Wei Shu-Ping, Xu Chao-Li, Zhang Qing, Zhang Qi-Rui, Zhao Yan-E, Huang Peng-Fei, Xie Ying-Dong, Zhou Chang-Sheng, Tian Fu-Li, Yang Bin
Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, 305# Zhongshan East Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305# Zhongshan East Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
Abdom Radiol (NY). 2017 Aug;42(8):2135-2145. doi: 10.1007/s00261-017-1111-x.
The study aimed to compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of contrast-enhanced computed tomography (CECT) in the evaluation of benign and malignant small renal masses (SRMs) (<4 cm) confirmed by pathology.
A total of 118 patients with 118 renal masses smaller than 4 cm diagnosed by both CEUS and CECT were enrolled in this study, including 25 benign lesions and 93 malignant lesions. All lesions were confirmed by histopathologic diagnosis after surgical resection. The diagnostic imaging studies of the patients were retrospectively reviewed by two independent ultrasonologists and two independent radiologists blinded to the CT or ultrasound findings and final histological results. All lesions on both CEUS and CECT were independently scored on a 3-point scale (1: benign, 2: equivocal, and 3: malignant). The concordance between interobserver agreement was interpreted using a weighted kappa statistic. The diagnostic efficiency of the evaluation of benign and malignant lesions was compared between CEUS and CECT.
All the 118 included lesions were detected by both CEUS and CECT. In CEUS and CECT imaging evaluation of the 118 lesions, the weighted kappa value interpreting the concordance between interobserver agreement was 0.89 (95% CI 0.79-0.98) and 0.93 (95% CI 0.87-0.99), respectively. Both CEUS and CECT demonstrated good diagnostic performance in differential diagnosis of benign and malignant SRMs with sensitivity of 93.5% and 89.2%, specificity of 68% and 76%, PPV of 91.6% and 93.3%, NPV of 73.9% and 65.5%, and AUC of 0.808 and 0.826, respectively. There was no statistically significant difference in any of the diagnostic performance indices between these two methods (P > 0.05). However, the qualitative diagnosis of small papillary renal cell carcinoma (RCC) by CEUS was significantly better than that by CECT (P < 0.05), while there was no significant difference in qualitative diagnostic accuracy on other histotypes of SRMs between CEUS and CECT (P > 0.05).
Both CEUS and CECT imaging modalities are effective for the differential diagnosis of benign and malignant SRMs. Furthermore, CEUS may be more effective than CECT for the qualitative diagnosis of small papillary RCC.
本研究旨在比较超声造影（CEUS）与计算机断层扫描造影（CECT）在评估经病理证实的良性和恶性小肾肿块（SRMs，<4 cm）中的诊断效率。
本研究纳入了118例经CEUS和CECT诊断为肾肿块小于4 cm的患者，包括25例良性病变和93例恶性病变。所有病变均在手术切除后经组织病理学诊断证实。由两名独立的超声科医生和两名独立的放射科医生对患者的诊断影像研究进行回顾性分析，他们对CT或超声检查结果以及最终组织学结果不知情。对CEUS和CECT上的所有病变分别进行3分制评分（1：良性，2：可疑，3：恶性）。观察者间一致性的一致性采用加权kappa统计量进行解释。比较CEUS和CECT在评估良性和恶性病变方面的诊断效率。
CEUS和CECT均检测到了所有118个纳入的病变。在对118个病变进行CEUS和CECT成像评估时，解释观察者间一致性的加权kappa值分别为0.89（95%CI 0.79 - 0.98）和0.93（95%CI 0.87 - 0.99）。CEUS和CECT在鉴别诊断良性和恶性SRMs方面均表现出良好的诊断性能，敏感性分别为93.5%和89.2%，特异性分别为68%和76%，阳性预测值分别为91.6%和93.3%，阴性预测值分别为73.9%和65.5%，曲线下面积分别为0.808和0.826。两种方法在任何诊断性能指标上均无统计学显著差异（P>0.05）。然而，CEUS对小乳头状肾细胞癌（RCC）的定性诊断明显优于CECT（P<0.05），而CEUS和CECT在SRMs其他组织学类型的定性诊断准确性上无显著差异（P>0.05）。
CEUS和CECT成像方式在鉴别诊断良性和恶性SRMs方面均有效。此外，CEUS在小乳头状RCC的定性诊断方面可能比CECT更有效。
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