title: Differentiation of subtypes of renal cell carcinoma with contrast-enhanced ultrasonography.
abstract: We aimed to assess the difference of enhancement patterns among the three RCC subtypes with contrast-enhanced ultrasound (CEUS). Two hundreds cases of pathologically proved clear cell renal cell carcinomas (ccRCC), 58 papillary renal cell carcinomas (pRCC) and 51 chromophobe renal cell carcinomas (chRCC) underwent preoperative conventional ultrasound and CEUS. The wash-in and wash-out pattern, peak enhancement degree and homogeneity, and the presence of pseudocapsule were evaluated by two blinded observers respectively. The interreader agreement in the characterization of CEUS features between two observers was good (κ  = 0.649-0.775). Compared with pRCCs and chRCCs, ccRCCs demonstrated higher frequency of simultaneous wash-in pattern, hyperenhancement and heterogeneity with necrotic areas. Most pRCCs and chRCCs manifested hypoenhancement, homogeneity, fast wash-out and presence of pseudocapsule. The only difference we obtained between pRCC and chRCC was the wash-in pattern, with slow wash-in in pRCC and simultaneous wash-in in chRCC. In small lesions with long diameter≤3 cm, the majority of the three subtypes of RCC showed homogeneous enhancement and there was no difference among them. CEUS was a useful method to preoperatively differentiate the ccRCC from non-ccRCC subtypes. There were no distinguishing features identifid on CEUS that allowed reliable differentiation of pRCC from chRCC.
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Medical Imaging, Shanghai, China.
authors.forename: Li-Yun
authors.initials: LY
authors.lastname: Xue
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Medical Imaging, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Medical Imaging, Shanghai, China.
authors.forename: Bei-Jian
authors.initials: BJ
authors.lastname: Huang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Medical Imaging, Shanghai, China.
authors.forename: Cui-Xian
authors.initials: CX
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Medical Imaging, Shanghai, China.
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Yan
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Medical Imaging, Shanghai, China.
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D002454:Cell Differentiation; D003287:Contrast Media / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Clear cell renal cell carcinoma; chromophobe renal cell carcinoma; contrast-enhanced ultrasonography; differential diagnosis; papillary renal cell carcinoma