背景:非透明细胞肾细胞癌(nccRCC)是临床上罕见的肾细胞癌(RCC)。现在可以理解,对比增强超声(CEUS)表现出多种表现,并且容易误诊。因此,总结超声造影的独特特征对于区分ccRCC至关重要。
目的:本研究旨在评估定性和定量CEUS在诊断nccRCC中的诊断功效,以增强我们对这种情况的认识。
方法:我们对21例术后确诊的nccRCC患者进行了回顾性分析,并评估了常规超声和CEUS影像学特征。采用配对Wilcoxon符号秩和检验比较病变与正常肾皮质之间CEUS时间-强度曲线(TIC)参数的差异。
结果:常规超声在21例nccRCC病例中显示出以下主要特征:低回声外观(10/21,47.6%),不存在液化(18/21,66.7%),规则形状(19/21,90.5%),边界清晰(21/21,100%),无钙化(17/21,81%)。彩色多普勒血流显像(CDFI)提示低血流信号(仅1例Ⅲ级)。定性CEUS分析表明nccRCC主要表现为缓慢进展(76.1%),快速冲洗(57%),均匀度(61.9%),低增强(71.5%),和戒指增强(61.9%)。定量CEUS分析显示,PE等参数,WiAUC,mTTI,WiR,WiPI,WoAUC,WiWoAUC,病变中的WOR明显低于正常肾皮质(Z=-3.980,-3.563,-2.427,-3.389,-3.980,-3.493,-3.528,-2.763,P<0.001,<0.001,=0.015,=0.001,<0.001,<0.001,<0.001,=0.006)。然而,RT没有显著差异,TTP,FT,或QOF(均P>0.05)。
结论:nccRCC表现出独特的CEUS特征,包括缓慢的进展,快速冲刷,低均匀性增强,和戒指增强,这可以帮助区分nccRCC和ccRCC。
BACKGROUND: Non-clear cell renal cell carcinoma (nccRCC) represents a rare form of renal cell carcinoma (RCC) in the clinic. It is now understood that contrast-enhanced ultrasound (CEUS) exhibits diverse manifestations and can be prone to misdiagnosis. Therefore, summarizing the distinctive features of contrast-enhanced ultrasonography is essential for differentiation from ccRCC.
OBJECTIVE: This study aims to evaluate the diagnostic efficacy of
qualitative and quantitative CEUS in diagnosing nccRCC to enhance our understanding of this condition.
METHODS: We conducted a retrospective analysis of 21 patients with confirmed nccRCC following surgery and assessed the characteristic conventional ultrasound and CEUS imaging features. The paired Wilcoxon signed-rank sum test was employed to compare differences in CEUS time-intensity curve (TIC) parameters between the lesions and the normal renal cortex.
RESULTS: Routine ultrasound revealed the following primary characteristics in the 21 nccRCC cases: hypoechoic appearance (10/21, 47.6%), absence of liquefaction (18/21, 66.7%), regular shape (19/21, 90.5%), clear boundaries (21/21, 100%), and absence of calcification (17/21, 81%). Color Doppler flow imaging (CDFI) indicated a low blood flow signal (only 1 case of grade III).
Qualitative CEUS analysis demonstrated that nccRCC predominantly exhibited slow progression (76.1%), fast washout (57%), uniformity (61.9%), low enhancement (71.5%), and ring enhancement (61.9%). Quantitative CEUS analysis revealed that parameters such as PE, WiAUC, mTTI, WiR, WiPI, WoAUC, WiWoAUC, and WOR in the lesions were significantly lower than those in the normal renal cortex (Z=-3.980, -3.563, -2.427, -3.389, -3.980, -3.493, -3.528, -2.763, P < 0.001, < 0.001, = 0.015, = 0.001, < 0.001, < 0.001, < 0.001, = 0.006). However, there were no significant differences in RT, TTP, FT, or QOF (all P > 0.05).
CONCLUSIONS: nccRCC exhibits distinctive CEUS characteristics, including slow progression, fast washout, low homogeneity enhancement, and ring enhancement, which can aid in distinguishing nccRCC from ccRCC.