML和TAML之间没有显著差异。在EAML与TAML的鉴别诊断中，假包膜征有价值（EAML中为40.0%，TAML中为0.0%，p<0.001），且EAML的TOC比（166.01±64.47%）远高于TAML（93.74±46.56%）（p<0.001），尽管它们与ccRCC也有重叠。以不均匀峰值增强或存在假包膜或TOC比>97.34%作为区分ccRCC和EAML与TAML的标准，敏感性和特异性分别为80.0%和87.5%。
定性和定量CEUS分析有助于ccRCC、EAML和TAML的鉴别诊断。
