The application of ultrasound contrast agents in the characterization of renal tumors

The aim of this article is to describe the current ultrasound (US) contrast agents employed in the characterization of renal tumors and to report our experience in the use of a contrast-specific ultrasound technique pulse inversion harmonic imaging (PIHI).A total of 23 renal masses were prospectively evaluated by conventional US, CDUS, PIHI and finally by helical-CT (HCT). The study was performed using a wideband convex array 2–5 MHz transducer and a US digital apparatus . PIHI scanning of each renal mass was performed before and after the injection of Levovist. To reach a definitive diagnosis HCT and/or histological findings were considered as the reference procedures. Eleven solid renal cell carcinomas (RCCs), one embryonal metanephric adenoma (EMA), seven angiomyolipomas (AMLs), and four cystic RCCs were analyzed. Solid RCCs revealed a higher contrast enhancement than AMLs with a typical pattern on conventional US. The EMA and AML with an atypical pattern revealed intense contrast enhancement during the arterial phase, progressively decreasing during the delayed phase. Cystic RCCs showed intense contrast enhancement on the peripheral thick wall during the arterial phase decreasing during the delayed phase. PIHI with Levovist may differentiate solid RCCs from AMLs with no hypervascular pattern while solid RCCs show a higher intensity of contrast enhancement than hypervascular AML.