Evaluation of image-pro plus assisted superb microvascular imaging for differential diagnosis of renal masses

Yiran Mao; Tingting Xia; Hailing Wang; Xi Wei; Jie Mu

doi:10.1016/j.urolonc.2024.04.026

Evaluation of image-pro plus assisted superb microvascular imaging for differential diagnosis of renal masses

Urol Oncol. 2024 May 16:S1078-1439(24)00445-9. doi: 10.1016/j.urolonc.2024.04.026. Online ahead of print.

Authors

Yiran Mao¹, Tingting Xia², Hailing Wang¹, Xi Wei¹, Jie Mu³

Affiliations

¹ Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, China.
² Oncology Department, Zibo First Hospital, Zibo, Shandong province, China.
³ Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, China. Electronic address: maggiemu2023@163.com.

PMID: 38760275
DOI: 10.1016/j.urolonc.2024.04.026

Abstract

Objective: Previous research on diagnostic assessment by superb microvascular imaging (SMI) were based on qualitative or semi-quantitative assessments of vascularity, which may be subjective and unrepeatable by different sonographers. This study aimed to evaluate diagnostic performance of SMI Image-pro Plus (IPP) based vascular index (VI) for malignant renal masses.

Method: We retrospectively reviewed 222 masses in 214 patients who underwent SMI between August 2019 and August 2022 in our study. We evaluated the diagnostic performance of blood flow via Alder grade, VI based on both IPP and SMI.

Results: The kappa consistency of the Adler grade and VI for renal masses was classified among different observers were 0.765 and 0.824. The intra-observers correlation ecoefficiency (ICC) were 0.727 and 0.874. Benign renal masses were mainly Adler grade 0, grade I, and grade II, VI was 4.30 ± 4.27 (Range 0.98-16.42); while malignant masses were mainly Adler grade III, VI was 14.95 ± 10.94 (Range 0.79-56.89). VI was higher in malignant than benign masses (t = 15.638, P < 0.01). Among the malignant masses, the mean VI in clear cell renal cell carcinoma was higher than that in papillary renal cell carcinoma and chromophobe renal cell carcinoma (F = 30.659, P < 0.01). The sensitivity, specificity and accuracy of SMI were 80.00%, 71.15%, and 78.64%, respectively. The sensitivity, specificity, and accuracy were 60.59%, 88.46%, and 80.18% by using a VI of 7.95 as the cutoff value to identify malignant lesions from benign masses yielded. VI had better diagnostic efficiency than ultrasonic characteristics and Adler grade in benign and malignant differential diagnosis (Z = 4.851, P < 0.01; Z = 2.732, P < 0.01).

Conclusion: VI was higher in malignant than benign in renal masses. In malignant masses, VI in CCRCC was higher than that in papillary renal cell carcinoma and ChRCC. As a noninvasive examination, it had important clinical significance in the differential diagnosis of renal masses. VI from IPP may assist sonographer in distinguish renal malignances as a quantitative tool for vascularity.

Keywords: Area under cure (AUC); Image-pro Plus (IPP); Renal masses; Superb Microvascular Imaging (SMI); vascular index (VI).