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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

JWJiarui WangShenzhen Institute of Information Technology WYWenxin YuanNanchang University HWHailan WuNanchang University

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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