title: Investigation of Renal Cell Carcinoma by Contrast-Enhanced Ultrasound- Predictive Value of Time Intensity Curve Analysis in Establishing Local Tumor Invasion and Stage: A Pilot Study.
abstract: OBJECTIVE
  Contrast-enhanced ultrasound (CEUS) allows for real-time examination of signal intensity changes in a region of interest (ROI) and quantification of contrast agent kinetics. This study assessed the predictive ability of time-intensity curve (TIC) parameters for local tumor invasion and T stage of renal cell carcinoma (RCC).
  
  
  METHODS
  Renal tumors in 41 patients were examined by CEUS. Thirty-two met the inclusion criteria, with a total of 33 tumors (27 clear cell, 4 chromophobe, and 2 papillary type I). Nineteen (57.6%) tumors were included in group A (stages pT1 and pT2) and 14 (42.4%) in group B (stage pT3). ROIs were established as: whole tumor (TuW); tumor area with the highest signal intensity (TuMAX) and renal cortex (Ref). The TIC param­eters for each ROI were calculated as below: peak signal intensity, time to peak (TTP), rise time (RT), and mean transit time (MTT). They were analyzed as a whole value for each ROI and as a ratio between the different ROIs.
  
  
  RESULTS
  There were significant differences between the tumors invading and not invading the renal sinus fat for TTP (TuW/Ref) [0.98 (0.67-1.25) vs. 1.18 (1.08-1.3), P < .05]. For differentiation between groups A and B, the following ratios were proven as predictors by univariate regression analysis: TTP (TuMAX/TuW); MTT (Tu­MAX/TuW); RT (TuMAX/TuW) (P = .03, P = .01 and P = .02, respectively). The value derived from the Receiver Operating Characteristic (ROC) curve for RT (TuMAX/TuW) was 0.8 with sensitivity = 78.6%, specificity = 89.5%, and cutoff value of > 0.91.
  
  
  CONCLUSIONS
  TIC parameters were predictors of locally noninvasive and invasive RCC.
authors.affiliation: Department of Ultrasonography, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. attitamas@yahoo.com.
authors.forename: Attila
authors.initials: A
authors.lastname: Tamas-Szora
authors.affiliation: Department of Ultrasonography, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Socaciu
authors.affiliation: Department of Urology, Cluj-Napoca Municipal Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Crișan
authors.affiliation: Department of Urology, Cluj-Napoca Municipal Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Florentin
authors.initials: F
authors.lastname: Dobrotă
authors.affiliation: Department of Urology, Cluj-Napoca Municipal Hospital, Iuliu Ha?ieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Paul
authors.initials: P
authors.lastname: Prunduș
authors.affiliation: Department of Pathology, Cluj-Napoca Municipal Hospital, Iuliu Ha?ieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Cătălina
authors.initials: C
authors.lastname: Bungărdean
authors.affiliation: Department Of Radiology and Imaging, Târgu Mures County Emergency Hospital, University of Medicine and Pharmacy, Târgu Mures, Romania.
authors.forename: Mircea
authors.initials: M
authors.lastname: Buruian
authors.affiliation: Department of Urology, Cluj-Napoca Municipal Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Coman
authors.affiliation: Department of Anatomy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Iulian
authors.initials: I
authors.lastname: Opincariu
authors.affiliation: Department of Ultrasonography, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Badea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D003287:Contrast Media