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Comparative diagnostic performance of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for differentiating clear cell and non-clear cell renal cell carcinoma

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Abstract

Objective

To compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the differential diagnosis of clear and non-clear cell renal cell carcinoma, as confirmed by subsequent pathology.

Methods

A total of 181 patients with 184 renal lesions diagnosed by both CEUS and DCE-MRI were enrolled in the study, including 136 clear cell renal cell carcinoma (ccRCC) and 48 non-clear cell renal cell carcinoma (non-ccRCC) tumors. All lesions were confirmed by histopathologic diagnosis after surgical resection. Interobserver agreement was estimated using a weighted kappa statistic. Diagnostic efficiency in evaluating ccRCC and non-ccRCC was compared between CEUS and DCE-MRI.

Results

The weighted kappa value for interobserver agreement was 0.746 to 0.884 for CEUS diagnosis and 0.764 to 0.895 for DCE-MRI diagnosis. Good diagnostic performance in differential diagnosis of ccRCC and non-ccRCC was displayed by both CEUS and DCE-MRI: sensitivity was 89.7% and 91.9%, respectively; specificity was 77.1% and 68.8%, respectively; and area under the receiver operating curve was 0.834 and 0.803, respectively. No statistically significant differences were present between the two methods (p = 0.54).

Conclusions

Both CEUS and DCE-MRI imaging are effective for the differential diagnosis of ccRCC and non-ccRCC. Thus, CEUS could be an alternative to DCE-MRI as a first test for patients at risk of renal cancer, particularly where DCE-MRI cannot be carried out.

Key Points

• CEUS and DCE-MRI features can help differentiate ccRCC and non-ccRCC.

• The differential diagnosis of ccRCC and non-ccRCC by CEUS is comparable to that of DCE-MRI.

• Interobserver agreement is generally high using CEUS and DCE-MRI.

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Abbreviations

ccRCC :

Clear cell renal cell carcinoma

CEUS :

Contrast-enhanced ultrasound

chRCC:

Chromophobe renal cell carcinoma

DCE-MRI:

Dynamic contrast-enhanced magnetic resonance imaging

MI:

Mechanical index

non-ccRCC :

Non-clear cell renal cell carcinoma

NPV:

Negative predictive value

PPV :

Positive predictive value

pRCC :

Papillary renal cell carcinoma

RCC:

Renal cell carcinoma

ROC :

Receiver operating characteristic

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Acknowledgements

The authors thank the pathologist (C.C.) for reviewing all of the specimens and evaluating histopathology.

Funding

The authors state that this work has not received any funding.

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Author notes

  1. Ping Zhao and Jianing Zhu contributed equally.

Authors and Affiliations

  1. School of Medicine, Nankai University, Tianjin, 300071, China

    Ping Zhao & Yukun Luo

  2. Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China

    Ping Zhao, Jianing Zhu, Lanke Wang, Nan Li, Yukun Luo & Qiuyang Li

  3. Medical School of Chinese PLA, Beijing, 100853, China

    Jianing Zhu, Yukun Luo & Qiuyang Li

  4. Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China

    Xinghua Zhang & Jinfeng Li

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  1. Ping Zhao
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Correspondence to Yukun Luo or Qiuyang Li.

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The scientific guarantor of this publication is Qiuyang Li.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because this study was a retrospective analysis and did not involve private patient information, informed consent was not required.

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Zhao, P., Zhu, J., Wang, L. et al. Comparative diagnostic performance of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for differentiating clear cell and non-clear cell renal cell carcinoma. Eur Radiol 33, 3766–3774 (2023). https://doi.org/10.1007/s00330-023-09391-9

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