Totally 85 patients with 93 renal lesions who underwent contrast-enhanced ultrasound (CEUS) were retrospectively studied with quantitative analysis to evaluate its value in the differential diagnosis of renal tumor histotypes. CEUS characteristics were analysed including the enhancement patterns, peak intensity, homogeneity of enhancement, and pseudocapsule. Quantitative parameters of peak intensity (P) and time to peak (TP) were measured with QontraXt software, and the index “relative enhancement percentage” ΔP% and “difference in TP between tumor and cortex” ΔTP were used to quantify the CEUS features of renal tumors. There are significant difference in CEUS features between the 46 clear cell renal cell carcinoma (CCRCC) and other types of renal tumors, including 17 low malignant lesions, 11 urothelial carcinoma of the renal pelvis, and 19 renal angiomyolipoma. The differences lie in the peak intensity, the homogeneity, the time of wash-in, peak, clearance and presence of pseudocapsule. The ΔTP and ΔP% of the CCRCC is significantly different from other tumors. With “fast to peak + high peak intensity” as the main criterion, assisted with “heterogeneous enhancement” and “fast wash-in” as the secondary criteria, the diagnostic accuracy of CCRCC is 91.4%, demonstrating quantitative CEUS imaging is highly valuable in differentiating CCRCC from other tumors.

No abstract

Angiogenesis plays an important role in tumor growth, invasiveness, and metastasis. It is well established that prostate cancer is exposed to fluctuating oxygen tensions and both acute and chronic hypoxia exist, and these conditions can upregulate angiogenesis-associated proteins such as hypoxia-inducible factor 1 alpha and vascular endothelial growth factor A. Low-frequency low-intensity ultrasound with microbubbles can induce obvious microvessel damage in tumors, cause cell necrosis or apoptosis. However, there is no information about whether the blocking blood effect of lowfrequency low-intensity ultrasound with microbubbles has an influence on hypoxia environment of prostate cancer. Therefore, we investigated the impact of different low-frequency low-intensity ultrasound with microbubbles radiation times on prostate tumors, observed the change in the hypoxia-inducible factor 1 alpha and vascular endothelial growth factor A protein levels, as well as cell proliferation, apoptosis, and tumor volume. The results indicated that as the radiation was repeated four times on each treatment day, the effects of interruption were durable, the cell proliferation was inhibited, and apoptosis was promoted, and the hypoxia-inducible factor 1 alpha and vascular endothelial growth factor A expression levels were lower in the treatment group than in the control group. When the radiation was carried out once per treatment day, the hypoxia response was stimulated, the hypoxia-inducible factor 1 alpha and vascular endothelial growth factor A expression levels were higher compared with the control group, and cell proliferation was promoted. In addition, the tumor volume increased obviously in the hypoxia-stimulated group, whereas tumors grew slowly in the hypoxia-suppressed group. The results of this work demonstrated that under the same conditions, different radiation times of low-frequency low-intensity ultrasound with microbubbles affect the hypoxia response differently, and the effect at least partly stimulates or inhibits tumor growth. KeywordsLow-frequency low-intensity ultrasound, prostate cancer, acute hypoxia, hypoxia-inducible factor 1 alpha, angiogenesis Date

BackgroundRenal cell carcinoma most commonly metastasizes to the lungs, skeleton or liver. Metastatic renal cell carcinoma to the breast is very rare, especially for clear cell carcinoma, and few cases regarding this condition have been reported.Case PresentationThe case we presented was a 68-year-old Chinese female with metastatic renal clear cell carcinoma of the left breast 10 years after a nephrectomy. Identification of the metastatic renal clear cell carcinoma in the breast required multiple breast imaging modalities. Imaging showed a single, ovary-shaped, well-defined hypo-echoic mass, with abundant blood flow on ultrasound images. The mass was enhanced early on MRI, and it was hypointense on a T1-weighted image and hyperintense on a fat-saturated T2-weighted image. Following surgical excision of the tumor, a routine immunohistochemistry antibody panel on the tumor cells revealed negative staining for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (Her-2). Strong positive staining for the cluster of differentiation 10 (CD10) and vimentin was present.ConclusionThis case is unusual because of the site of metastatic progression. It is important for physicians to be aware of this progression so early diagnoses can be made, and appropriate therapeutic planning can be initiated.

Objectives: To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) ＜3 cm in size. Methods: The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. Results: In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. Conclusions: This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. Advances in knowledge: In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.

Recently, it has become a main consensus that early diagnosis of benign prostatic hyperplasia (BPH) is meaningful in delaying disease progression. Although ultrasound has been well recognized as the most useful early screening technique, the lack of a standard observation plane makes it difficult to determine the BPH stages in a way that is operator-independent and satisfies clinical expectations. Strong enthusiasm has fueled intense research on ultrasound coupled with artificial intelligence (AI) for automated or semiautomated classification of different clinical diseases. Therefore, it is crucial to formulate standard planes for ultrasound imaging with the implementation of AI to evaluate BPH. This study was a preliminary examination of AI-assisted ultrasound in the prostate disease diagnostic classification task, which aimed to define and assess the clinical value of the length of the proximal prostatic urethra (Lppu), detected via transrectal ultrasound within the uniquely calibrated standardized plane, in 643 patients suffering from BPH between January 2015 and December 2016. International Prostate Symptom Score (IPSS), quality of life (QoL) and PSA levels were also recorded. The mean (standard deviation) of Lppu was 28.54 mm (9.19 mm), and there were significant differences in the mean Lppu among men who were over 50 yrs old. Lppu was colinear with IPSS, voiding-IPSS, storage-IPSS and QoL with individual r values of 0.13, 0.09, 0.04, and 0.03, respectively (P<0.001). Compared with the traditional ultrasound screening indicator represented by transitional zone index (TZI), the main advantage of measuring Lppu is that it is reasonable in terms of the pathophysiological characteristics of BPH, it is operator-error-free, it is based on the uniquelycalibrated observation plane, and it is effective in guiding personalized management of BPH, especially among men with severe LUTS but small prostates. Furthermore, this screening method is economical and improves the cost-efficiency of public health. After systematic evaluation, Lppu is believed to be an excellent quantitative measurement parameter and early screening tool for evaluating LUTS/BPH and BPH stages.INDEX TERMS Transrectal ultrasound, benign prostatic hyperplasia, the length of the proximal prostatic urethra, early screening, ultrasound diagnostic criteria.

No abstract

No abstract