title: Quantitative evaluation of contrast-enhanced ultrasound for differentiation of renal cell carcinoma subtypes and angiomyolipoma.
abstract: OBJECTIVE
  To investigate the value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in the differentiation of subtypes of renal cell carcinoma (RCC) and angiomyolipoma (AML).
  
  
  METHODS
  The quantitative characteristics of 341 RCCs and 88 AMLs were analyzed with quantitative software (SonoLiver). Quantitative analysis was conducted in the whole tumor (ROItumor) and the maximum enhanced area of the tumor (ROImax), acquiring the parameters of maximum intensity (IMAX), rise time (RT), time to peak (TTP), mean transit time (mTT), and area under the curve (AUC), were derived and analyzed. The difference values between ROImax and normal renal cortex (ΔPar.s, including ΔIMAX, ΔRT, ΔTTP, ΔmTT, ΔAUC) were compared among renal histotypes.
  
  
  RESULTS
  All time-related parameters (including RT, TTP and mTT) of ROImax were shorter than the corresponding parameters of ROItumor in RCC subtypes (all p<0.05), but made no statistical difference in AMLs (all p>0.05). There were significant differences of all ΔPar.s among RCC subtypes and AML (all p<0.01). ΔIMAX and ΔAUC showed the trend that ccRCC>AML>pRCC=chRCC. ΔTTP showed AML=pRCC=chRCC>ccRCC, ΔRT and ΔmTT showed AML>pRCC=chRCC=ccRCC. ΔmTT could distinguish RCC from AML with the area under the ROC curve (AUC) of 0.86. The AUC of ΔIMAX and ΔAUC was 0.89 and 0.92 vs 0.85 and 0.85 for discriminating between pRCC (or chRCC) and AML vs ccRCC and AML.
  
  
  CONCLUSIONS
  Quantitative analysis of CEUS is a useful modality in AML and RCC subtypes' differentiation, by using ΔmTT, ΔIMAX and ΔAUC.
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China; Ultrasonic Medicine and Engineering Research Institute of Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Cui-Xian
authors.initials: CX
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China; Ultrasonic Medicine and Engineering Research Institute of Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China; Ultrasonic Medicine and Engineering Research Institute of Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China. Electronic address: huang.beijian@zs-hospital.sh.cn.
authors.forename: Bei-Jian
authors.initials: BJ
authors.lastname: Huang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Li-Yun
authors.initials: LY
authors.lastname: Xue
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Yan
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Feng-Yang
authors.initials: FY
authors.lastname: Zheng
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Jie-Xian
authors.initials: JX
authors.lastname: Wen
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, No. 180 of Fenglin Road, Xuhui District, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China; Ultrasonic Medicine and Engineering Research Institute of Fudan University, No. 180 of Fenglin Road, Shanghai 200032, China.
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
mesh_terms: D018207:Angiomyolipoma / Q000000981:diagnostic imaging*; D019540:Area Under Curve; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007672:Kidney Cortex / Q000000981:diagnostic imaging; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D003287:Contrast Media
keywords: Angiomyolipoma; Contrast-enhanced ultrasound; Quantitative analysis; Renal cell carcinoma; Subtype