Skip to main content
Top
Published in: BMC Medical Imaging 1/2020

Open Access 01-12-2020 | Nephrectomy | Research article

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

Authors: Hongli Cao, Liang Fang, Lin Chen, Jia Zhan, Xuehong Diao, Yingchun Liu, Chen Lu, Zhengwang Zhang, Yue Chen

Published in: BMC Medical Imaging | Issue 1/2020

Login to get access

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.
Literature
1.
go back to reference Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRef Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRef
2.
go back to reference Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. Eur Urol. 2019;75(1):74–84.CrossRef Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. Eur Urol. 2019;75(1):74–84.CrossRef
3.
go back to reference Chen XY, Lan M, Zhou Y, Chen WZ, Hu D, Liu JM, et al. Risk factors for bone metastasis from renal cell cancer. J Bone Oncol. 2017;9:29–33.CrossRef Chen XY, Lan M, Zhou Y, Chen WZ, Hu D, Liu JM, et al. Risk factors for bone metastasis from renal cell cancer. J Bone Oncol. 2017;9:29–33.CrossRef
4.
go back to reference Hartman DS, Goldman SM, Friedman AC, Davis CJ Jr, Madewell JE, Sherman JL. Angiomyolipoma: ultrasonic-pathologic correlation. Radiology. 1981;139(2):451–8.CrossRef Hartman DS, Goldman SM, Friedman AC, Davis CJ Jr, Madewell JE, Sherman JL. Angiomyolipoma: ultrasonic-pathologic correlation. Radiology. 1981;139(2):451–8.CrossRef
5.
go back to reference Esheba GS, Esheba NS. Angiomyolipoma of the kidney: Clinicopathological and immunohistochemical study. J Egypt Natl Canc Inst. 2013;25(3):125–34.CrossRef Esheba GS, Esheba NS. Angiomyolipoma of the kidney: Clinicopathological and immunohistochemical study. J Egypt Natl Canc Inst. 2013;25(3):125–34.CrossRef
6.
go back to reference Chen L, Wang L, Diao X, Qian W, Fang L, Pang Y, et al. The diagnostic value of contrast-enhanced ultrasound in differentiating small renal carcinoma and angiomyolipoma. Biosci Trends. 2015;9(4):252–8.CrossRef Chen L, Wang L, Diao X, Qian W, Fang L, Pang Y, et al. The diagnostic value of contrast-enhanced ultrasound in differentiating small renal carcinoma and angiomyolipoma. Biosci Trends. 2015;9(4):252–8.CrossRef
7.
go back to reference Oh TH, Lee YH, Seo IY. Diagnostic efficacy of contrast-enhanced ultrasound for small renal masses. Korean J Urol. 2014;55(9):587–92.CrossRef Oh TH, Lee YH, Seo IY. Diagnostic efficacy of contrast-enhanced ultrasound for small renal masses. Korean J Urol. 2014;55(9):587–92.CrossRef
8.
go back to reference Huang DY, Yusuf GT, Daneshi M, Husainy MA, Ramnarine R, Sellars ME, et al. Contrast-enhanced US – guided interventions: improving success rate and avoiding complications using US contrast agents. Radiographics. 2017;37(2):652–64.CrossRef Huang DY, Yusuf GT, Daneshi M, Husainy MA, Ramnarine R, Sellars ME, et al. Contrast-enhanced US – guided interventions: improving success rate and avoiding complications using US contrast agents. Radiographics. 2017;37(2):652–64.CrossRef
9.
go back to reference Kasoji SK, Chang EH, Mullin LB, Chong WK, Rathmell WK, Dayton PA. A pilot clinical study in characterization of malignant renal-cell carcinoma subtype with contrast-enhanced ultrasound. Ultrason Imaging. 2017;39(2):126–36.CrossRef Kasoji SK, Chang EH, Mullin LB, Chong WK, Rathmell WK, Dayton PA. A pilot clinical study in characterization of malignant renal-cell carcinoma subtype with contrast-enhanced ultrasound. Ultrason Imaging. 2017;39(2):126–36.CrossRef
10.
go back to reference Rübenthaler J, Paprottka K, Marcon J, Hameister E, Hoffmann K, Joiko N, et al. Comparison of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear solid renal lesions. Clin Hemorheol Microcirc. 2016;64(4):757–63.CrossRef Rübenthaler J, Paprottka K, Marcon J, Hameister E, Hoffmann K, Joiko N, et al. Comparison of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear solid renal lesions. Clin Hemorheol Microcirc. 2016;64(4):757–63.CrossRef
