Korean J Radiol.  2015 Apr;16(2):334-341. 10.3348/kjr.2015.16.2.334.

Qualitative and Quantitative Analysis with Contrast-Enhanced Ultrasonography: Diagnosis Value in Hypoechoic Renal Angiomyolipoma

• Lu Q
• Huang BJ
• Wang WP
• Li CX
• Xue LY

• KMID: 2070177
• DOI: http://doi.org/10.3348/kjr.2015.16.2.334

Abstract

OBJECTIVE
To evaluate the value of enhancement features and quantitative parameters of contrast-enhanced ultrasonography (CEUS) in differentiating solid hypoechoic renal angiomyolipomas (AMLs) from clear cell renal cell carcinomas (ccRCCs).
MATERIALS AND METHODS
We analyzed the enhancement features and quantitative parameters of CEUS in 174 hypoechoic renal masses (32 AMLs and 142 ccRCCs) included in the study.
RESULTS
Centripetal enhancement pattern was more common in AMLs than in ccRCCs on CEUS (71.9% vs. 23.2%, p < 0.001). At peak enhancement, all AMLs showed homogeneous enhancement (100% in AML, 27.5% in ccRCCs; p < 0.001). Quantitative analysis showed no significant difference between rise time and time to peak. Tumor-to-cortex (TOC) enhancement ratio in AMLs was significantly lower than that in ccRCCs (p < 0.001). The criteria of centripetal enhancement and homogeneous peak enhancement together with TOC ratio < 91.0% used to differentiate hypoechoic AMLs from ccRCCs resulted in a sensitivity and specificity of 68.9% and 95.8%, respectively.
CONCLUSION
Both qualitative and quantitative analysis with CEUS are valuable in the differential diagnosis of hypoechoic renal AMLs from ccRCCs.

Keyword

Angiomyolipoma; Renal cell carcinoma; Contrast-enhanced ultrasonography; Quantitative analysis; Minimal fat

MeSH Terms

Adult
Aged
Angiomyolipoma/*diagnosis/pathology/*ultrasonography
Carcinoma, Renal Cell/*diagnosis/pathology/*ultrasonography
Contrast Media
Diagnosis, Differential
Female
Humans
Kidney Neoplasms/diagnosis/pathology/*ultrasonography
Language
Lipoma/ultrasonography
Male
Middle Aged
Sensitivity and Specificity
Contrast Media

Figure

• 

  Fig. 1 Epithelioid angiomyolipoma (arrows) in 28-year-old man. A. Ultrasonography shows 35 × 34 mm solid hypoechoic lesion in low pole of right kidney. B. At 14 seconds after injection of Sonovue, lesion shows centripetal enhancement. C. At 22 seconds, lesion shows homogeneous peak enhancement. D. Quantitative analysis with CEUS shows TOC ratio of 61.7%. Enhancement degree of lesion is lower than that of adjacent renal cortex (yellow, reference ROI; green, analysis ROI). CEUS = contrast-enhanced ultrasonography, ROI = regions of interest, TOC ratio = tumor-to-cortex enhancement ratio

• 

  Fig. 2 Clear cell renal cell carcinoma (arrows) in 65-year-old man. A. Ultrasonography shows 35 × 32 mm solid hypoechoic lesion, located in upper pole of right kidney. B. At 16 seconds time point post-injection of Sonovue, lesion shows entire enhancement with inner non-enhanced area (asterisk). C. Lesion shows peak enhancement at 22 seconds, with non-enhanced area throughout CEUS progress (asterisk). D. Quantitative analysis with CEUS shows TOC ratio of 178.1%. Enhancement degree of lesion is higher than that of adjacent renal cortex (yellow, reference ROI; green, analysis ROI, encompassing enhanced area as much as possible with irregular shape). CEUS = contrast-enhanced ultrasonography, ROI = regions of interest, TOC ratio = tumor-to-cortex enhancement ratio

• 

  Fig. 3 CEUS shows incomplete pseudocapsule sign (arrows) around homogeneous enhanced lesion. A. 36 × 34 mm epithelioid minimal-fat renal angiomyolipoma in upper pole of right kidney in 43-year-old woman. At 18 seconds time point post-injection of Sonovue. B. 41 × 40 mm epithelioid minimal-fat renal angiomyolipoma in middle pole of left kidney in 52-year-old man. At 20 seconds time point post-injection of Sonovue. CEUS = contrast-enhanced ultrasonography

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