Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time–intensity curves: how we do it

• Published in: Abdominal Imaging Vol. 40; no. 7; pp. 2461 - 2471
• Main Authors: King, Kevin G., Gulati, Mittul, Malhi, Harshawn, Hwang, Darryl, Gill, Inderbir S., Cheng, Phillip M., Grant, Edward G., Duddalwar, Vinay A.
• Format: Journal Article Book Review
• Language: English
• Published: New York Springer US 01.10.2015; Springer Nature B.V
• Subjects: Carcinoma, Renal Cell - diagnostic imaging; Contrast Media; Diagnosis, Differential; Gastroenterology; Hepatology; Humans; Image Enhancement; Imaging; Kidney - diagnostic imaging; Kidney - pathology; Kidney Neoplasms - diagnostic imaging; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Radiology; Review Article; Tomography, X-Ray Computed; Ultrasonography; Oncocytoma; Renal mass; Angiomyolipoma; Contrast-enhanced ultrasound; Renal cell carcinoma; Time–intensity curve
• ISSN: 0942-8925; 2366-004X; 1432-0509; 2366-0058
• DOI: 10.1007/s00261-015-0468-y

Purpose To discuss the evaluation of the enhancement curve over time of the major renal cell carcinoma (RCC) subtypes, oncocytoma, and lipid-poor angiomyolipoma, to aid in the preoperative differentiation of these entities. Differentiation of these lesions is important, given the different prognoses of the subtypes, as well as the desire to avoid resecting benign lesions. Methods We discuss findings from CT, MR, and US, but with a special emphasis on contrast-enhanced ultrasound (CEUS). CEUS technique is described, as well as time–intensity curve analysis. Results Examples of each of the major RCC subtypes (clear cell, papillary, and chromophobe) are shown, as well as examples of oncocytoma and lipid-poor angiomyolipoma. For each lesion, the time–intensity curve of enhancement on CEUS is reviewed, and correlated with the enhancement curve over time reported for multiphase CT and MR. Conclusions Preoperative differentiation of the most common solid renal masses is important, and the time–intensity curves of these lesions show some distinguishing features that can aid in this differentiation. The use of CEUS is increasing, and as a modality it is especially well suited to the evaluation of the time–intensity curve.