Clear cell renal cell carcinoma: Contrast-enhanced ultrasound features relation to tumor size

Objectives: To analyze the contrast-enhanced ultrasound (CEUS) features of clear cell renal cell carcinoma (CCRCC) in relation to tumor size. Materials and methods: The CEUS appearance of 92 CCRCCs confirmed pathologically were retrospectively analyzed. Tumor size was stratified into six groups with a 1 cm interval. For each lesion, the degree of enhancement, the homogeneity of enhancement and the presence of pseudocapsule sign were evaluated and compared with the pathologic findings. Results: The tumors of groups I-VI were counted for 13, 26, 21, 11, 10 and 11, respectively. All the CCRCCs mainly showed a marked enhancement, and there was no statistically significance between the degree of enhancement and tumor size (P > 0.05). However, both homogeneity of enhancement and frequency of pseudocapsule correlated well with the tumor size (P<0.01). Homogeneous enhancement was shown in 85%, 65%,19%,9%, 0% and 0% of the tumors in the six groups, respectively. In tumors <= 3 cm the frequency (72%) of homogeneity was significantly higher than in tumors >3 cm (9%: P < 0.01). The detection rate of pseudocapsule sign in the six group was 23%, 62%, 71%, 64%, 50% and 0%, respectively. The frequency of pseudocapsule sign was significantly higher in tumors 2.1-5 cm than <2 cm and >5 cm (66%,23%, 24%, respectively; P< 0.01). On the pathologic examinations, the mean MVD was significantly higher in marked enhancement tumors than slight enhancement tumors (46.0 +/- 15.9,27.5 +/- 8.3, respectively; P< 0.01). Any tumors with a heterogeneous enhancement pattern were accompanied by intratumoral necrosis or cysts on histologic specimen. A pseudocapsule was seen at pathology in all the 46 cases with perilesional enhancement and 4 of 46 tumors without perilesional enhancement at CEUS. Conclusion: CEUS features of CCRCCs vary with the size of the tumor, especially in the homogeneity of enhancement and the presence of pseudocapsule sign. CEUS is effective in demonstrating the sonographic visualization of tumoral characteristics. (C) 2008 Elsevier Ireland Ltd. All rights reserved.