A Comparative Study In The Diagnosis Of Renal Cystic Lesions Between Contrast-enhanced Ultrasonography And Contrast-enhanced Computed Tomography

Purpuse:To compare the different characteristics of contrast-enhanced ultrasonography(CEUS)and contrast-enhanced computed tomography(CECT)in patients with renal cystic lesions,and to compare the diagnostic and differential diagnostic value of CEUS and CECT in the diagnosis of renal cystic lesions.Methods:From September 2017 to September 2019,59 patients with renal cystic lesions diagnosed by conventional ultrasound in our hospital were examined by CEUS and CECT.The final diagnosis was pathological results or imaging follow-up.The characteristics of different signs of CEUS and CECT were analyzed retrospectively.All data was analyzed by SPSS 24.0 software.The mean ± standard deviation was used for quantitative data and the frequency / percentage was used for qualitative data.According to the final diagnosis,renal cystic lesions was divided into two groups: benign and malignant.Chi square test was performed between the two groups of data.The ROC curve was drawn according to the CEUS diagnosis results(CEUS Bosniak III and IV as the diagnosis standard of malignant renal cystic disease)and CECT diagnosis results(CECT Bosniak III and IV as the diagnosis standard of malignant renal cystic disease).The area under the curve(AUC)was analyzed by Medcalc software,and the sensitivity and specificity of CEUS and CECT were calculated respectively.The consistency test with the final diagnosis was conducted by Kappa test,the judgment criteria are as follows: the consistency is good when κ≥0.75,general when 0.4≤κ<0.75,and poor when κ < 0.4.Results:1.According to the final diagnosis,the patients were divided into benign group(n = 20)and malignant group(n = 39).Among 59 cases of renal cystic lesions,45 cases were treated by operation,14 cases had stable follow-up.Postoperative pathological results: renal clear cell carcinoma(n = 36),renal papillary cell carcinoma(n = 3),multilocular cystic nephroma(n = 1),renal abscess(n = 1),renal cyst(n = 4).Stable follow-up of benign renal cystic lesions(n = 14).In 59 cases of renal cystic lesions,CEUS diagnosed Bosniak II(n = 8),Bosniak IIF(n = 8),Bosniak III(n = 20),Bosniak IV(n = 23);CECT diagnosed Bosniak II(n = 10),Bosniak IIF(n = 9),Bosniak III(n = 19),Bosniak IV(n = 21).2.CEUS and CECT showed that the number of intracapsular septum,thickening of intracapsular septum,thickening of cyst wall,enhancement of intracapsular septum,enhancement of cyst wall and solid nodules in the malignant group were significantly more than those in the benign group.There were differences in intracapsular septum thickening,cyst wall thickening,cyst wall enhancement and solid nodule enhancement between the two groups(P < 0.05).There was no difference in the number of intracapsular septum between the two groups(P > 0.05).In addition,there was difference in intracapsular septum enhancement between the two groups on CECT,but there was no difference in CEUS between the two groups.3.CEUS and CECT were used to diagnose malignant renal cystic lesions.Compared with CECT,the sensitivity of CEUS(97.4%)was higher than that of CECT(94.9%),the specificity of CEUS(75.0%)was less than that of CECT(85.0%).The diagnosis of malignant renal cystic lesions by CEUS and CECT were consistent with the final diagnosis(kappa ≥ 0.75).The area under the ROC curve of CEUS and CECT was 0.862 and 0.899 respectively,and there was no significant difference between them(P > 0.05).4.CEUS and CECT were used to diagnose malignant renal cystic lesions.Compared with CECT,the misdiagnosis rate of CEUS(25.0%)was higher than that of CECT(15.0%).The missed diagnosis rate of CEUS(2.5%)was less than that of CECT(5.1%).Conclusion:1.CEUS and CECT are used to diagnose malignant renal cystic lesions.Both of them are consistent with the final diagnosis.CEUS is more sensitive for the detection of malignant renal cystic lesions,and CECT is more specific for the detection of malignant renal cystic lesions.2.CEUS and CECT are used to diagnose malignant renal cystic lesions.the missed diagnosis rate of CEUS for malignant renal cystic lesions is lower,and the misdiagnosis rate of CECT for malignant renal cystic lesions is lower.