| Objectives Conventional ultrasound(CUS),superb microvascular imaging(SMI)and contrast-enhanced ultrasound(CEUS)were applied to analyze the ultrasonic characteristics of benign and malignant renal tumors,and to explore the efficacy of single,two,and multiple ultrasound techniques in the diagnosis of benign and malignant renal tumors.Methods A total of 106 patients with 106 renal tumors(62 cases<4cm,44 cases>4cm)diagnosed and treated in affiliated hospital of North China University of Science and Technology from July 2020 to January 2022 were retrospectively collected.106 renal tumors were classified as benign group(40 cases)and malignant group(66 cases)according to pathological and/or enhanced CT and MRI diagnosis and more than 5-year follow-up.CUS and SMI were performed by Canon Aplio i800 color Doppler ultrasonography in 106 patients,and CEUS tests were also performed in 55 patients,and the SonoVue is the contrast agent of CEUS.Data on gender and age were collected.The location,size,echo,boundary,shape,convexity,calcification and anechoic zone characteristics of renal tumors on CUS,blood flow grading,vascular morphology and peripheral blood flow characteristics on SMI,enhanced strength,uniformity,contrast agent entry and regression,pseudocapsule,relationship between tumor and surrounding tissue,peak intensity,peak time and average passing time on CEUS were observed and recorded,respectively.SPSS 24.0 statistical software was used to analyze and compare the differences of ultrasonic characteristics of benign and malignant renal tumors,measurement data were expressed by (?)±s,and comparison between groups was performed by t test,paired t test,enumeration data were expressed by rate,χ2 test and Fisher’s precision probability test were used for comparison between groups,ROC curve was used to evaluate the diagnostic efficacy of single,two and multiple ultrasound techniques for benign and malignant renal tumors,Kappa test was used to evaluate the consistency of diagnosis,and P<0.05 was considered statistically significant.Results 1 Comparison of parameters of 106 benign and malignant renal tumors(40 tumors in the benign group,66 tumors in the malignant group)examined by CUS and SMI:(1)Comparison of general information:The malignant group was predominantly male,while the benign group was predominantly female(χ2=17.140,P<0.001).Patients in the malignant group were older than those in the benign group(t=-2.245,P=0.027).(2)Comparison of CUS characteristics:The maximum diameter of renal tumors in malignant group was larger than that in benign group(t=-4.012,P<0.001).The renal tumors in malignant group mostly showed uneven hypo-echo with fluid anechoic zone,while the renal tumors in benign group mostly showed uniform hyper-echo,and the detection rate of convexity and calcification in malignant group was higher than that of benign group(all P<0.05).The area under ROC curve for CUS diagnosis of 106 benign and malignant renal tumors was 0.699,and the diagnostic accuracy was 71.7%,which was 0.398 consistent with the "gold standard" diagnosis results.(3)Comparison of blood flow characteristics:On color Doppler flow imaging(CDFI)and SMI,the blood flow grade,vascular morphology grade and peripheral ring or semi-ring detection rate of renal tumors in malignant group were higher than those in benign group(all P<0.05).The area under ROC curve for SMI diagnosis of 106 benign and malignant renal tumors was 0.809,and the diagnostic accuracy was 83.0%,which was 0.631 consistent with the "gold standard"diagnosis results.(4)The comparison of CEUS characteristics of 55 benign and malignant renal tumors(18 tumors in the benign group,37 tumors in the malignant group)examined by CEUS:The maximum diameter of renal tumors in malignant group after CEUS was larger than that on CUS(t=7.217,P<0.001).Renal tumors in malignant group mostly showed uneven and high enhancement of centripetal "fast into and fast retreat" and high detection rate of pseudocapsule,while renal tumors in benign group mostly showed uniform and equal enhancement of overall or centrifugal "simultaneous into and slow retreat" and low detection rate of pseudocapsule(all P<0.05).Compared with malignant renal tumor surrounding normal renal cortex and benign group renal tumor,the renal tumor in malignant group had higher peak intensity and shorter time to peak,and malignant group renal tumor had shorter mean transit time than surrounding normal renal cortex(all P<0.05).The area under ROC curve of CEUS in diagnosing 55 benign and malignant renal tumors was 0.792,and the diagnostic accuracy was 87.3%,which was 0.689 consistent with the "gold standard" diagnosis results.2(1)The area under ROC curve for CUS combined with SMI diagnosis of 106 benign and malignant renal tumors was 0.852,the diagnostic accuracy was 87.7%,which was 0.730 consistent with the "gold standard"diagnosis results;(2)Among the 55 renal tumors examined by CEUS,the area under ROC curve for CUS combined with CEUS diagnosis of 55 benign and malignant renal tumors was 0.861,the diagnostic accuracy was 90.9%,which was 0.778 consistent with the "gold standard" diagnosis results.3 Among the 55 renal tumors examined by CEUS,CUS combined with SMI and CEUS for the diagnosis of benign and malignant renal tumors,the area under ROC curve was 0.917,and the diagnostic accuracy was 94.5%,which was 0.871 consistent with the "gold standard" diagnosis results.4(1)Comparison of parameters benign and malignant renal tumors of 62≤4cm examined by CUS and SMI:On CUS,the detection rate of convex protrusion in malignant group was higher than that in benign group(χ2=5.939,P=0.015).On SMI,dendritic blood flow dominant in malignant group.The diagnostic accuracy of CUS combined with SMI for differentiating benign and malignant kidney tumors in ≤4cm was 90.3%,it was significantly higher than CUS and SMI.(2)Comparison of parameters benign and malignant renal tumors of 44>4cm examined by CUS and SMI:On CUS,there was no significant difference in the detection rate of convex protrusion between benign and malignant group(χ2=0.021,P=0.884).On SMI,irregular blood flow dominant in malignant group.The diagnostic accuracy of CUS combined with SMI for differentiating benign and malignant kidney tumors in>4cm was 84.0%,it was higher than CUS and SMI.Conclusions 1 SMI can display low-speed microblood flow information and provide imaging basis for preoperative evaluation of the nature of renal tumors.Malignant renal tumors are mainly characterized by dendritic or irregularly shaped grade 3 blood flow,and the peripheral blood flow is mostly circular.2 On CEUS,the uneven high enhancement of"fast into and fast retreat",the pseudocapsule,and the maximum diameter of the tumor increased after CEUS can be used as the specific CEUS characteristics for the determination of malignant kidney tumor.CEUS quantitative analysis is helpful for the objective judgment of the nature of kidney tumor.3 Multi-mode ultrasound has high diagnostic efficiency for benign and malignant renal tumors,which is helpful for preoperative accurate prediction of benign and malignant renal tumors.Figure 8;Table 24;Reference 119... |
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