Comparison Of The Value Of Contrast-enhanced Ultrasound And Enhanced CT In The Diagnosis Of WHO/ISUP Pathological Nuclear Grading Of Renal Clear Cell Carcinoma

Objective:A discussion is made on the preoperative evaluation of clear cell renal cell carcinoma（clear cell renal cell carcinoma）by contrast enhanced ultrasound（CEUS）and contrast enhanced computed tomography（CECT）.The feasibility of ccRCC（World Health Organization/International Society of Urology,WHO/ISUP）pathological nuclear grading,and the diagnostic value and consistency between them were compared,in order to provide a reliable basis for the formulation of treatment and follow-up programs for patients with ccRCC.Method:The data of 45 cases of ccRCC diagnosed by pathology in our hospital from July2017 to December 2021 were collected in this study.Then,qualitative indexes such as lesion location,echo,enhancement uniformity,whether there is false capsule or not,contrast agent perfusion and regression mode,and quantitative indexes such as average lesion diameter,peak intensity（PI）,time to peak（TTP）,△ PI and △ TTP were recorded and analyzed.The location of the lesion,the presence or absence of tumor thrombus,the homogeneity of enhancement of the lesion and other qualitative indicators in the CT images were recorded and analyzed,as well as the average diameter of the lesion,the CT value of the lesion and the renal cortex,the CT value of the cortical phase and the parenchyma phase,the CT difference,the enhancement percentage and the Quantitative indicators such as enhancement index at each stage of the lesion.To compare the accuracy and consistency of CEUS and CECT in assessing the WHO/ISUP classification of ccRCC patients.For data analysis,all data P<0.05 was statistically significant.Result:1.The mean diameters of ccRCC lesions in the low-grade and high-grade groups were 3.3±1.7 cm and 5.5±2.4 cm,respectively,with significant difference between the two groups（P=0.001）.There was no significant difference in gender,age and lesion location between the two groups（P>0.05）.2.Image features of different WHO/ISUP grading imagingThe △PI of ccRCC in the middle and low-level CEUS group was 25.4±19.6%,18 cases（56.3%）of false coatings were visible,26 cases（81.3%）of contrast perfusion mode was "fast forward",the △PI of high-level group ccRCC was 6.2±10.3%,2 cases of false coating（15.4%）,and the contrast agent perfusion mode was "slow forward" 7cases（53.8%）,and there was statistical difference between the two groups.（P < 0.05）.There were no statistical differences in lesion echo,enhancement homogeneity,contrast medium regression pattern,TTP（s）,△TTP and PI between the two groups of ccRCC patients（P > 0.05）.The cortical and parenchymal CT values,CT differences,percent enhancement percentage,and enhancement index of ccRCC lesions in the low-grade and high-grade CECT groups decreased with the increase of WHO/ISUP grading,and there were statistical differences（P<0.05）.In addition,the incidence of tumor thrombus was higher in high-grade ccRCC patients（P<0.05）.3.The diagnostic value and consistency test of the WHO/ISUP classification of ccRCC by CEUS and CECTCEUS and CECT had a high agreement（Kappa value = 0.736,0.747,P <0.001）with no statistical difference in 45 patients（P>0.05）.The receiver operating characteristic（ROC）was plotted according to △ PI and the percentage of lesion cortical phase enhancement,and the area under curve（AUC）was 0.837 and 0.766,respectively,and there was no statistically significant difference in diagnostic value between the two（P >0.05）.After combining the two,the diagnostic accuracy of ccRCC in 45 patients and low-grade group was 95.6% and 96.9%,respectively.CEUS and CECT had low diagnostic consistency for 45 patients（Kappa value =0.325,P=0.029）.The diagnostic consistency was poor in the low-level group ccRCC（Kappa value = 0.200,P = 0.252）and moderate in the high-level group ccRCC（Kappa value = 0.629,P = 0.015）.Conclusion:（1）It is feasible to evaluate the WHO/ISUP classification of ccRCC patients before surgery by CEUS and CECT.（2）There is no significant difference between CEUS and CECT in the diagnostic accuracy of WHO/ISUP classification of ccRCC patients.（3）The diagnostic consistency of CEUS and CECT on the WHO/ISUP grading of45 ccRCC patients was low,and the higher the WHO/ISUP grading,the better the diagnostic consistency between the two.