Vas Daniel, Paño Blanca, Soler-Perromat Alexandre, Corominas Daniel, Salvador Rafael, Sebastià Carmen, Buñesch Laura, Nicolau Carlos
Department of Radiology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
Diagnostics (Basel). 2025 Jul 16;15(14):1795. doi: 10.3390/diagnostics15141795.
: The aim of the study was to assess the utility of contrast-enhanced ultrasound (CEUS), using both qualitative and quantitative perfusion analysis, in differentiating subtypes of renal cell carcinoma (RCC). : This prospective, single-center study includes 91 patients with histologically confirmed RCC. We performed a CEUS within one week prior to nephrectomy. Qualitative parameters (enhancement pattern, heterogeneity, pseudocapsule) and quantitative perfusion metrics were assessed. Logistic regression models were developed to evaluate the diagnostic performance of CEUS in differentiating high-grade (clear cell RCC) from low-grade RCC (papillary and chromophobe). : Qualitative CEUS findings showed that hyperenhancement and isoenhancement were significantly associated with high-grade RCC (OR = 38.3 and OR = 7.8, respectively; < 0.001 and = 0.014). Hypoenhancement was predominant in low-grade RCC (80.0%). Quantitative parameters, including peak enhancement and wash-in/wash-out area under the curve, significantly differed between tumor grades ( < 0.001). A model using qualitative parameters alone achieved an AUC of 0.847 and 81.9% accuracy. Adding quantitative metrics marginally improved performance (AUC 0.912, accuracy 86.2%), though not significantly. : CEUS provides valuable diagnostic information in differentiating RCC subtypes, with qualitative parameters alone demonstrating strong predictive power. While quantitative analysis slightly enhances diagnostic accuracy, its added value may be limited by technical challenges.
本研究的目的是评估使用定性和定量灌注分析的超声造影（CEUS）在鉴别肾细胞癌（RCC）亚型中的效用。本前瞻性单中心研究纳入了91例经组织学证实的RCC患者。我们在肾切除术前一周内进行了CEUS检查。评估了定性参数（增强模式、异质性、假包膜）和定量灌注指标。建立逻辑回归模型以评估CEUS在鉴别高级别（透明细胞RCC）与低级别RCC（乳头状和嫌色细胞）中的诊断性能。定性CEUS结果显示，高增强和等增强与高级别RCC显著相关（OR分别为38.3和7.8；<0.001和=0.014）。低增强在低级别RCC中占主导（80.0%）。包括峰值增强和曲线下洗入/洗出面积在内的定量参数在肿瘤分级之间存在显著差异（<0.001）。仅使用定性参数的模型的AUC为0.847，准确率为81.9%。添加定量指标略微改善了性能（AUC为0.912，准确率为86.2%），但改善不显著。CEUS在鉴别RCC亚型方面提供了有价值的诊断信息，仅定性参数就显示出强大的预测能力。虽然定量分析略微提高了诊断准确性，但其附加值可能受到技术挑战的限制。
