The Clinical Study Of Contrast-enhanced Ultrasonography In The Qualitative Diagnosis Of Benign And Malignant Tumors Of The Kidney

Objective 1. To evaluate qualitative diagnostic value of conventional ultrasound for benign and malignant tumors of kidney. 2. To evaluate qualitative diagnostic value of contrast-enhanced ultrasound(CEUS) for benign and malignant tumors of kidney. 3.To study on the correlation between Contrast-enhanced ultrasonography Mode and Fuhrman nuclear grading in subtypes of renal cell carcinoma.Methods 207 cases(207 lesions) patients with renal tumors, which were confirmed by pathological diagnosis. with conventional ultrasound, to observate area, size, internal echo,boundary and blood flow of tumors and to evaluate its qualitative diagnostic value of benign and malignant tumors of kidney;tumors were examed by CEUS, continuous, real-time, dynamic observation of CEUS perfusion for benign and malignant tumors of kidney, recording the enhanced form and mode during period stage, essence stage, fade stage after contrast agents are injected, comparing with enhanced CT(CECT), evaluating its qualitative diagnostic value for benign and malignant tumors of kidney;In this study, 93 cases of renal cell carcinomas’ subtype(80 cases of renal clear cell carcinomas, 13 cases of renal color cell carcinomas,to analyze their enhanced mode and time-intensity curve parameters, including Peak intensity, time to peak(TP), Sharpness, the area under the curve(AUC),and to evaluate their relevance with the nuclear grade.Results 77 cases of renal benign tumors, 130 cases of malignant tumors, 72 cases of benign tumors and 135 cases of malignant tumors are diagnosed by conventional ultrasound, the diagnostic coincidence rate is 88.9%; the diagnostic accordance rate of Conventional ultrasonography in angiomyolipomas, complex renal cyst, clear cell carcinoma, chromophobe cell carcinoma, papillary carcinoma, invasive urothelial carcinoma were 81.5%, 75.0%, 87.5%, 75.0%,20.0% and 56.2%, respectively.Manifestations of CEUS : Renal angiomyolipomas were mainly for "simultaneously in slow out"(66.1%), "slow in slow out"(16.9%), low enhancement(58.5%),high enhancement(36.9%);Complexity renal cysts were mainly for "slow in slow out"(41.7), low enhancement(33.3%) or no enhancement(41.7%);Clear cell carcinomas were mainlyfor "fast in fast out"(55%), high enhancement(85%).chromophobe cell carcinomas were mainly for "fast in fast out"(46.1%), low enhancement(53.8%), in which 3 cases(23%) were wheel radial high echo;Papillary carcinomas were mainly for "slow in slow out"(80%), high enhancement(60%).Invasive urothelial carcinomas were mainly for "slow in fast out"(59.4%),high enhancement(75%).the diagnostic accordance rate of CEUS in angiomyolipomas,complex renal cyst, clear cell carcinoma, chromophobe cell carcinoma, papillary carcinoma,invasive urothelial carcinoma were 95.4%, 83.3%, 91.2%, 83.3%, 40%, 71.9%, respectively.The diagnostic accordance rate of CECT for angiomyolipomas, complex renal cyst, clear cell carcinoma, chromophobe cell carcinoma, papillary carcinoma, invasive urothelial carcinoma were93.8%, 75%, 88.8%, 75%, 40% and 75%, respectively.GradeⅠccRCC were mainly for "slow in slow out", accounted for 39%(14/35); grade Ⅱ and Ⅲ ccRCC were mainly for "fast in fast out",were 67%(16/23), and 67%(3/4);Time intensity curve parameters,such as TP and Sharpness were correlated to nuclear grading.Grade ⅡcRCC were mainly for "slow in slow out", accounted for39%(14/35);Grade Ⅲ cRCC were mainly for "fast in fast out", accounted for 67%(16/23);Sharpness was associated with nuclear grade. Peak and TP between grade Ⅲ andⅠccRCC, difference were statistically significant;Peak and sharpness between grade Ⅲ and ⅡccRCC were statistically significant;Peak and sharpness between grade Ⅲ cRCC were statistically significant(P < 0.05).Conclusions Conventional ultrasound was helpful for qualitative diagnosis of benign and malignant tumors of kidney, but it can’t betterly evaluate microflow of tumors;to some extent,CEUS and CECT can compensate this disadvantage, they have no obvious difference for the diagnostic efficiency for renal benign and malignant tumors of renal, all providing important basis for clinical diagnosis, but CEUS has more value in blood perfusion, psuedocapsule display and diagnosing small renal cancer;time intensity curve parameters of RCC subtypes were associated with fuhrman nuclear grading;TP had the most significant correlation on ccRCC nuclear grading;Sharpness had the most significant correlation on cRCC nuclear grading;Peak may be used to differentiate ccRC and cRCC.