Computerized contrast angiosonography: a new diagnostic tool for the urologist?
OBJECTIVE
To evaluate the diagnostic potential of echo-enhanced ultrasonography (US) for depicting the vascularization pattern of renal cell carcinoma (RCC), and calculating the first-pass effect using harmonic imaging, against that obtained by triphasic helical computed tomography (CT).


METHODS
Sixty patients with surgically confirmed RCC underwent US using B-mode and power Doppler methods with or without an intravenous microbubble echo-enhancing agent. After depicting and defining the tumour extent by B-mode US, the first-pass effect/enhancement by the echo-enhancing agent within the lesion, and that of a reference area of unaffected renal cortex, were recorded on-line by calculating the mean pixel intensity. Time-intensity curves, i.e. the rise time and gradient of both the suspected tumour and reference areas, were constructed.


RESULTS
Using B-mode US, the extent of all tumours was delineated (mean tumour size 3.8 cm, SD 0.6). After applying the microbubble agent all tumours were enhanced, whereas the perfusion was decreased (in 48%), increased (in 16%) or similar (in 36%) compared with the cortical reference area. Using the Hounsfield classification, these results correlated well with the hypo/hypervascularity shown on CT.


CONCLUSIONS
Ultrasonography has considerable potential in diagnosing RCC, if combined with echo-enhancing methods, harmonic imaging and computer-based calculation of tumour vascularization. Dynamic US studies should provide a diagnostic yield similar to that of CT.
Reichelt
O
O
Department of Urology, Friedrich-Schiller-University Jena, Germany. olaf.reichelt@med.uni-jena.de
Wunderlich
H
H
Weirich
T
T
Schlichter
A
A
Schubert
J
J
D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D009389:Neovascularization, Pathologic; D010865:Pilot Projects; D011134:Polysaccharides; D018615:Ultrasonography, Doppler, Color / Q000379:methods
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508