Value Of Contrast-enhanced Ultrasound In The Qualitative Diagnosis Of Renal Carcinoma And Its Correlation With Pathological Types

Objective To investigate the relationship between contrast-enhanced ultrasonic characteristics of clear cell renal carcinoma(ccRCC)and tumor invasiveness and to analyze the value of contrast-enhanced ultrasonography in the differential diagnosis of renal clear cell carcinoma and chromophobe renl cell carcinoma(chRCC).To further evaluate the diagnostic efficacy of contrast-enhanced ultrasound in renal cell carcinoma.Methods Collected that performed the preoperative contrast-enhanced ultrasonic examination of renal and 75 cases of patients with cc RCC confirmed by postoperative pathology from May 2012 to June 2015,According to the pathological results,renal clear cell carcinoma was divided into non-invasive group(41 cases),invasion group(34 cases),among them,the invasion group was divided into invaded without penetrated the renal capsule group(12 cases)and invaded and penetrated the renal capsule group(22 cases).And then collected from May 2013 to May 2016 that performed the preoperative contrast-enhanced ultrasonic examination of renal and 86 cases of patients with ccRCC and 11 cases of patients with chRCC confirmed by postoperative pathology.the dynamic datas of constrast-enhanced ultrasound of all the tumors were studied and analyzed in the way of retrospective.Observe the degree of enhancement,enhanced and regression phase,enhance uniformity,peripheral pseudocapsule sign of the tumors.And then through the Q-Lab software in the instrument by selecting a region of interest in the tumor and the surrounding normal renal parenchyma respectively to product the time-enhanced curve.From the curve to obtain the relevant quantitative analysis parameters,Including the arrive time(AT),rise time(RT),time to peak(TTP),curve sharpness(sharpness),area under the curve(AUC)and peak intensity(PI),And obtains the corrected AT(?AT),TTP(?TTP),PI(?PI)by calculation.And then were analyzed.Results 1.The contrast-enhanced ultrasonography image of ccRCC in the enhancement,regression phase and the enhanced degree,there was no significant difference between non-invasive group and invasion group(P = 0.121,P = 0.16,P = 0.085).The inhomogeneous enhancement of ccRCC was more common in invasion group(P <0.001),while the psuedocapsuleand the diameter ? 3 cm of ccRCC was more common in non invasion group(P < 0.001,P =0.005).2.The Sharpness,AUC and ?PI of ccRCC in invasion group were higher than those of the non invasion group(P = 0.008,P = 0.524,P = 0.004),ccRCC invaded and penetrated the capsule were higher than that invaded without penetrated the capsule on the Sharpness and ?PI(P = 0.008,P = 0.004).3.ccRCC were mainly her-enhancement(46/86,53.49%),diffusibility enhancement(58/86,67.44%),nonuniform enhancement(65/86,75.58%),and 54.65%(47/86)had psuedocapsule.chRCC were mainly low enhanment(22/31,70.97%),centripetal enhancement(17/31,54.83%),homogeneous enhancement(20/31,64.52%),and 61.29%(19/31)had psuedocapsule.there was statistical difference in enhanced degree,pattern and shape between ccRCC and chRCC(P< 0.001,P = 0.012,P< 0.001),but there was no statistical difference in detection rate of psuedocapsule(P = 0.523).4.There were no statistical difference in ?AT and?TTP between ccRCC and chRCC(P = 0.068,P = 0.077).?PI of ccRCC was significantly higher than that of chRCC(P < 0.001).Taking ?PI = 0.05% as the threshold to differential diagnosis of ccRCC and ch RCC,it had the highest accuracy rate,and sensiticity of was 84.9%,specificity was100%,the AUC of the ROC curve was 0.97.the percentage of cc RCC with perirenal and(or)renal sinus fat involvement,renal hilum and(or)retroperitoneal lymph node metastasis were both higher than those of chRCC(P = 0.025,P = 0.027).Result There are different CEUS characteristics about ccRCC has or does not violate the surrounding tissue,CEUS can be used for initial evaluation of ccRCC invasiveness.ccRCC and chRCC also have different characteristics in qualitative observation and quantitative parameters of contrast-enhanced ultrasound,contrast-enhanced ultrasound has a differential diagnostic value for both.