11.
go back to reference Xu ZF, Xu HX, Xie XY, Liu GJ, Zheng YL, Lu MD. Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast-enhanced ultrasonography. J Ultrasound Med. 2010;29(5):709–17.CrossRef Xu ZF, Xu HX, Xie XY, Liu GJ, Zheng YL, Lu MD. Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast-enhanced ultrasonography. J Ultrasound Med. 2010;29(5):709–17.CrossRef
12.
go back to reference Jiang J, Chen Y, Zhou Y, Zhang H. Clear cell renal cell carcinoma: contrast-enhanced ultrasound features relation to tumor size. Eur J Radiol. 2010;73(1):162–7.CrossRef Jiang J, Chen Y, Zhou Y, Zhang H. Clear cell renal cell carcinoma: contrast-enhanced ultrasound features relation to tumor size. Eur J Radiol. 2010;73(1):162–7.CrossRef
13.
go back to reference Xue LY, Lu Q, Huang BJ, Li CX, Yan LX, Wang WP. Differentiation of subtypes of renal cell carcinoma with contrast-enhanced ultrasonography. Clin Hemorheol Microcirc. 2016;63(4):361–71.CrossRef Xue LY, Lu Q, Huang BJ, Li CX, Yan LX, Wang WP. Differentiation of subtypes of renal cell carcinoma with contrast-enhanced ultrasonography. Clin Hemorheol Microcirc. 2016;63(4):361–71.CrossRef
14.
15.
go back to reference Markić D, Krpina K, Ahel J, Španjol J, Gršković A, Štifter S, et al. Different presentations of renal cell cancer on ultrasound and computerized tomography. Urologia. 2014;81(4):228–32.CrossRef Markić D, Krpina K, Ahel J, Španjol J, Gršković A, Štifter S, et al. Different presentations of renal cell cancer on ultrasound and computerized tomography. Urologia. 2014;81(4):228–32.CrossRef
16.
go back to reference Yamashita Y, Honda S, Nishiharu T, Urata J, Takahashi M. Detection of pseudocapsule of renal cell carcinoma with MR imaging and CT. AJR Am J Roentgenol. 1996;166(5):1151–5.CrossRef Yamashita Y, Honda S, Nishiharu T, Urata J, Takahashi M. Detection of pseudocapsule of renal cell carcinoma with MR imaging and CT. AJR Am J Roentgenol. 1996;166(5):1151–5.CrossRef
17.
go back to reference Siracusano S, Bertolotto M, Ciciliato S, Valentino M, Liguori G, Visalli F. The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology. World J Urol. 2011;29(5):633–8.CrossRef Siracusano S, Bertolotto M, Ciciliato S, Valentino M, Liguori G, Visalli F. The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology. World J Urol. 2011;29(5):633–8.CrossRef
18.
go back to reference Klezl P, Kaspar M, Klecka J, Richterova R, Stanc O, Burgetova A, et al. The role of contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT) in the preoperative diagnosis of renal lesions. Urologe A. 2018;57(2):181–90.CrossRef Klezl P, Kaspar M, Klecka J, Richterova R, Stanc O, Burgetova A, et al. The role of contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT) in the preoperative diagnosis of renal lesions. Urologe A. 2018;57(2):181–90.CrossRef
19.
go back to reference Ziegelmüller BK, Spek A, Szabados B, Casuscelli J, Clevert DA, Staehler M. Epidemiology and diagnostic assessment of small renal masses. Urologe A. 2018;57(3):274–9.CrossRef Ziegelmüller BK, Spek A, Szabados B, Casuscelli J, Clevert DA, Staehler M. Epidemiology and diagnostic assessment of small renal masses. Urologe A. 2018;57(3):274–9.CrossRef
20.
go back to reference Gummadi S, Eisenbrey JR, Lyshchik A. Contrast-enhanced ultrasonography in interventional oncology. Abdom Radiol (NY). 2018;43:3166–75.CrossRef Gummadi S, Eisenbrey JR, Lyshchik A. Contrast-enhanced ultrasonography in interventional oncology. Abdom Radiol (NY). 2018;43:3166–75.CrossRef
21.
