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.
AminM.B., AminM.B., TamboliP., JavidanJ., StrickerH., De-PeraltaV.M., DeshpandeA. and MenonM., Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: An experience of 405 cases, Am J Surg Pathol26 (2002), 281–291.
2.
AscentiG., GaetaM., MagnoC., MazziottiS., BlandinoA., MelloniD. and ZimbaroG., Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma, AJR Am J Roentgenol182 (2004), 1525–1530.
3.
BarrR.G., PetersonC. and HindiA., Evaluation of indeterminate renal masses with contrast-enhanced US: A diagnostic performance study, Radiology271 (2014), 133–142.
4.
BataP., GyebnarJ., TarnokiD.L., TarnokiA.D., KekesiD., SzendroiA., FejerB., SzaszA.M., NyiradyP., KarlingerK. and BercziV., Clear cell renal cell carcinoma and papillary renal cell carcinoma: Differentiation of distinct histological types with multiphase CT, Diagn Interv Radiol19 (2013), 387–392.
5.
BeckS.D., PatelM.I., SnyderM.E., KattanM.W., MotzerR.J., ReuterV.E. and RussoP., Effect of papillary and chromophobe cell type on disease-free survival after nephrectomy for renal cell carcinoma, Ann Surg Oncol11 (2004), 71–77.
6.
BosniakM.A., BirnbaumB.A., KrinskyG.A. and WaismanJ., Small renal parenchymal neoplasms: Further observations on growth, Radiology197 (1995), 589–597.
7.
CapitanioU., CloutierV., ZiniL., IsbarnH., JeldresC., ShariatS.F., PerrotteP., AntebiE., PatardJ.J., MontorsiF. and KarakiewiczP.I., A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: A population-based study, Bju Int103 (2009), 1496–1500.
8.
ChevilleJ.C., LohseC.M., ZinckeH., WeaverA.L. and BluteM.L., Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma, Am J Surg Pathol27 (2003), 612–624.
9.
ClaudonM., DietrichC.F., ChoiB.I., CosgroveD.O., KudoM., NolsoeC.P., PiscagliaF., WilsonS.R., BarrR.G., ChammasM.C., ChaubalN.G., ChenM.H., ClevertD.A., CorreasJ.M., DingH., ForsbergF., FowlkesJ.B., GibsonR.N., GoldbergB.B., LassauN., LeenE.L., MattreyR.F., MoriyasuF., SolbiatiL., WeskottH.P. and XuH.X., Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS, Ultrasound Med Biol39 (2013), 187–210.
10.
EgbertN.D., CaoiliE.M., CohanR.H., DavenportM.S., FrancisI.R., KunjuL.P. and EllisJ.H., Differentiation of papillary renal cell carcinoma subtypes on CT and MRI, AJR Am J Roentgenol201 (2013), 347–355.
11.
GerstS., HannL.E., LiD., GonenM., TickooS., SohnM.J. and RussoP., Evaluation of renal masses with contrast-enhanced ultrasound: Initial experience, AJR Am J Roentgenol197 (2011), 897–906.
12.
GreisC., Technical aspects of contrast-enhanced ultrasound (CEUS) examinations: Tips and tricks, Clin Hemorheol Microcirc58 (2014), 89–95.
13.
HertsB.R., CollD.M., NovickA.C., ObuchowskiN., LinnellG., WirthS.L. and BakerM.E., Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys, AJR Am J Roentgenol178 (2002), 367–372.
14.
IgneeA., StraubB., BrixD., SchuesslerG., OttM. and DietrichC.F., The value of contrast enhanced ultrasound (CEUS) in the characterisation of patients with renal masses, Clin Hemorheol Microcirc46 (2010), 275–290.
15.
JiangJ., ChenY., ZhouY. and ZhangH., Clear cell renal cell carcinoma: Contrast-enhanced ultrasound features relation to tumor size, Eur J Radiol73 (2010), 162–167.
16.
JinzakiM., TanimotoA., MukaiM., IkedaE., KobayashiS., YuasaY., NarimatsuY. and MuraiM., Double-phase helical CT of small renal parenchymal neoplasms: Correlation with pathologic findings and tumor angiogenesis, J Comput Assist Tomogr24 (2000), 835–842.
17.
JungS.C., ChoJ.Y. and KimS.H., Subtype differentiation of small renal cell carcinomas on three-phase MDCT: Usefulness of the measurement of degree and heterogeneity of enhancement, Acta Radiol53 (2012), 112–118.
18.
KimJ.H., BaeJ.H., LeeK.W., KimM.E., ParkS.J. and ParkJ.Y., Predicting the histology of small renal masses using preoperative dynamic contrast-enhanced magnetic resonance imaging, Urology80 (2012), 872–876.
