Lu Qing, Xue Li-yun, Huang Bei-jian, Wang Wen-ping, Li Cui-xian
Department of Ultrasound, Shanghai Medical Imaging Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China,
Abdom Imaging. 2015 Aug;40(6):1675-83. doi: 10.1007/s00261-014-0340-5.
The purpose of this study is to evaluate qualitative and quantitative analysis of contrast-enhanced ultrasound (CEUS) in differential diagnoses of hypo-echoic renal tumor histotypes.
Our study cohort comprised 103 clear cell renal cell carcinomas (ccRCCs), 24 papillary renal cell carcinomas (pRCCs), 28 chromophobe renal cell carcinomas (cRCCs), and 34 angiomyolipomas (AMLs), hypo-echoic on ultrasound, and imaged between January 2011 and December 2013. Enhancement homogeneity and tumor-to-cortex intensity ratio (TOC ratio) were retrospectively analyzed.
Overall, heterogeneous enhancement was more common in ccRCCs than AMLs, pRCCs, and cRCCs. TOC ratio showed the trend ccRCC > AML > pRCC = cRCC. Similar trends were seen in tumors <4 cm. Using heterogeneous enhancement or TOC ratio >107.5% to differentiate ccRCC from other histotypes, the sensitivity, specificity, positive and negative predictive values were 93.1%, 74.5%, 84.8%, and 87.5%, respectively. Tumors >4 cm exhibited considerable overlap in enhancement homogeneity among different histotypes. TOC ratios were similar between homo- and heterogeneously enhancing tumors for ccRCCs and for pRCCs and cRCCs, but higher in homogeneously enhancing than heterogeneously enhancing AMLs. In homo- and heterogeneously enhancing tumors, TOC ratios followed the trends ccRCCs > AMLs > pRCCs = cRCCs and ccRCCs > AMLs = pRCCs = cRCCs, respectively. With TOC ratio >105.81% and >72.37% to differentiate homo- and heterogeneously enhancing ccRCCs from other histotypes in tumors >4 cm with same enhancement homogeneity, the sensitivity, specificity, positive and negative predictive values were 70.0%, 85.7%, 70.0%, 85.7%, and 91.7%, 94.4%, 95.7%, 89.5%, respectively.
CEUS homogeneity and TOC ratio are helpful in differential diagnosis of hypo-echoic renal tumor histotypes. Diameter and enhancement homogeneity should be considered when deciding the diagnostic TOC ratio cutoff.
本研究旨在评估超声造影（CEUS）在低回声肾肿瘤组织学类型鉴别诊断中的定性和定量分析。
我们的研究队列包括103例透明细胞肾细胞癌（ccRCC）、24例乳头状肾细胞癌（pRCC）、28例嫌色细胞肾细胞癌（cRCC）和34例肾血管平滑肌脂肪瘤（AML），这些肿瘤在超声检查中表现为低回声，并于2011年1月至2013年12月期间进行了成像。回顾性分析增强均匀性和肿瘤与皮质强度比（TOC比）。
总体而言，ccRCC中不均匀增强比AML、pRCC和cRCC更常见。TOC比呈现ccRCC>AML>pRCC = cRCC的趋势。在<4 cm的肿瘤中也观察到类似趋势。使用不均匀增强或TOC比>107.5%来区分ccRCC与其他组织学类型，其敏感性、特异性、阳性和阴性预测值分别为93.1%、74.5%、84.8%和87.5%。直径>4 cm的肿瘤在不同组织学类型之间的增强均匀性存在相当大的重叠。ccRCC、pRCC和cRCC中均匀和不均匀增强肿瘤的TOC比相似，但均匀增强的AML的TOC比高于不均匀增强的AML。在均匀和不均匀增强的肿瘤中，TOC比分别遵循ccRCC>AML>pRCC = cRCC和ccRCC>AML = pRCC = cRCC的趋势。对于直径>4 cm且增强均匀性相同的肿瘤，使用TOC比>105.81%和>72.37%来区分均匀和不均匀增强的ccRCC与其他组织学类型，其敏感性、特异性、阳性和阴性预测值分别为70.0%、85.7%、70.0%、85.7%以及91.7%、94.4%、95.7%、89.5%。
CEUS均匀性和TOC比有助于低回声肾肿瘤组织学类型的鉴别诊断。在确定诊断性TOC比临界值时应考虑肿瘤直径和增强均匀性。