go back to reference Ascenti G, Gaeta M, Magno C, Mazziotti S, Blandino A, Melloni D, et al. Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma. AJR Am J Roentgenol. 2004;182(6):1525–30.CrossRef Ascenti G, Gaeta M, Magno C, Mazziotti S, Blandino A, Melloni D, et al. Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma. AJR Am J Roentgenol. 2004;182(6):1525–30.CrossRef
22.
go back to reference Van Oostenbrugge TJ, Runneboom W, Bekers E, Heidkamp J, Langenhuijsen JF, Veltien A, et al. MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses. Eur Radiol. 2019;29(2):509–16.CrossRef Van Oostenbrugge TJ, Runneboom W, Bekers E, Heidkamp J, Langenhuijsen JF, Veltien A, et al. MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses. Eur Radiol. 2019;29(2):509–16.CrossRef
23.
go back to reference Rübenthaler J, Reimann R, Hristova P, Staehler M, Reiser M, Clevert DA. Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 2015;63(2):89–97.CrossRef Rübenthaler J, Reimann R, Hristova P, Staehler M, Reiser M, Clevert DA. Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 2015;63(2):89–97.CrossRef
24.
go back to reference Kazmierski B, Deurdulian C, Tchelepi H, Grant EG. Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol. 2018;43(4):880–98.CrossRef Kazmierski B, Deurdulian C, Tchelepi H, Grant EG. Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol. 2018;43(4):880–98.CrossRef
25.
go back to reference Sun D, Wei C, Li Y, Lu Q, Zhang W, Hu B. Contrast-enhanced ultrasonography with quantitative analysis allows differentiation of renal tumor Histotypes. Sci Rep. 2016;6:35081.CrossRef Sun D, Wei C, Li Y, Lu Q, Zhang W, Hu B. Contrast-enhanced ultrasonography with quantitative analysis allows differentiation of renal tumor Histotypes. Sci Rep. 2016;6:35081.CrossRef
26.
go back to reference Li CX, Lu Q, Huang BJ, Xue LY, Yan LX, Zheng FY, et al. Quantitative evaluation of contrast-enhanced ultrasound for differentiation of renal cell carcinoma subtypes and angiomyolipoma. Eur J Radiol. 2016;85(4):795–802.CrossRef Li CX, Lu Q, Huang BJ, Xue LY, Yan LX, Zheng FY, et al. Quantitative evaluation of contrast-enhanced ultrasound for differentiation of renal cell carcinoma subtypes and angiomyolipoma. Eur J Radiol. 2016;85(4):795–802.CrossRef
27.
go back to reference Xu ZF, Xu HX, Xie XY, Liu GJ, Zheng YL, Liang JY, et al. Renal cell carcinoma: real-time contrast-enhanced ultrasound findings. Abdom Imaging. 2010;35(6):750–6.CrossRef Xu ZF, Xu HX, Xie XY, Liu GJ, Zheng YL, Liang JY, et al. Renal cell carcinoma: real-time contrast-enhanced ultrasound findings. Abdom Imaging. 2010;35(6):750–6.CrossRef
28.
go back to reference King KG, Gulati M, Malhi H, Hwang D, Gill IS, Cheng PM, et al. Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time-intensity curves: how we do it. Abdom Imaging. 2015;40(7):2461–71.CrossRef King KG, Gulati M, Malhi H, Hwang D, Gill IS, Cheng PM, et al. Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time-intensity curves: how we do it. Abdom Imaging. 2015;40(7):2461–71.CrossRef
29.
go back to reference Lu Q, Xue LY, Huang BJ, Wang WP, Li CX. Histotype differentiation of hypo-echoic renal tumors on CEUS: usefulness of enhancement homogeneity and intensity. Abdom Imaging. 2015;40(6):1675–83.CrossRef Lu Q, Xue LY, Huang BJ, Wang WP, Li CX. Histotype differentiation of hypo-echoic renal tumors on CEUS: usefulness of enhancement homogeneity and intensity. Abdom Imaging. 2015;40(6):1675–83.CrossRef
Metadata
Title
The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound
Authors
Hongli Cao
Liang Fang
Lin Chen
Jia Zhan
Xuehong Diao
Yingchun Liu
Chen Lu
Zhengwang Zhang
Yue Chen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2020
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-020-00436-9

Other articles of this Issue 1/2020

BMC Medical Imaging 1/2020 Go to the issue