Diagnostic Value Of Contrast-Enhanced Ultrasound In Renal Tumors

Objective: To investigate the value of contrast-enhanced ultrasound in the diagnosis and differential between benign and malignant r[enal tumors。Methods: 1 45 cases of renal lesions confirmed by surgery were selected,and underwent contrast-enhanced Ultrasound.The time-intensity curves and a series of quantitative parameters were obtained,including the relative peak intensity(ΔPeak)、the relative time to peak(ΔTTP)、the relative area under curve(Δ AUC)and the relative gradient(Δ Grad).All the perfusion parameters were compared with independent-samples t test.45 cases of renal lesions were also examined by contrast-enhanced CT(CECT),to judge benign or malignant.The corresponding sensibility、specificity、precision、positive predictive value(PPV)and negative predictive value(NPV)between CECT and CEUS were compared with chi-square test to judge the diagnostic efficiency and the accuracy.And all lesions were confirmed by pathologic results。Results: The perfusion enhancement modes of renal malignant tumors were different and diversity.1 In malignant tumors,most presented “fast-in and hyper-enhancement significantly”.Twelve of the confirmed malignant tumors presented non-uniform enhancement.And of fifteen renal cell carcinomas,surrounding the tumors appeared pseudocapsule,perilesional rim-like enhancement.The enhancement pattern of benign tumors was mainly “slow-in and iso-enhancement”.Three renal cysts showed no enhancement continuously.Cystic wall 、septum、mural nodules in two complex cysts presented perfusion enhancement.The abscess、necrosis showed no enhancement in three focal inflammatory renal lesions.Four of benign lesions showed inhomogeneous enhancement.The rim of two benign oncocytomas appeared pseudocapsule.2 The slope of ascending curve in the malignant tumors was quick and steep,forming obvious peak;the up slope of curve in the benign tumors was slow and gentle,and had no obvious peak.The intensity curve in cysts showed a small jagged line,along the baseline.3 Difference between the two groups of renal lesions was statistically significant(P<0.05).ΔPeak(3.76±5.50)d B、ΔAUC(190.86±593.98)dBs and ΔGrad(0.53±1.23)d B/s were more than those of benign(-0.04±7.31)dB、(-122.50±448.53)dBs、(-0.31±1.62)dB/s.And ΔTTP(-0.87±5.40)s was shorter than that of benign(1.96±4.11)s.4 There was no statistical difference in the diagnostic sensibility 、 the specificity、the precision and the PPV between CEUS and CECT in diagnosis of renal lesions(P>0.05).But there was a statistical difference in the NPV between CEUS and CECT(P<0.05).Conclusions: CEUS and CECT can provide important information for clinic,both having high accuracy and consistency in diagnosis of renal lesions.CEUS can perform better than CECT in the depiction of tumor vascularity,necrosis,and pseudocapsule timely.Combining TIC quantitatively analyzing the characteristics of the tumor blood perfusion to provide important reference basis,for clinical diagnosis and differential diagnosis of benign and malignant tumor kidney,preoperative selection.