Qualitative and quantitative characteristics of CEUS for renal cell carcinoma and angiomyolipoma: a narrative review.
Piervito DipintoVittorio CanaleRocco MinelliMarco Alex CapuanoOrlando CatalanoGiovanni Battista Di PierroUmberto AnceschiSisto PerdonàAntonio TufanoPublished in: Journal of ultrasound (2024)
Incidental findings of renal masses are increasing. However, a substantial portion of surgically treated renal masses turn out to be benign on histopathological examination. Thus, there is a clear need for improved pre-surgical assessment to minimize unnecessary invasive procedures. The challenge intensifies when distinguishing between renal cell carcinoma (RCC) and angiomyolipoma (AML) in renal lesions smaller than 4 cm with minimal adipose tissue. In such cases, contrast-enhanced ultrasound (CEUS) has emerged as a valuable diagnostic tool, by utilizing both qualitative and quantitative parameters. Quantitative measures offer objectivity, reliability, and reproducibility compared to qualitative parameters, enabling the characterization of RCC subtypes and differentiation from AML. Qualitative features as enhancement pattern, degree, and peak were less helpful in distinguishing triphasic minimal fat AML (TAML) from epithelioid AML (EAML), with the pseudocapsule sign potentially being the only distinguishing qualitative feature. The pseudocapsule sign was more frequently observed in ccRCCs (38.0%) than in AMLs (15.6%). Moreover, it was detected in 40.0% of EAMLs and 34.5% of ccRCCs but not in TAMLs due to similar growth patterns between EAMLs and low-grade ccRCCs. Quantitative measures such as the time-to-peak (TTP) ratio can further enhance diagnostic accuracy and also TOC ratio should be considered, as it was higher in clear cell RCCs (ccRCCs) and in EAMLs compared to TAMLs, indicating behavior similar to ccRCCs. However, CEUS remains an operator-dependent exam.
Keyphrases
- renal cell carcinoma
- contrast enhanced ultrasound
- acute myeloid leukemia
- adipose tissue
- low grade
- high resolution
- systematic review
- high grade
- allogeneic hematopoietic stem cell transplantation
- machine learning
- magnetic resonance imaging
- insulin resistance
- magnetic resonance
- high fat diet
- contrast enhanced
- ultrasound guided
- metabolic syndrome
- deep learning
- fatty acid
- quantum dots