The Assessment Of Diagnosis Of Renal Pelvis And Ureter Carcinoma With Contrast-enhanced Ultrasonography

Part one Clinical application and value of diagnosis of renal pelvic carcinoma with contrast-enhanced ultrasonographyObjective To explore the potential value of diagnosis of renal pelvic carcinoma with contrast-enhanced ultrasonography (CEUS).Methods The ultrasonogram of conventional ultrasound and CEUS were analyzed retrospectively in61patients with pathologically proved renal pelvic carcinoma. The size, echo, boundary and color flow signal of renal pelvic lesions were observed by conventional ultrasound. The enhancement pattern and phases of tumors were also observed by CEUS, including wash-in and wash-out time, as well as the perfusion appearances.Results The maximum diameter of61renal pelvic tumors ranged from1.5cm to12.7cm. Conventional ultrasound detected flat mass in18tumors, irregular mass in43tumors and the same side hydronephrosis in32patients. Color Doppler flow imaging (CDFI) disclosed fairly rich flow signal of13tumors, a small amount of flow signal around tumor in20tumors and no-flow signal in the rest tumors. CEUS detected the cortical phase enhancement in all renal pelvic tumors, including synchronously enhancement in22tumors and delayed enhancement in39tumors. At the time of peak enhancement, hypoechogenicity compared to the normal renal cortex was showed in48tumors, hyperechogenicity in6tumors and isoechogenicity in7tumors. Fast wash-out in parenchymal phase was displayed in51tumors, isochronously wash-out in5tumors and delayed wash-out in5tumors. The diagnostic accuracy of the conventional ultrasound and CEUS was54.10%(33/61) and78.69%(48/61), respectively.Conclusion CEUS can depict blood flow supply better than conventional US and improve the diagnostic rate of renal pelvic carcinoma.Part two Clinical application and value of diagnosis of ureteral carcinoma with contrast-enhanced ultrasonographyObjective To study the diagnostic value of contrast-enhanced ultrasonography (CEUS) in ureteral carcinoma.Methods We retrospectively analyzed the ultrasonogram of conventional ultrasound and CEUS in21patients with pathologically proved ureteral carcinoma. The size, inner echoes, boundary and color blood signal of ureteral lesions were observed by conventional ultrasound. The pattern and phases of enhancement, including arrival time, peak time, washout time and appearance of internal structure, were observed by CEUS.Results The maximum length of21ureteral tumors ranged from1.8cm to7.7cm. Conventional ultrasound showed11hypoechoic masses,8isoechoic masses,1hyperechoic mass and1unclear mass. Color Doppler flow imaging (CDFI) showed fairly rich blood signal in8tumors, a small amount of blood signal around tumor in5tumors and no blood signal in the rest. In early phase, CEUS showed enhancement in all21ureteral lesions, including synchronously enhancement in10tumors and delayed enhancement in11tumors. At the time of peak enhancement, hypoechogenicity compared to the normal renal cortex was shown in4tumors, hyperechogenicity in11tumors and isoechogenicity in6tumors. In late phase, fast wash-out was displayed in16tumors, isochronously wash-out in2tumors, delayed wash-out in2tumors and unclear in1tumor. The diagnostic accuracy of the conventional ultrasound and CEUS was38.10%(8/21) and80.95%(17/21) respectively.Conclusion CEUS can improve blood supply and boundary display, as well as the diagnostic rate of ureteral carcinoma.Part three Comparative analysis of diagnosis of renal pelvis and ureter carcinoma by contrast-enhanced ultrasonography and contrast-enhanced computed tomographyObjective To compare and analyze the similarities and differences of the blood perfusion characteristics of renal pelvis and ureter carcinoma displayed by contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography (CECT), and explore the clinical value of contrast-enhanced ultrasonography in renal pelvis and ureter carcinoma.Methods To retrospectively analyze the ultrasonogram of contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography(CECT) in82renal pelvis and ureter carcinoma cases confirmed by operation and pathology. We compared the appearance and characteristics of renal pelvis and ureter carcinoma by these two methods.Results CEUS detected the cortical phase enhancement in all renal pelvis and ureter tumors, including synchronously enhancement in32tumors and delayed enhancement in50tumors. At the time of peak enhancement, hypoechogenicity compared to the normal renal cortex was shown in52tumors, hyperechogenicity in17tumors and isoechogenicity in13tumors. Fast wash-out in parenchymal phase was displayed in57tumors, isochronously wash-out in7tumors and delayed wash-out in7tumors. The minimum diameter of82renal pelvis and ureter carcinoma tumors is1.5cm. CECT showed the enhancement in79tumors, mostly mild to moderate homogeneous enhancement. The enhanced intensity of tumors was lower than those of renal parenchyma. The diagnostic accuracy of CEUS was79.27%(65/82), and the diagnostic accuracy of CECT was87.80%(72/82). The difference was not statistically significant between CEUS and CECT (P>0.05)Conclusion Both CEUS and CECT have higher diagnostic accuracy of renal pelvis and ureter carcinoma, so combining the two methods can increase the detection rate of the renal pelvis and ureter carcinoma.