声辐射力脉冲成像技术鉴别诊断肾脏肿瘤

目的 评价声辐射力脉冲弹性成像（ARFI）技术诊断肾肿瘤的价值。方法 对86例肾肿瘤患者的86个病灶行常规超声及ARFI检查,比较肿瘤和周围肾实质、良恶性肾肿瘤的剪切波速度（SWV）、声触诊组织成像（VTI）评分的差异。结果 86例肾肿瘤患者中,良性肿瘤32例,均为血管平滑肌脂肪瘤;恶性肿瘤54例,包括肾透明细胞癌26例,肾嫌色细胞癌8例,肾乳头状细胞癌5例,浸润性尿路上皮癌15例;病灶与周围肾实质间SWV、VTI评分的差异均有统计学意义（P均<0.05）,肾良性肿瘤的SWV及VTI评分低于肾恶性肿瘤（P均<0.05）。以SWV > 1.37 m/s或VTI评分 > 3.83判定良恶性肾肿瘤的曲线下面积分别为0.898、0.847（P均<0.05）,敏感度分别为88.9%、83.3%,特异度分别为84.4%、78.1%;肾恶性肿瘤中,ccRCC的SWV及VTI评分明显高于其他恶性肿瘤,以SWV > 2.06 m/s或VTI评分 > 4.31鉴别ccRCC与肾其他肾恶性肿瘤的ROC曲线下面积分别为0.766、0.729（P均<0.05）,敏感度分别为65.4%、57.7%,特异度分别为82.1%、78.6%。结论 ARFI技术在肾良恶性肿瘤的鉴别诊断中具有一定价值,并有助于区分ccRCC与其他肾恶性肿瘤。     

Association of qualitative and quantitative imaging features on multiphasic multidetector CT with tumor grade in clear cell renal cell carcinoma

Purpose

The purpose of the study was to determine if enhancement features and qualitative imaging features on multiphasic multidetector computed tomography (MDCT) were associated with tumor grade in patients with clear cell renal cell carcinoma (ccRCC).

Methods

In this retrospective, IRB approved, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low grade (LG) and 43 high grade (HG) ccRCCs underwent preoperative four-phase MDCT in unenhanced (UN), corticomedullary (CM), nephrographic (NP), and excretory (EX) phases. Previously published quantitative (absolute peak lesion enhancement, absolute peak lesion enhancement relative to normal enhancing renal cortex, 3D whole lesion enhancement and the wash-in/wash-out of enhancement within the 3D whole lesion ROI) and qualitative (enhancement pattern; presence of necrosis; pattern of; tumor margin; tumor–parenchymal interface, tumor–parenchymal interaction; intratumoral vascularity; collecting system infiltration; renal vein invasion; and calcification) assessments were obtained for each lesion independently by two fellowship-trained genitourinary radiologists. Comparisons between variables included χ², ANOVA, and student t test. p values less than 0.05 were considered to be significant. Inter-reader agreement was obtained with the Gwet agreement coefficient (AC1) and standard error (SE) was reported.

Results

No significant differences were observed between the LG and HG ccRCC cohorts with respect to absolute peak lesion enhancement and relative lesion enhancement ratio. There was a significant inverse correlation between low and high grade ccRCC and tumor enhancement the NP (71 HU vs. 54 HU, p < 0.001) and EX (52 HU vs. 39 HU, p < 0.001) phases using the 3D whole lesion ROI method. The percent wash-in of 3D enhancement from the UN to the CM phase was also significantly different between LG and HG ccRCCs (352% vs. 255%, p = 0.003). HG lesions showed significantly more calcification, necrosis, collecting system infiltration and ill-defined tumor margins (p < 0.05). Overall agreement between the two readers had a mean AC1 of 0.8172 (SE 0.0235).

Conclusions

Quantitatively, high grade ccRCC had significantly lower whole lesion enhancement in the NP and EX phases on MDCT. Qualitatively, high grade ccRCC were significantly more likely to be associated with calcifications, necrosis, collecting system infiltration, and an ill-defined tumor margin.

     

LINC01232 serves as a novel biomarker and promotes tumour progression by sponging miR-204-5p and upregulating RAB22A in clear cell renal cell carcinoma

