| Part I : Application research on Sonazoid contrast-enhanced ultrasound in renal space occupying lesions Objective:To preliminary explore the enhancement features of Sonazoid contrast-enhanced ultrasound in renal space occupying lesions,and compared with Sono Vue contrast-enhanced ultrasound,thus to evaluate the value of Sonazoid contrast-enhanced ultrasound in renal clear cell carcinoma.Methods:A total of 35 patients with renal space-occupying lesions confirmed by pathological or clinical comprehensive evaluation were collected,including 37 lesions,and there were28 clear cell renal carcinomas,5 malignant renal pelvis lesions,and 4 angiomyolipomas.All lesions were examined by conventional ultrasound and Sonazoid CEUS.First observe its conventional ultrasonic characteristics,then according to the time sequence of arrival of contrast agent to renal cortex and lesions,the enhancement methods were divided into fast enhancement(fast forward/simultaneous enhancement),slow enhancement(slow forward)and uncertain.According to the difference of echo intensity between the lesion and the surrounding normal renal cortex,the peak intensity was divided into high/equal enhancement,low enhancement and uncertainty.According to whether there was perfusion defect when the contrast reached the peak,the uniformity of peak-time enhancement was divided into uniform enhancement and non-uniform enhancement.Dynamic images were played back to observe the enhancement process,and the enhancement mode,peak intensity and peak enhancement uniformity were summarized.Compare Sonazoid CEUS images of 28 cases of renal clear cell carcinoma with Sono Vue CEUS images of 22 cases of renal clear cell carcinoma.Then observe the differences of enhancement mode,peak intensity and enhancement uniformity at peak between the two groups.Results:(1)In conventional ultrasound,perfusion defect areas were observed in 12 lesions of28 clear cell carcinomas,while no perfusion defect areas were observed in 4angiomyolipoma lesions and 5 renal pelvis lesions,with an overall display rate of 32%(12/37).After Sonazoid CEUS,19 clear cell carcinomas,2 angiomyolipomas and 1 renal pelvis mass showed perfusion defects,with an overall rate of 59%(22/37).There was statistical significance in the overall rate of renal mass perfusion defect areas between the two(P < 0.05).(2)Among the 28 renal clear cell carcinoma foci,20 showed rapid enhancement,6showed slow enhancement,and 2 showed uncertain enhancement.The peak intensities showed 21 high/equal intensities,5 low intensities and 2 uncertain intensities.At the peak,the enhancement uniformity showed 19 non-uniform enhancement and 9 uniform enhancement.Among the 4 angiomyolipoma lesions,2 were rapid enhancement and 2were slow enhancement.The peak intensity showed two high/equal intensities and two low intensities.The enhancement uniformity showed two homogeneous enhancement and two non-homogeneous enhancement when reaching the peak.Among the 5 renal pelvis lesions,2 lesions were not clearly shown by conventional ultrasound and contrast-enhanced ultrasound,the other 3 lesions showed 1 fast enhancement and 2 slow enhancement.The peak intensity showed two high/equal enhancement and one low enhancement.The enhancement uniformity showed two homogeneous enhancement and one non-homogeneous enhancement when reaching the peak.(3)There were no statistically significant differences in enhancement mode,peak intensity and peak-time enhancement uniformity between 28 Sonazoid CEUS images and22 Sono Vue CEUS images between the two groups.Conclusions:(1)compared with conventional ultrasound,Sonazoid ceus can improve the display of perfusion defect areas in tumor.(2)Sonazoid CEUS of renal clear cell carcinoma showed rapid and heterogeneous enhancement of rich blood supply lesions.(3)Compared with Sono Vue CEUS,Sonazoid CEUS showed no significant difference in the enhancement mode,peak intensity and peak enhancement uniformity.Part II: A preliminary study on quantitative parameters of Sonazoid CEUS for renal clear cell carcinoma Objective:To explore the significance of the quantitative parameters of Sonazoid CEUS time-intensity curve(TIC)in renal clear cell carcinoma.Methods:After excluding the lesions with greater respiratory activity and those without normal renal cortex,25 renal clear cell carcinomas were selected for analysis.The TIC analysis function of GE LOGIQ E9 color ultrasound diagnostic device was used to analyze Sonazoid CEUS images of renal clear cell carcinoma.The focal area and normal renal cortex were selected as regions of Interest ROI,and relevant perfusion parameters were obtained by Wash in curve.IMAX(Maximum intensity),TTP(Time to peak)and Grad(Curve gradient)were analyzed and compared between the lesions and normal renal parenchyma.Results:Compared with the normal renal parenchyma,IMAX and Grad in the lesions were greater than that in the normal renal parenchyma,while TTP was smaller than that in the normal renal parenchyma,with statistically significant differences.Conclusions:Compared with normal renal parenchyma,IMAX and Grad of renal clear cell carcinoma foci are larger than normal renal parenchyma,while TTP is smaller than normal renal parenchyma.It reflects that the blood volume and blood flow in the renal clear cell carcinoma foci are larger than those in the surrounding normal renal parenchyma.It was consistent with the rapid enhancement and high/equal enhancement of contrast-enhanced ultrasound,suggesting that the clear cell carcinoma lesion was rich in blood supply.TIC curve can provide objective quantitative data for disease diagnosis and reduce the error caused by the subjectivity of naked eye observation. |
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