Department of Radiology, Careggi University Hospital, Florence, Italy.
Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
World J Urol. 2021 Aug;39(8):2853-2860. doi: 10.1007/s00345-021-03589-6. Epub 2021 Jan 22.
To assess the safety and efficacy of contrast-enhanced ultrasound (CEUS) imaging for monitoring small (< 4 cm) renal masses (SRM) in patients undergoing active surveillance (AS).
We retrospectively selected all consecutive patients with SRMs who underwent AS for at least 6 months at our Institution between January 2014 and December 2018. CEUS imaging was performed by two experienced genitourinary radiologists at established time points. The accuracy of CEUS for monitoring SRM size was compared with that of CT scan. For solid SRMs, four enhancement patterns (EP) were recorded. Radiological progression was defined as SRM growth rate ≥ 5 mm/year.
Overall, 158/1049 (15.1%) patients with SRMs underwent AS. At a median follow-up of 25 months (IQR 13-39), no patient died due to renal cell carcinoma (RCC). No patients experienced CEUS-related adverse events. There was a large variability in the pattern of growth of SRMs (overall median growth rate: 0.40 mm/year), with 9.5% of SRMs showing radiological progression. The median SRM size was comparable between CEUS and CT scan examinations at all time points. The vast majority (92.7%) of SRMs did not show a change in their EP over time; and there was no association between the SRM's EP and radiological progression or SRM size. Overall, 43 (27.2%) patients underwent delayed intervention (DI); median SRM size, and median growth rate were significantly higher in these patients as compared to those continuing AS.
In experienced hands, CEUS is a safe and effective strategy for active monitoring of SRMs in well-selected patients undergoing AS.
评估对比增强超声（CEUS）成像用于监测接受主动监测（AS）的患者中（<4cm）小肾脏肿块（SRM）的安全性和有效性。
我们回顾性选择了 2014 年 1 月至 2018 年 12 月期间在我院接受 AS 治疗至少 6 个月的所有连续患有 SRM 的患者。CEUS 成像由两位经验丰富的泌尿生殖系统放射科医生在既定时间点进行。比较了 CEUS 监测 SRM 大小的准确性与 CT 扫描的准确性。对于实性 SRM，记录了四个增强模式（EP）。将 SRM 生长速度≥5mm/年定义为放射学进展。
共有 158/1049 例（15.1%）SRM 患者接受 AS。在中位随访 25 个月（IQR 13-39）期间，没有患者因肾细胞癌（RCC）死亡。没有患者发生与 CEUS 相关的不良事件。SRM 的生长模式存在很大的变异性（总体中位生长速度：0.40mm/年），9.5%的 SRM 出现放射学进展。在所有时间点，CEUS 和 CT 扫描检查的 SRM 大小中位数均无差异。绝大多数（92.7%）SRM 随时间推移其 EP 无变化；SRM 的 EP 与放射学进展或 SRM 大小之间无关联。总体而言，43 例（27.2%）患者接受了延迟干预（DI）；与继续接受 AS 的患者相比，这些患者的 SRM 大小和中位生长速度明显更高。
在经验丰富的医生手中，CEUS 是一种安全有效的策略，可用于对接受 AS 治疗的精选患者进行 SRM 的主动监测。
