Emilio Quaia MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To evaluate whether contrast-enhanced US with SonoVue (Bracco, Italy) could improve diagnostic performance of baseline US/CDUS in renal masses characterization. Methods and Materials: Eighteen renal masses, indeterminate on baseline US and smaller than 4 cm, in 18 patients, were evaluated by baseline US/CDUS and then by PIM (Pulse Inversion Mode) after SonoVue injection using continous low acoustic power output, during arterial (15-60 seconds from injection) and late (60-120 seconds) phase. Histologic findings on surgical/bioptic specimens were considered for definite characterization. Contrast enhancement intensity was assessed by a subjective scoring system (SSS; 0-3) by 2 on-site songraphers in consensus. To assess diagnostic performance of baseline US/CDUS and CSMs in defining malignant lesions and different types of benign and malignant lesions, receiver operating characteristic (ROC) curves analysis was performed on the basis of 2 independent readers blinded evaluation. Results: Twelve solid renal masses (5 solid renal cell carcinomas -RCCs-, 3 renal metastases, 2 embryonal matanephric adenomas -EMAs-, 2 angiomyolipomas -AMLs- atypical on baseline US), and 6 cystic renal masses (3 cystic RCCs, 3 complex benign cysts) were identified. CSMs allowed a better depiction of tumoral vascularity during initial arterial phase (15-30 seconds) than CDUS, which was limited in deep located tumors and by motion artifacts. Solid RCCs showed peripheral/intratumoral arterial vessels and revealed a significantly higher (p<.05; Mann Whithey U test) contrast enhancement (SSS = 2.4 ± 0.6) than metastases (SSS = 0.6 ± 0.57), EMA (SSS = 1.5± 0.7) and AMLs (SSS = 2.5 ± 0.7) during arterial phase, progressively decreasing during late phase. Cystic RCCs and complex benign cysts revealed peripheral arterial vessels and intense contrast enhancement on the thick peripheral wall during arterial phase (SSS=2.5 ± 0.5) decreasing on late phase (SSS=1.3 ± 0.5). Diagnostic performance in malignancy diagnosis did not increase significantly after CSMs (Az observer 1/observer 2: 0.688/0.506 for baseline US-CDUS, 0.890/0.877 for US/CDUS/CSMs; p>.05), with good-high interobservers agreement (k=0.60-0.90). Anyway, renal metastases diagnosis improved significantly (p>.05) after assessment of contrast enhancement pattern. Conclusion: CSMs did not improve general diagnostic performance of baseline US/CDUS in defining renal masses malignancy, even though improved renal metastases characterization and depiction of renal masses vascularity.       Questions about this event email: quaia@univ.trieste.it

Quaia MD, E, Characterization of Renal Masses Scanned Using Low Acoustic Power US Contrast Specific Mode after SonoVue Injection.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3103239.html