19.
KimJ.K., KimT.K., AhnH.J., KimC.S., KimK.R. and ChoK.S., Differentiation of subtypes of renal cell carcinoma on helical CT scans, AJR Am J Roentgenol178 (2002), 1499–1506.
20.
OnishiT., OishiY., GotoH., YanadaS. and AbeK., Histological features of hypovascular or avascular renal cell carcinoma: The experience at four university hospitals, Int J Clin Oncol7 (2002), 159–164.
21.
ParkB.K., KimS.H. and ChoiH.J., Characterization of renal cell carcinoma using agent detection imaging: Comparison with gray-scale US, Korean J Radiol6 (2005), 173–178.
22.
PiscagliaF. and BolondiL., The safety of Sonovue in abdominal applications: Retrospective analysis of 23188 investigations, Ultrasound Med Biol32 (2006), 1369–1375.
23.
PiscagliaF., NolsoeC., DietrichC.F., CosgroveD.O., GiljaO.H., BachmannN.M., AlbrechtT., BarozziL., BertolottoM., CatalanoO., ClaudonM., ClevertD.A., CorreasJ.M., D’OnofrioM., DrudiF.M., EydingJ., GiovanniniM., HockeM., IgneeA., JungE.M., KlauserA.S., LassauN., LeenE., MathisG., SaftoiuA., SeidelG., SidhuP.S., ter HaarG.,
TimmermanD. and
WeskottH.P., The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications, Ultraschall Med33 (2012), 33–59.
24.
PrasadSR,
HumphreyPA,
CatenaJR,
NarraVR,
SrigleyJR,
CortezAD,
DalrympleNC, ChintapalliKN, Common and uncommon histologic subtypes of renal cell carcinoma: Imaging spectrum with pathologic correlation, Radiographics26 (2006), 1795–1806, 1806-1810.
25.
Ruppert-KohlmayrA.J., UggowitzerM., MeissnitzerT. and RuppertG., Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters, AJR Am J Roentgenol183 (2004), 1387–1391.
26.
ShebelH.M., ElsayesK.M., SheirK.Z., AbouE.A.H., El-SherbinyA.F., EllisJ.H. and El-DiastyT.A., Quantitative enhancement washout analysis of solid cortical renal masses using multidetector computed tomography, J Comput Assist Tomogr35 (2011), 337–342.
27.
SheirKZ,
El-AzabM,
MosbahA,
El-BazM,
ShaabanAA,
Differentiation of renal cell carcinoma subtypes by multislice computerized tomography, J Urol174 (2005), 451–455, 455.
28.
SteffensS., RoosF.C., JanssenM., BeckerF., SteinestelJ., AbbasM., SteinestelK., WegenerG., SiemerS., ThuroffJ.W., HofmannR., StockleM., SchraderM., HartmannA., JunkerK., KuczykM.A. and SchraderA.J., Clinical behavior of chromophobe renal cell carcinoma is less aggressive than that of clear cell renal cell carcinoma, independent of Fuhrman grade or tumor size, Virchows Arch465 (2014), 439–444.
29.
TamaiH., TakiguchiY., OkaM., ShingakiN., EnomotoS., ShirakiT., FurutaM., InoueI., IguchiM., YanaokaK., AriiK., ShimizuY., NakataH., ShinkaT., SankeT. and IchinoseM., Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors, J Ultrasound Med24 (2005), 1635–1640.
30.
XuY., ZhangS., WeiX., PanY. and HaoJ., Contrast enhanced ultrasonography prediction of cystic renal mass in comparison to histopathology, Clin Hemorheol Microcirc58 (2014), 429–438.
31.
XueL.Y., LuQ., HuangB.J., LiC.L., YanC.J., WenJ.X. and WangW.P., Evaluation of renal urothelial carcinoma by contrast-enhanced ultrasonography, Eur J Radiol82 (2013), e151–e157.
32.
XueL.Y., LuQ., HuangB.J., MaJ.J., YanL.X., WenJ.X. and WangW.P., Contrast-enhanced ultrasonography for evaluation of cystic renal mass: In comparison to contrast-enhanced CT and conventional ultrasound, Abdom Imaging39 (2014), 1274–1283.
33.
ZhangJ., LefkowitzR.A., IshillN.M., WangL., MoskowitzC.S., RussoP., EisenbergH. and HricakH., Solid renal cortical tumors: Differentiation with CT, Radiology244 (2007), 494–504.
34.
ZhouX., YanF., LuoY., PengY.L., ParajulyS.S., WenX.R., CaiD.M. and LiY.Z., Characterization and diagnostic confidence of contrast-enhanced ultrasound for solid renal tumors, Ultrasound Med Biol37 (2011), 845–853.
