Study On The Relationship Between Contrast Enhanced Ultrasonography And Quantitative Analysis With WHO/ISUP Grade Of Clear Cell Renal Carcinoma

ObjectiveTo investigate the correlation between contrast-enhanced ultrasonography findings and quantitative analysis in WHO/ISUP grade of clear cell renal carcinoma.Methods62 patients with primary clear cell renal carcinoma confirmed by operation and pathology in our hospital from January 2019 to October 2020were collected（all lesions were unilateral and single）.All patients were examined by two-dimensional ultrasound,CDFI and contrast-enhanced ultrasonography before operation.62 cases of renal cell carcinoma were classified according to WHO/ISUP classification,including 9 cases of ISUP1 grade,32 cases of grade 2,16 cases of grade 3 and 5 cases of grade4.In this study,there were 41 cases in the low-level group（ISUP1 grade and 2 grade）and 21 cases in the high-level group（ISUP3 grade and 4grade）.Observed and recorded the location,diameter,sonographic findings andcontrast-enhancedultrasonographyfeaturesofthe lesions（pseudocapsule,enhancement degree,enhancement uniformity,contrast mode and quantitative parameters on TIC curve）.The recorded data were statistically analyzed by T-test,Rank-sum test,Fisher exact probability method,χ²test,subject working characteristic curve and Logistic regression analysis to evaluate the correlation between each index and WHO/ISUP grade of clear cell renal carcinoma.ResultsThere was no significant difference in sex,lesion location,contrast medium perfusion and regression mode,enhancement degree and uniformity,quantitative parametersΔRS、ΔSPH、ΔTTP、ΔIT、ΔT^1/2between low-grade group and high-grade group（P=0.187、1.0、0.633、0.066、1.0、0.288、0.699、0.76、0.201、0.923,P>0.05）.There were significant differences in clinical symptoms,maximum and minimum diameter of mass,occurrence rate of pseudocapsule,quantitative parametersΔAUC andΔPI between the two groups（P=0.03、0.005、0.004、0.015、0.012、0.022,P<0.05）.ROC curve analysis showed that the areas under the curve of maximum diameter,minimum diameter,ΔAUC andΔPI were 0.719,0.728,0.697 and 0.679,respectively.Logistic regression analysis showed that pseudocapsule was closely related to ISUP nuclear grading（OR=6.979,95%CI）,which was an independent predictor of low-grade cc RCC,while large tumor diameter,highΔAUC andΔPI and no circumferential high-enhancement signs suggested high-grade cc RCC.ConclusionContrast-enhanced ultrasonography and quantitative analysis are helpful for the diagnosis,differential diagnosis and WHO/ISUP grade of clear cell renal carcinoma before operation.