Korean J Radiol.  2005 Sep;6(3):173-178. 10.3348/kjr.2005.6.3.173.

Characterization of Renal Cell Carcinoma Using Agent Detection Imaging: Comparison with Gray-Scale US

• Park BK
• Kim SH
• Choi HJ

• KMID: 1102714
• DOI: http://doi.org/10.3348/kjr.2005.6.3.173

Abstract

OBJECTIVE
We wanted to compare the imaging features of renal cell carcinoma (RCC) and their diagnostic accuracy on agent detection imaging (ADI) and gray-scale ultrasonography (US). MATERIALS AND METHODS: Thirty non-consecutive patients (age range; 32-80 years, mean age; 53.7 years) with 30 RCCs were examined with gray-scale US and with ADI in conjunction with using SH U 508A. We described the imaging features of the renal tumors obtained from ADI according to their enhancement pattern, the intratumoral anechoic areas and the presence of any pseudocapsule. The imaging features and diagnostic accuracy of ADI and gray-scale US were then compared. RESULTS: On the ADI exam, the RCCs were shown as being heterogeneous in 87% of the cases (26/30), homogeneous in 7% of the cases (2/30), and there was peripheral irregular enhancement in 7% of the cases (2/30). Intratumoral anechoic areas and pseudocapsule were seen in 87% and 77% of the RCCs on the ADI exam, whereas these features were seen in 53% and 17% of the cases on the gray-scale US, respectively. The diagnostic sensitivity, specificity, and accuracy for RCC with ADI were 97%, 93%, and 95%, respectively. However, those for RCC with using gray-scale US were 70%, 86%, and 78%, respectively. There was a significant difference for the diagnostic accuracy of RCC between ADI and gray-scale US (p < 0.05). CONCLUSION: Agent detection imaging can help visualize the enhancement pattern of RCC and improve the diagnostic accuracy of this tumor by better displaying the intratumoral anechoic areas and the pseudocapsule than does the gray-scale US.

Keyword

Contrast media; Ultrasound (US)

MeSH Terms

Ultrasonography/methods
Sensitivity and Specificity
Middle Aged
Male
Kidney Neoplasms/*ultrasonography
Humans
Female
Carcinoma, Renal Cell/*ultrasonography
Aged, 80 and over
Aged
Adult

Figure

• 

  Fig. 1 Small renal cell carcinoma in a 64-year-old man. A. Transverse image on gray-scale US shows an ill-defined isoechoic mass (arrows) containing suspicious anechoic cysts. Any pseudocapsule is not seen around the tumor. B. The transverse image of agent detection imaging that was obtained 17 seconds after the administration of SH U 508A shows a thick pseudocapsule (arrows) around the tumor. C. The transverse image of agent detection imaging that was obtained 34 seconds after the administration of SH U 508A shows heterogeneous enhancement of the tumor with multiple anechoic cysts, and these are better depicted here than on gray-scale US. The pseudocapsule as well as the tumor is also enhanced (arrows). A feeding vessel (blank arrow) is clearly seen on the agent detection imaging exam. D. The cut surface of the gross specimen shows small cysts, necrosis and hemorrhage within the renal cell carcinoma (arrows). A feeding vessel (blank arrow) is demonstrated on the pathologic exam, and this correlated very well with the findings on the agent detection imaging exam.

• 

  Fig. 2 Renal cell carcinoma in a 60-year-old man. A. Transverse image of the gray-scale US shows a slightly hyperechoic solid mass (arrows) with no intratumoral anechoic areas and a pseudocapsule in the right kidney. B. Transverse image of agent detection imaging that was obtained 15 seconds after the administration of SH U 508A shows heterogeneous enhancement of the tumor with a thin pseudocapsule (arrows). C. Transverse image of agent detection imaging that was obtained 1 minute after the administration of SH U 508A shows heterogeneous enhancement of the tumor with multiple intratumoral anechoic areas (blank arrows). The pseudocapsule is not clearly seen due to the delayed enhancement. D. The cut surface of the gross specimen shows multiple small cystic and necrotic portions (blank arrows) in the renal cell carcinoma with a pseudocapsule (arrows).

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