Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany.
Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany.
Medicina (Kaunas). 2020 Nov 19;56(11):624. doi: 10.3390/medicina56110624.
The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses.
18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent.
Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%).
In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.
本研究旨在评估超声造影（CEUS）在鉴别良恶性肾脏实性肿块中的诊断性能。
本单中心研究纳入了 18 例经组织病理学证实的良性肾脏实性肿块患者（11 例嗜酸细胞瘤，7 例血管平滑肌脂肪瘤）和 96 例经 CEUS 检查后接受根治性或部分肾切除术的肾细胞癌（RCC）患者。CEUS 检查由一位经验丰富的放射科医生（EFSUMB 3 级）进行，包括应用第二代造影剂。
肾血管平滑肌脂肪瘤、嗜酸细胞瘤和肾细胞癌在 CEUS 中表现出不同的声像学特征。血管平滑肌脂肪瘤呈不均匀回声（57%低回声，43%高回声），而所有病变均表现出快速增强，其中 2 个病变还出现静脉洗脱（29%）。值得注意的是，11 例嗜酸细胞瘤中有 9 例可在常规超声中检测到（64%低回声，9%高回声，9%等回声），11 例中有 2 例仅在静脉应用造影剂时才能显示（18%）。所有嗜酸细胞瘤在 CEUS 中均表现为高增强，7/11 例病变出现静脉洗脱（64%）。
与目前的知识水平一致，本研究未发现 CEUS 中能够准确区分良恶性肾脏实性肿块的特定声像学特征。
