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Ultraschall Med 2011; 32(3): 286-292
DOI: 10.1055/s-0029-1245992
Originalarbeit/Original

© Georg Thieme Verlag KG Stuttgart · New York

Der Beitrag der Bildanalyse für die Differenzialdiagnose der fokalen Nierenparenchymveränderungen

Image Analysis in the Differential Diagnosis of Renal Parenchyma LesionsJ. Tuma1 , B. Novakova2 , H. R. Schwarzenbach3 , K.-P. Jungius4 , A. Hollerweger5 , F. Zatura6 , M. Kuchta2 , C. F. Dietrich7
  • 1Innere Medizin, Sonografie-Institut, Uster, CH
  • 2LF UPJŠ v Košiciach, SK
  • 3Praxis Innere Medizin, Melide, CH
  • 4Röntgeninstitut, Schwyz, CH
  • 5Radiologie und Nuklearmedizin, KH Barmherzige Brüder, Salzburg, A
  • 6Urologicka Klinika, FN Olomouc, CZ
  • 7Med. Klinik 2, Caritas-Krankenhaus, Bad Mergentheim, D
Further Information

Publication History

eingereicht: 6.4.2010

angenommen: 15.12.2010

Publication Date:
10 June 2011 (online)

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Zusammenfassung

Ziel: Die Quantifizierung der Echointensität könnte einen Beitrag für die Differenzialdiagnose von fokalen Nierenveränderungen leisten. Material und Methoden: Bei 145 Patienten mit fokalen Nierenparenchymveränderungen wurden digitalisierte Bilder ausgewertet (40 Angiomyolipome [A], 70 Nierenzellkarzinome [B], 20 Pseudotumoren [C] sowie 15 andere fokale Veränderungen [D]). Mit Photoshop® wurden die durchschnittlichen Grauwerte der Läsion (definiert als Echointensität, EF) und deren Varianz s2 (als Maß für Inhomogenität, IF) gemessen. Als Vergleich diente die umgebende Nierenrinde. Berechnet wurden Echointensitätsquotient, Echointensitätsindex, Inhomogenitätsquotient und Inhomogenitätsindex. Ergebnisse: Angiomyolipome hatten einen höheren Echointensitätsquotient EQ und Echointensitätsindex EI als Nierenzellkarzinome, Pseudotumoren sowie andere Läsionen (p < 0,001). Pseudotumoren hatten einen niedrigeren Inhomogenitätsquotienten IQ als Angiomyolipome (p < 0,001) und Nierenzellkarzinome (p < 0,05). Ein Echointensitätsquotient ≥ 2,0 und Echointensitätsindex ≥ 0,5 waren typisch für Angiomyolipome; bei Tumoren < 3 cm lag die Sensitivität bei 96,4 %, Spezifität bei 97,3 %. Schlussfolgerung: Die quantitative Echointensitätsmessung objektiviert die Differenzialdiagnose fokaler Nierenveränderungen. Die Unterscheidung typischer Angiomyolipome von anderen Läsionen wird dadurch erleichtert.

Abstract

Purpose: Visual analysis of echo intensity is of importance for the differential diagnosis of focal renal lesions. Quantification of the echo intensity and of other parameters might help with differential diagnosis. Materials and Methods: In 145 patients with focal renal lesions, digitized images were evaluated (40 angiomyolipomas [group A], 70 renal cell carcinomas [group B], 20 pseudo-tumors [group C] and 15 other focal lesions in group D). With Photoshop®, the average grayscale values of the lesion (defined as echo intensity focal, EF) and its variance s2 (as expression of the inhomogeneity focal, IF) were measured. These measurements were compared to the renal cortex (echo intensity renal cortex = ER, inhomogeneity renal renal cortex = IR). Other calculated parameters: Echo intensity quotient, echo intensity index, inhomogeneity quotient and inhomogeneity index. Results: Angiomyolipomas had a higher echo intensity quotient EQ and echo intensity index EI than renal cell carcinomas, pseudo-tumors and other lesions (p < 0.001). Pseudo-tumors had a lower inhomogeneity quotient than angiomyolipomas (p < 0.001), renal cell carcinomas (p < 0.05). Echo intensity quotient EQ ≥ 2.0 and echo intensity index EI ≥ 0.5 were typical for angiomyolipomas with a sensitivity of 96.4 % and a specificity of 97.3 % for tumors < 3 cm. Conclusion: Quantitative echo intensity measurements enhance the differential diagnosis of focal renal lesions. The differentiation of typical angiomyolipomas to other lesions could be improved.

Key words

abdomen - ultrasound - neoplasms

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Prof. Christoph F. Dietrich

Innere Medizin 2, Caritas-Krankenhaus

Uhlandstr. 7

97980 Bad Mergentheim

Phone: ++ 49/79 31/58 22 01

Fax: ++ 49/79 31/58 22 90

Email: Christoph.Dietrich@ckbm.de

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