Kranert Paul Christian, Kranert Paula, Banas Miriam C, Jung Ernst Michael, Banas Bernhard, Putz Franz Josef
Department of Nephrology, University Hospital Regensburg, 93053 Regensburg, Germany.
Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany.
Diagnostics (Basel). 2024 Sep 10;14(18):2002. doi: 10.3390/diagnostics14182002.
Angiomyolipoma (AML) are the most common benign solid renal mass. Differentiation from malignant tumours is essential. Imaging features in ultrasound may overlap between malignant lesions, especially between renal cell carcinoma (RCC) and AML. So far, sectional imaging has been necessary for reliable differentiation. The aim of this study is to evaluate the use of the ultrasound-guided attenuation parameter (UGAP), a recently established tool for assessing hepatic steatosis, in the differentiation of AMLs from other renal masses. Therefore, 27 patients with unknown solid renal masses were examined by ultrasound including UGAP. The attenuation was assessed qualitatively by attenuation map and quantitatively in comparison to the surrounding renal tissue. UGAP was applicable in 26/27 patients. Findings were compared with CT/MRI as the current imaging standard. A total of 18 AML and 9 other renal tumours were found. The diagnostic performance of B-Mode (hyperechogenic lesion) ultrasound was 77.8% in identifying AML. The diagnostic performance of the attenuation map showed a diagnostic performance of 92.6%, whereby UGAP measurements were successful in 76.9% of cases. Quantitatively, we found a significant difference ( < 0.034) in mean measured attenuation between AML (0.764 ± 0.162 dB/cm/MHz) vs. other renal tumours (0.658 ± 0.155 dB/cm/MHz). The best performance was found by a combined parameter of a hyperechogenic lesion with a positive attenuation map with an accuracy of 95.0%. In conclusion, UGAP may represent a possibility for differentiating solid renal lesions more accurately by ultrasound, especially classic hyperechoic AMLs from other renal lesions. Further studies are needed to increase the diagnostic reliability further.
血管平滑肌脂肪瘤（AML）是最常见的肾脏良性实性肿块。与恶性肿瘤进行鉴别至关重要。超声检查的影像学特征在恶性病变之间可能存在重叠，尤其是肾细胞癌（RCC）和AML之间。到目前为止，断层成像对于可靠的鉴别是必要的。本研究的目的是评估超声引导下衰减参数（UGAP）在AML与其他肾脏肿块鉴别中的应用，UGAP是一种最近建立的用于评估肝脂肪变性的工具。因此，对27例肾脏实性肿块性质不明的患者进行了包括UGAP在内的超声检查。通过衰减图对衰减进行定性评估，并与周围肾组织进行定量比较。27例患者中有26例可进行UGAP检查。将检查结果与作为当前成像标准的CT/MRI进行比较。共发现18例AML和9例其他肾脏肿瘤。B超（高回声病变）鉴别AML的诊断性能为77.8%。衰减图的诊断性能为92.6%，其中UGAP测量在76.9%的病例中取得成功。在定量方面，我们发现AML（0.764±0.162 dB/cm/MHz）与其他肾脏肿瘤（0.658±0.155 dB/cm/MHz）之间的平均测量衰减存在显著差异（<0.034）。高回声病变与阳性衰减图的联合参数表现最佳，准确率为95.0%。总之，UGAP可能为通过超声更准确地鉴别肾脏实性病变提供一种可能，尤其是将典型的高回声AML与其他肾脏病变区分开来。需要进一步研究以进一步提高诊断的可靠性。
