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March 14, 2026Current Medical Imaging Formerly Current Medical Imaging Reviews0 citations

Value of High Frame Rate Contrast-enhanced Ultrasound in Evaluating Vascular Morphology of Renal Cell Carcinoma

Key Points

This study evaluates the effectiveness of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in assessing the vascular morphology of renal cell carcinoma (RCC).
Retrospective analysis of 163 RCC patients classified as clear cell RCC (ccRCC) or non-clear cell RCC (nccRCC).
Patients underwent conventional ultrasound (US), conventional CEUS (C-CEUS), and H-CEUS preoperatively.
Vascular morphology categorized into five types (I-V) during early CEUS perfusion.
Differences analyzed using chi-square or Fisher's exact test, inter-observer agreement evaluated with Kappa coefficient.
Significant difference in intra-nodal blood flow between ccRCC and nccRCC groups (χ²=11.755, p=0.008).
Higher prevalence of Type III morphology in ccRCC on H-CEUS (62.6%) compared to C-CEUS (45.8%) (χ²=6.099, p=0.014).
Type IV morphology predominant in nccRCC, with no significant difference between imaging modalities.
Statistically significant difference in vascular morphology for ccRCC tumors ≤4 cm under H-CEUS (χ²=9.307, p=0.038).
Substantial inter-observer agreement for both modalities (Kappa coefficients of 0.751 for C-CEUS and 0.657 for H-CEUS).

Abstract

Background: Different subtypes of renal cell carcinoma (RCC) exhibit distinct tumor vascular morphological features. However, current imaging techniques still have limitations in delineating the vascular morphology of RCC. Objective: This study aimed to evaluate the value of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in assessing the vascular morphology of RCC. results: Comparative analysis of US parameters between ccRCC and nccRCC groups revealed a significant difference in intra-nodal blood flow (χ²=11.755, p=0.008). No significant differences were observed in other parameters, including patient gender, age, nodule laterality, location, diameter, echogenicity, margin, shape, and calcification (all p > 0.05). Type III (peripheral nodular enhancement) was the predominant manifestation in both ccRCC and nccRCC groups under both C-CEUS and H-CEUS imaging modalities. In the ccRCC group, Type III accounted for 45.8% (49/107) and 62.6% (67/107) of cases under C-CEUS and H-CEUS, respectively, with a significant difference (χ²=6.099, p=0.014). Type IV (diffuse enhancement) was the primary manifestation in the nccRCC group, accounting for 58.9% (33/56) and 44.6% (25/56) of cases under C-CEUS and H-CEUS, respectively, without a significant difference (χ²=2.289, p=0.130). In tumors ≤4 cm, the early perfusion vascular morphology in the ccRCC group under C-CEUS was as follows: Type I (0 cases), Type II (3 cases), Type III (26 cases), Type IV (15 cases), and Type V (14 cases). Under H-CEUS, the distribution was: Type I (1 case), Type II (7 cases), Type III (36 cases), Type IV (8 cases), and Type V (6 cases). This difference was statistically significant (χ²=9.307, p=0.038). In the nccRCC group, no significant difference was observed in vascular morphology between C-CEUS and H-CEUS modalities (p > 0.05). For tumors >4 cm, no significant differences were found in vascular morphology between ccRCC and nccRCC groups under either imaging modality (p > 0.05). Inter-observer agreement for vascular morphology evaluation was substantial for both C-CEUS (Kappa coefficient = 0.751, p4 cm. Inter-observer agreement for vascular morphology evaluation was substantial for both C-CEUS (κ=0.751) and H-CEUS (κ=0.657) (both P<0.001). Conclusion: H-CEUS shows superior visualization capabilities in evaluating vascular morphology for ccRCC lesions ≤4 cm, which provides valuable insights into its potential as a non-invasive imaging modality for differentiating RCC subtypes and tailoring treatment strategies.

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