The Evaluation Of Contrast-enhanced Ultrasound For Diagnosis Of Small Renal Cell Carcinoma

Objective: Explore the value of contrast-enhanced ultrasound in the diagnosis of small renal carcinoma to improve the diagnostic accuracy of small renal carcinoma.Methods: A total of 30 patients who suffered from renal carcinoma were picked up randomly from Urology Ward 1 in Bai Qiuen Hosipital, Jilin University between October 2014 and February 2016. Those patients underwent both contrast-enhanced ultrasonography and contrast-enhanced CT imaging, with 30 lesions were detected. All patients accepted surgical treatment. The diagnostic results separately from contrast-enhanced ultrasonography and contrast-enhanced CT were compared, according to the pathological diagnostic criteria.Results: 30 cases of kidney tumor patients with pathologically confirmed, including 25 cases of malignant tumors(23 clear cell carcinoma, 1 papillary cell carcinoma, 1 chromophobe cell carcinoma), 5 cases are benign tumor which are renal angiomyolipoma.The maximum diameter of each tumor are less than 3cm while the average diameter is 2.34 cm, which is consistent with the clinical definition of small renal carcinoma.The analysis software of CEUS showed that:In 23 clear cell carcinomas: perfusion pattern of CEUS showed "quick in and quick out ", which accounted for 100.0%(23 / 23); perfusion pattern of CECTshowed "quick in and quick out ", which accounted for 82.6%(19/23), "quick in and slow out" accounted for 17.4%(4/23). Enhancement degree of CEUS showed " hyper-enhanced", accounted for 91.3%(21/23), "hypo-enhanced" accounted for 8.7%(2/23); enhancement degree of CECT showed " hyper-enhanced", accounted for 87.0%(20/23), "hypo-enhanced" accounted for 13.0%(3/23). Enhancement pattern of CEUS showed "homogeneous enhancement" accounted for 17.4%(4/23),"heterogeneous enhancement" accounted for 17.4%(4/23);enhancement pattern of CECT showed "homogeneous enhancement" accounted for 21.7%(5/23),"heterogeneous enhancement" accounted for 78.3%(18/23);Pseudocapsule of CEUS showed "positive" accounted for 39.1%(9/23),"negative" accounted for 60.9%(14/23);pseudocapsule of CECT showed "positive" accounted for 26.1%(6/23), "negative" accounted for 73.9%(17/23);1 case of papillary cell carcinoma,CEUS showed "slow in and slow out", homogeneous hyper enhancement, pseudocapsule sign is positive; CECT showed "quick in and slow out", heterogeneous hyper enhancement, pseudocapsule sign is positive.1 case of chromophobecell carcinoma,CEUS showed "quick in and quick out", homogeneous hyper enhancement, pseudocapsule sign is positive; CECT showed "quick in and slow out", homogeneoushyper enhancement, pseudocapsule sign is positive. Making pathological diagnosis as the gold standard, compared with pathological diagnosis, CEUS"s sensitivity was 92.0%, specificity is 80.0%, positive predictive value was 95.8%, negative predictive value was 66.7%, diagnostic accuracy rate was 90.0%, Youden=0.72; CECT’s sensitivity was 88.0%, specificity was 60.0%, positive predictive value was 91.7%, negative predictive value was 50.0%, diagnostic accuracy rate was 83.3%, Youden=0.52. Compared the consistency in the diagnosis of the small renal carcinoma between CEUS and CECT, the PA=0.96, Pe=0.82,K=0.78.The combined diagnosis approach’s sensitivity was 92.0%, specificity is 60.0%, positive predictive value was 92.0%, negative predictive value was 60.0%, diagnostic accuracy rate was 86.7%, Youden=0.52.Conclusion: 1. In diagnostic procedure of small renal carcinoma, no significant difference in imaging features is shown between CEUS and CECT. 2. CEUS shows relatively high value in the diagnosis of small renal carcinoma. 3. CEUS and CECT are complementary in the diagnostic procedure of small renal carcinoma, and a combined diagnosis approach can improve the accuracy of the diagnosis.