title: The role of directional power Doppler in early detection of the onset of neoangiogenesis in a case of small hyperechoic renal lesion.
abstract: METHODS
  A small hyperechoic renal mass was detected in a 57 year old female. This renal mass was further characterized by the absence of peripheral or intratumoral vascularity using directional power Doppler (dpD); however, there were intralesion spots colored after Levovist (pattern 1, according to Jinzaki). By computer tomography (CT) scan, the renal mass was considered a benign lesion. Three months later, no changes were detected using ultrasonography (US), while there was evidence of a focal intra-lesion neovascular zone using dpD (pattern 1 of Jinzaki). Magnetic resonance imaging (MRI) did not display evidence for malignancy. After six months, the MRI considered the mass an angiomyolipoma (AML). However, a vascular pattern around and inside the mass (pattern 4 of Jinzaki) was evident by using US-dpD and a percutaneous renal biopsy revealed a renal cell carcinoma.
  
  
  CONCLUSIONS
  This case suggests that directional power Doppler is useful for the detection of small hyperechoic renal masses considered benign by both CT scan and MRI, since dpD allows for early detection of the onset and development of neo-vascular structures. Therefore, directional power Doppler sonography would be useful in the follow up of renal masses which mimic benign lesions.
authors.affiliation: Unit of Internal Medicine and Unit of Radiology, Hospital G. Da Procida, Salerno, Italy. pasqualina.disiervi@tiscali.it
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Di Siervi
authors.forename: Federico
authors.initials: F
authors.lastname: Pagano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bellizzi
authors.forename: Anna
authors.initials: A
authors.lastname: Rega
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Terracciano
authors.forename: Domenico
authors.initials: D
authors.lastname: Ricciardi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fiorillo
authors.forename: Biagio
authors.initials: B
authors.lastname: Rossi
mesh_terms: D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D018608:Ultrasonography, Doppler