title: Evaluation of renal masses with contrast-enhanced ultrasound: initial experience.
abstract: OBJECTIVE
  Nearly 25% of solid renal tumors are indolent cancer or benign and can be managed conservatively in selected patients. This prospective study was performed to determine whether preoperative IV microbubble contrast-enhanced ultrasound can be used to differentiate indolent and benign renal tumors from more aggressive clear cell carcinoma.
  
  
  METHODS
  Thirty-four patients with renal tumors underwent preoperative gray-scale, color, power Doppler, and octafluoropropane microbubble IV contrast-enhanced ultrasound. Three blinded radiologists reading in consensus compared rate of contrast wash-in, grade and pattern of enhancement, and contrast washout compared with adjacent parenchyma. Contrast ultrasound findings were compared with surgical histopathologic findings for all patients.
  
  
  RESULTS
  The 34 patients had 23 clear cell carcinomas, three type 1 papillary carcinomas, one chromophobe carcinoma, one clear rare multilocular low-grade malignant tumor, two unclassified lesions, three oncocytomas, and one benign angiomyolipoma. The combination of heterogeneous lesion echotexture and delayed lesion washout had 85% positive predictive value, 43% negative predictive value, 48% sensitivity, and 82% specificity for predicting whether a lesion was conventional clear cell carcinoma or another tumor. Diminished lesion enhancement grade had 75% positive predictive value, 81% negative predictive value, 55% sensitivity, and 91% specificity for non-clear cell histologic features, either benign or low-grade malignant. Combining delayed washout with quantitative lesion peak intensity of at least 20% of kidney peak intensity had 91% positive predictive value, 40% negative predictive value, 63% sensitivity, and 80% specificity in the prediction of clear cell histologic features.
  
  
  CONCLUSIONS
  Ultrasound features of gray-scale heterogeneity, lesion washout, grade of contrast enhancement, and quantitative measure of peak intensity may be useful for differentiating clear cell carcinoma and non-clear cell renal tumors.
authors.affiliation: Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Rm 705, New York, NY 10065, USA. gersts@mskcc.org
authors.forename: Scott
authors.initials: S
authors.lastname: Gerst
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Hann
authors.forename: Duan
authors.initials: D
authors.lastname: Li
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Satish
authors.initials: S
authors.lastname: Tickoo
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sohn
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren