The diagnostic value of multimodal ultrasound and contrast-enhanced computed tomography in the discrimination of clear cell and non-clear cell renal cell carcinoma: a comparative study
ZHAO Jiaofeng1,XIA Yongsheng1, CHEN Shunping1, JI Wenbin2
1.Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China; 2.Department of Radiology, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou 317000, China
ZHAO Jiaofeng,XIA Yongsheng,CHEN Shunping, et al. The diagnostic value of multimodal ultrasound and contrast-enhanced computed tomography in the discrimination of clear cell and non-clear cell renal cell carcinoma: a comparative study[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(10): 807-813.
Abstract：Objective: To compare and analyze the diagnostic performance of multimodal ultrasound and contrast-enhanced computed tomography (CECT) in differentiating clear cell renal cell carcinoma (ccRCC) from non-clear cell renal cell carcinoma (non-ccRCC). Methods: This study included 121 patients with renal cell carcinoma (RCC) and 125 renal lesions, including 88 ccRCCs and 37 non-ccRCCs. Preoperative multimodal ultrasonography and CECT were performed in all patients, whose postoperative pathological results were obtained. Clinical data and imaging variables of all tumors were analyzed to compare the diagnostic performance of multimodal ultrasound and CECT in ccRCC and non-ccRCC. Weighted kappa statistics was used to estimate the interobserver agreement. Results: Univariate and multivariate analyses showed that tumor cystic changes (OR=2.744, 95%CI=1.022-7.369, P=0.045), parenchymal phase enhancement (OR=4.102, 95%CI=1.154-14.573,P=0.029) and the wash-out pattern (OR=0.226, 95%CI=0.083-0.613, P=0.004) in multimodal ultrasound were independent predictors for distinguishing ccRCC from non-ccRCC. CECT parameters including tumor necrosis (OR=3.163, 95%CI=1.181-8.468, P=0.022), arterial phase enhancement (OR=4.103, 95%CI=1.192-14.117,P=0.025) and peak enhancement (OR=4.942, 95%CI=1.587-15.382, P=0.006)were independent predictors for ccRCC and non-ccRCC. Multimodal ultrasound and CECT both showed good diagnostic properties in distinguishing ccRCC from non-ccRCC, with sensitivity being 81.8% and 80.7%, specificity being 75.7% and 81.1%, and areas under the receiver operating curve being 0.832 and 0.838, respectively. There was no significant difference between the two methods. In addition, the diagnostic accuracy of multimodal ultrasound and CECT was 82.4% and 76.8%, respectively, with no statistical difference (P=0.620). The weighted kappa values of the interobserver agreement for multimodal ultrasound and CECT both ranged from 0.706-1.000. Conclusion: Both multimodal ultrasound and CECT have excellent diagnostic performance in distinguishing between ccRCC and non-ccRCC. Multimodal ultrasound can be used as an important supplement to CECT in the evaluation of renal cell carcinoma, especially in patients with iodinated contrast agent allergy and renal insufficiency.
