| Objective:The main purpose of our study was to determine the correlation between ccRCC grade,the MVD,the degree of angiogenesis differentiation and CEUS features,so as to determine the practicability of CEUS in evaluating the grade of tumors,the MVD of angiogenesis and the degree of angiogenesis differentiation.Method:This study analyzed angiogenesis features and the CEUS features of 86confirmed patients of ccRCC in our hospital from January 2017 to October 2020.To determine the MVD and differentiation degree of angiogenesis of ccRCC,the angiogenesis of tissue samples were marked with CD34 and CD31 monoclonal antibodies.The CEUS analysis software was used to delineate the region of interest(lesion),to polt the time-intensity curve(TIC),and the relevant parameters were obtained:peak intensity(PI),time to peak(TTP),homogeneity of enhancement,integrity of marginal high-enhancement ring of lesions,contrast agent filling mode and contrast agent clearance mode.All were analyzed statistically.Result:The median values of PI for 30 cases of high grade(WHO/ISUP gradeⅢ-Ⅳ)and 56 case of low grade(WHO/ISUP gradeⅠ-Ⅱ)of ccRCC was 34.5%and 56.6%and the median values of TTP was 21 s and 76 s,respectively.The PI and TTP of high grade were lower than those of low grade of ccRCC,showed relative lack of blood supply.High grade of ccRCC showed incomplete the marginal high-enhancement ring of lesions(63.3%),heterogeneous enhancement(76.7%),slow wash-in(63.3%),slow wash-out(53.3%).Low grade of ccRCC showed incomplete the marginal high-enhancement ring of lesions(58.9%),heterogeneous enhancement(71.4%),fast wash-in(73.2%),fast wash-out(57.1%).There were statistically significant differences between high-grade ccRCC and low-grade ccRCC in PI,TTP,integrity of marginal high-enhancement ring of lesions and contrast agent filling mode(P<0.05).There was no statistical significance in homogeneity of enhancement and contrast agent clearance mode between high grade ccRCC and low grade ccRCC(P>0.05).Receiver operating characteristic(ROC)curve was calculated according to the PI and the results showed that when 45.6%was taken as the cut-off value,the accuracy of distinguishing between high-grade ccRCC and low-grade ccRCC was the highest,with a sensitivity of 90%,a specificity of 62.5%,and an area under curve(AUC)of 0.776,P<0.001.The mean±standard deviation of CD31~+MVD of high-grade and low-grade ccRCC was 41.0±11.1/HP and 66.3±19.2/HP,and CD34~+MVD was 31.52±12.0/HP and 61.1±20.4/HP,respectively.CD31~+MVD and CD34~+MVD of high-grade ccRCC were lower than those of low-grade ccRCC,and the difference was statistically significant(P<0.05).The mean±standard deviation of undifferentiated vessels(CD3~-/CD31~+MVD)of high-grade and low-grade ccRCC was 9.5±3.7/HP and 5.2±4.5/HP,respectively.The undifferentiated vessels(CD34~-/CD31~+MVD)of high-grade ccRCC were higher than those of low-grade ccRCC,and the difference was statistically significant(P<0.001).PI was positively correlated with CD34~+MVD and CD31~+MVD,and PI was negatively correlated with undifferentiated blood vessels(CD34~-/CD31~+MVD).Conclusion:(1)The CEUS features were correlated with tumor grade,the MVD of tumor angiogenesis and degree of angiogenesis differentiation of ccRCC,and CEUS can be used to evaluate tumor grade and angiogenesis in ccRCC.(2)CEUS features of high-grade ccRCC showed decreased in PI and TTP,incomplete the marginal high-enhancement ring of lesions,slow wash-in,showing the characteristics of lack of blood supply;high-grade ccRCC showed decreased MVD of angiogenesis and increased undifferentiated blood vessels,showing the characteristics of lack of blood supply.(3)Preoperative PI can be used as an important predictor of high grade ccRCC. |
