The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound

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Abstract

Background

The value of contrast-enhanced ultrasound (CEUS) in differentiating between renal cell carcinoma (RCC) and angiomyolipoma (AML) was analyzed. The purpose of this study was to identify the independent indicators of CEUS for predicting RCC.

Methods

A total of 172 renal tumors (150 RCCs, 22 AMLs) in 165 patients underwent conventional ultrasound (CUS) and CEUS examinations before radical or partial nephrectomy, and the features on CUS and CEUS were analyzed.

Results

There were significant differences in echogenicity, blood flow signals in color Doppler flow imaging (CDFI), peak intensity, homogeneity of enhancement, wash in, wash out, and perilesional rim-like enhancement between RCC and AML ( P < 0.05 for all). Multivariate analysis indicated that perilesional rim-like enhancement ( P = 0.035, odds ratio [OR] = 9.907, 95% confidence interval [CI]: 1.169–83.971) and fast wash out ( P = 0.001, OR = 9.755, 95%[CI]: 2.497–38.115) were independent indicators for predicting RCC. The area under the receiver operating characteristic (ROC) curve (AUC) for perilesional rim-like enhancement was 0.838 (95% CI: 0.774–0.890) with 76.7% sensitivity and 90.9% specificity, while the AUC of fast wash out was 0.833 (95% CI:0.768–0.885) with 74.7% sensitivity and 81.8% specificity.

Conclusions

This study indicated that CEUS has value in differentiating RCC and AML. Present perilesional rim-like enhancement and fast wash out may be important indicators for predicting RCC.

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Most cited references 27

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Clear cell renal cell carcinoma: contrast-enhanced ultrasound features relation to tumor size.

Jun Jiang, Yaqing Chen, Yongchang Zhou … (2010)

To analyze the contrast-enhanced ultrasound (CEUS) features of clear cell renal cell carcinoma (CCRCC) in relation to tumor size.

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Detection of pseudocapsule of renal cell carcinoma with MR imaging and CT.

J Urata, T Nishiharu, S Honda … (1996)

A pseudocapsule surrounding a renal cell carcinoma is a pathologic feature seen frequently in the early stages of this disease. Partial nephrectomy or simple enucleation may be indicated when a pseudocapsule is detected. The purpose of this study is to analyze the roles of MR imaging and CT in showing the pseudocapsule in renal cell carcinomas. MR imaging and CT appearances of the kidneys in 52 patients with 54 renal cell carcinomas--and 40 patients with 45 other renal masses for comparison--were prospectively analyzed and correlated with pathologic results. The frequency of a pseudocapsule in renal cell carcinomas and in various renal tumors was analyzed. We compared the detectability of a pseudocapsule in renal cell carcinomas with MR imaging on T1-weighted spin-echo, T2-weighted spin-echo, and contrast-enhanced T1-weighted spin-echo sequences, and on contrast-enhanced CT. At pathologic evaluation, a pseudocapsule was seen in 66% (19 of 29) of tumors 4 cm or less in diameter and in 28% (7 or 25) of tumors larger than 4 cm in diameter. All tumors with a pseudocapsule were low histologic grade. Large renal cell carcinomas and other tumors appeared expansile but not encapsulated. A rim corresponding to the pseudocapsule was seen around the tumor in seven lesions on T1-weighted images, 26 lesions on T2-weighted images, and 11 lesions on postcontrast T1-weighted images. T2-weighted imaging was the most sensitive technique for visualization of the pseudocapsule (sensitivity, 68%; specificity, 91%). All pseudocapsules detected on T1-weighted images or postcontrast T1-weighted images could be detected on T2-weighted images. With postcontrast images, enhancement of the pseudocapsule resulted in poor contrast relative to the surrounding tissue. At contrast-enhanced CT, the pseudocapsule was not visible in any tumors. In all MR imaging sequences and in CT, a pseudocapsule were not found in other pathologic conditions except oncocytoma. A pseudocapsule was seen in 66% of renal cell carcinomas 4 cm in diameter or smaller. T2-weighted MR imaging is the most sensitive technique for showing this feature.

