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Ultraschall Med 2013; 34(1): 30-37
DOI: 10.1055/s-0032-1325548
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Contrast-Enhanced Ultrasonography in the Diagnosis of Upper Urinary Tract Urothelial Cell Carcinoma: A Preliminary Study

Diagnose des urothelialen Zellkarzinoms des oberen Harntraktes mittels kontrastverstärkter Sonografie: eine Vorstudie
F. M. Drudi
1   Department of Radiology, University La Sapienza, Rom
,
G. Di Candio
2   Dipartimento Traslazionale, University of Pisa
,
N. Di Leo
3   Departement of Radiology, “Sapienza”, Univ. of Rome
,
F. Malpassini
4   Radiology, University La Sapienza, Rom
,
M. Gnecchi
4   Radiology, University La Sapienza, Rom
,
V. Cantisani
1   Department of Radiology, University La Sapienza, Rom
,
F. Iori
5   Department of Urology, University “La Sapienza”, Rom
,
M. Liberatore
6   Department of Nuclear Medicine, University “La Sapienza”, Rom
› Author Affiliations
Further Information

Publication History

27 July 2012

01 October 2012

Publication Date:
19 November 2012 (online)

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Abstract

Purpose: The main objective was to assess the effectiveness of contrast-enhanced ultrasonography (CEUS) in the diagnosis of upper urinary tract malignancies by comparing with multidetector computed tomographic urography (MDCTU) and magnetic resonance urography (MRU). Secondary objectives were to compare the tumor size measured with CEUS, MDCTU and MRU and to assess the usefulness of CEUS in distinguishing high-grade tumors from low-grade ones.

Materials and Methods: In connection with this prospective study carried out from January 2009 to September 2011, 18 patients underwent MDCTU or MRU, grayscale ultrasonography (US), color Doppler ultrasonography and CEUS followed by surgery and histological examination of the specimen. Quantitative analysis was performed using perfusion software. Time intensity curves were extracted and the following parameters were considered: wash-in time, time-to-peak, maximum signal intensity and wash-out time.

Results: Grayscale US identified 15/18 lesions; color Doppler showed no flow signal in 8 lesions, low color signal in 9 lesions and an intense color signal in 1 lesion; CEUS identified 17/18 lesions with the undetected lesion being the smallest one (1.2 cm) located in the upper pelvicalyceal system. Semi-quantitative analysis produced different data for high-grade and low-grade urothelial cell carcinoma (UCC). All detected upper urinary tract masses were UCCs. MRU, MDCTU and grayscale US overestimated the tumor size, while CEUS was the most accurate.

Conclusion: CEUS is useful for evaluating upper urinary tract masses as this method permits differentiation between high-grade and low-grade tumors as well as distinction of the tumor from the adjacent structures and accurate mass measurements.

Zusammenfassung

Ziel: Hauptziel: Die Bestimmung der Effektivität der kontrastverstärkten Sonografie (CEUS) im Vergleich mit der Multi-Detektor-Computertomografie-Urografie (MDCTU) und der Magnetresonanz-Urografie (MRU) bei der Diagnose von Malignomen des oberen Harntraktes. Sekundäre Ziele: Vergleich der durch CEUS, MDCTU und MRU gemessenen Tumorgröße und die Bewertung des Nutzens von CEUS bei der Unterscheidung von hoch- und niedriggradigen Tumoren.

Material und Methoden: In Zusammenhang mit dieser retrospektiven Studie, die von Januar 2009 bis September 2011 durchgeführt wurde, wurde bei 18 Patienten MDCTU oder MRU, Graustufen-Ultraschall (US), Farbdoppler-Sonografie und CEUS nach der Operation und eine histologischen Untersuchung der Präparats durchgeführt. Die quantitative Analyse wurde unter Verwendung einer Perfusionssoftware durchgeführt; Zeit-Intensitätskurven wurden extrahiert und folgende Parameter wurden berücksichtigt: Wash-in-Zeit, Zeit zur Spitze, maximale Signalintensität und Wash-out-Zeit.

Ergebnisse: Der Graustufenultraschall entdeckte 15/18 Läsionen, der Farbdoppler zeigte in 8 Läsionen kein Flusssignal, in 9 Läsionen niedrige Farbsignale und in einem Herd ein deutliches Farbsignal; CEUS erkannte 17/18 Herdbefunde, die nicht nachgewiesene Läsion war die Kleinste (1,2 cm) und befand sich im Nierenbeckenkelchsystem. Die semiquantitative Analyse führte zu unterschiedlichen Ergebnissen für hoch- und niedriggradige urotheliale Zellkarzinome (UCC). Alle nachgewiesenen Raumforderungen des oberen Harntraktes waren UCCs. MRU, MDCTU und der Graustufenultraschall überschätzten die Tumorgröße, während CEUS am genauesten war.

Schlussfolgerung: CEUS ist für die Bewertung von Raumforderungen des oberen Harntraktes geeignet, da diese Methode eine Differenzierung von hoch- und niedriggradigen Tumoren sowie die Abgrenzung des Tumors von den umgebenden Strukturen und eine exakte Größenbestimmung der Raumforderung ermöglicht.

Key words

CEUS - upper urinary tract - urothelial cell carcinoma - ultrasound - CT urography MR urography
 

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