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Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma.

Silvio Mazziotti, CARLO MAGNO, G Zimbaro … (2004)

Our purpose was to assess the capacity of contrast-enhanced second-harmonic sonography to detect a pseudocapsule in renal masses compared with conventional gray-scale sonography. SUBJECTS AND METHODS. Thirty-two patients with 40 renal masses suspicious for renal cancer (mean diameter, 3.1 cm) were prospectively studied with contrast-enhanced second-harmonic sonography during IV administration of a second-generation sonographic contrast agent. The sonographic criteria for the presence of a pseudocapsule were a peritumoral hypoanechoic halo on conventional gray-scale imaging and a rim of perilesional enhancement, increasing in the tardive phase of the examination, on contrast-enhanced second-harmonic imaging. Multiphasic helical CT or dynamic MRI or both were performed in all patients. Final diagnoses of the 40 renal masses were as follows: hemorrhagic cysts, five; angiomyolipomas, four; lymphomas, four; metastasis from lung cancer, one; and renal cell carcinomas (RCCs), 26. Histologic diagnosis of RCC was surgically obtained in all patients. Nephron-sparing surgery was performed in 12 of 26 RCCs, and radical nephrectomy was performed in the remaining 14. At pathologic examination, pseudocapsule was found in 14 (53.8%) of 26 RCCs. On conventional sonography, the presence of a pseudocapsule was detected in 3 of 14 RCCs (sensitivity, 21%). Sonographic contrast-enhanced harmonic imaging revealed the presence of pseudocapsule in 12 of 14 RCCs (sensitivity, 85.7%). In the remaining 12 RCCs with either absent or extensive neoplastic infiltration of pseudocapsule seen at pathologic evaluation, pseudocapsule was not visible on either conventional or contrast-enhanced second-harmonic sonography. The pseudocapsule was not visible in any of the 14 noncancerous renal masses on either conventional or contrast-enhanced sonography. Sonographic contrast-specific imaging with a second-generation contrast agent is effective in improving the sonographic visualization of tumoral pseudocapsule. This finding could be useful both in the sonographic diagnosis and in the choice of conservative surgery for renal cell carcinoma. The potential role of second-harmonic contrast-enhanced sonography in the management of renal cell carcinoma should be investigated in larger series and compared with the findings of state-of-the-art MRI and CT.

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Author and article information

Contributors

Lin Chen: cl_point@126.com

Journal

Journal ID (nlm-ta): BMC Med Imaging

Journal ID (iso-abbrev): BMC Med Imaging

Title: BMC Medical Imaging

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2342

Publication date (Electronic): 30 March 2020

Publication date PMC-release: 30 March 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 32

Affiliations

[1 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Department of Ultrasound, Huadong Hospital, , Fudan University, ; 211 West Yan’an Road, Shanghai, China

[2 ]Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China

[3 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Department of Pathology, Huadong Hospital, , Fudan University, ; Shanghai, China

[4 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Department of Urology, Huadong Hospital, , Fudan University, ; Shanghai, China

Article

Publisher ID: 436

DOI: 10.1186/s12880-020-00436-9

PMC ID: 7104488

PubMed ID: 32228606

SO-VID: bc2b531b-a6de-441b-87f4-5f3082e7d281

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 28 November 2019

Date accepted : 24 March 2020

Funding

Funded by: Shanghai Municipal Health and Family Planning Commission of China

Award ID: 201640285

Award Recipient : Lin Chen

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ScienceOpen disciplines: Radiology & Imaging

Keywords: renal cell carcinoma,angiomyolipoma,contrast-enhanced ultrasound,ultrasonography

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ScienceOpen disciplines: Radiology & Imaging

Keywords: renal cell carcinoma, angiomyolipoma, contrast-enhanced ultrasound, ultrasonography

The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound

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Abstract

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Most cited references 27

Clear cell renal cell carcinoma: contrast-enhanced ultrasound features relation to tumor size.

Detection of pseudocapsule of renal cell carcinoma with MR imaging and CT.

Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma.

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