BackgroundLong non-coding RNAs (lncRNAs) are involved in the progression of various cancers, including clear cell renal cell carcinoma (ccRCC). This study aimed to investigate the expression and prognostic value of long intergenic non-protein coding RNA (LINC) 01232 in ccRCC and preliminary explore the molecular mechanism underlying the role of LINC01232 in ccRCC progression.MethodsTumour tissues and adjacent normal tissues of 122 patients with ccRCC were collected in this study. The levels of LINC01232, microRNA (miR)-204-5p and RAB22A were measured by quantitative real-time PCR. The proliferation, migration and invasion of ccRCC cells were detected by cell counting kit-8 assay and Transwell assay, respectively. The interaction among LINC01232, miR-204-5p and RAB22A was confirmed by bioinformatics analysis, dual-luciferase reporter assay and Pearson correlation analysis. The association of LINC01232 and miR-204-5p with ccRCC patient survival was verified by the Kaplan–Meier method and log-rank test. The prognostic value of LINC01232 in ccRCC was confirmed by Cox regression analysis.ResultsLINC01232 expression was increased in ccRCC tumour tissues and ccRCC cells and independently predicted the prognosis of ccRCC patients. In addition, LINC01232 silencing inhibited ccRCC cell proliferation, migration and invasion. Moreover, LINC01232 served as a sponge for miR-204-5p, and miR-204-5p reduction reversed the inhibitory effect of LINC01232 silencing on ccRCC cell function. Furthermore, LINC01232 could sponge miR-204-5p, causing the elevation of RAB22A in ccRCC, thereby promoting ccRCC cell function.ConclusionLINC01232 may be an independent prognostic biomarker in ccRCC and plays an oncogenic role in ccRCC progression by sponging miR-204-5p and upregulating RAB22A.     

Clear cell renal cell carcinoma: identifying PTEN expression on multiphasic MDCT

Purpose

To investigate whether multiphasic MDCT enhancement profiles can help to identify PTEN expression in clear cell renal cell carcinomas (ccRCCs). Lack of PTEN expression is associated with worsened overall survival, a more advanced Fuhrman grade, and a greater likelihood of lymph mode metastasis.

Methods

With IRB approval for this retrospective study, we derived a cohort of 103 histologically proven ccRCCs with preoperative 4-phase renal mass MDCT from 2001–2013. Following manual segmentation, a computer-assisted detection algorithm selected a 0.5-cm-diameter region of maximal attenuation within each lesion in each phase; a 0.5-cm-diameter region of interest was manually placed on uninvolved renal cortex in each phase. The relative attenuation of each lesion was calculated as [(Maximal lesion attenuation − cortex attenuation)/cortex attenuation] × 100. Absolute and relative attenuation in each phase were compared using t tests. The performance of multiphasic enhancement in identifying PTEN expression was assessed with logistic regression analysis.

Results

PTEN-positive and PTEN-negative ccRCCs both exhibited peak enhancement in the corticomedullary phase. Relative corticomedullary phase attenuation was significantly greater for PTEN-negative ccRCCs in comparison to PTEN-positive ccRCCs (33.7 vs. 9.5, p = 0.03). After controlling for lesion stage and size, relative corticomedullary phase attenuation had an accuracy of 84% (86/103), specificity of 100% (84/84), sensitivity of 11% (2/19), positive predictive value of 100% (2/2), and negative predictive value of 83% (84/101) in identifying PTEN expression.

Conclusion

Relative corticomedullary phase attenuation may help to identify PTEN expression in ccRCCs, if validated prospectively.

     

定量CT纹理分析鉴别诊断透明细胞型与非透明细胞型肾癌

目的 探讨定量CT纹理分析鉴别透明细胞型肾癌和非透明细胞型肾癌的可行性。方法 回顾性分析100个透明细胞型肾癌和27个非透明细胞型肾癌病灶的CT图像,应用TexRAD软件分析各扫描期相两种类型肾癌的纹理特征。结果 增强图像上,非透明细胞型肾癌的平均灰度值、标准差、熵、正像素的平均值明显低于透明细胞型肾癌,而峰度高于透明细胞型肾癌（P均<0.001）,偏度差异无统计学意义（P>0.05）。在皮髓质期的粗糙纹理上,正像素的平均值鉴别两种类型肾癌的ROC曲线下面积为0.92±0.04,敏感度为0.85,特异度为0.93,准确率为0.87。结论 透明细胞型肾癌与非透明细胞型肾癌的CT纹理特征间存在显著差异,定量CT纹理分析鉴别诊断这两种类型肾癌具有临床价值。     

Expression and clinical significance of PTPN12 in clear cell renal cell carcinoma

BackgroundClear cell renal cell carcinoma (ccRCC) is a common urological disease. Expression of the protein tyrosine phosphatase 12 gene (PTPN12) is decreased in many cancers; however, the relationship between PTPN12 gene function and renal cancer remains unclear.MethodsWe detected PTPN12 protein expression in ccRCC and corresponding normal tissues from 64 patients with ccRCC by immunohistochemistry, and relative PTPN12 mRNA levels by real-time quantitative polymerase chain reaction. The relationships between the relative expression levels of PTPN12 mRNA and the patients’ clinical data were analyzed.ResultsPTPN12 protein and mRNA expression levels were significantly lower in ccRCC compared with the corresponding normal tissues. The mRNA expression levels in the ccRCC and corresponding normal tissues from the 64 patients with ccRCC were 0.459±0.445 and 1.001±0.128, respectively, compared with the control (glyceraldehyde 3-phosphate dehydrogenase). There was a significant correlation between relative expression of PTPN12 mRNA in ccRCC tissues and tumor diameter and clinical stage.ConclusionThe expression levels of PTPN12 protein and mRNA were significantly lower in ccRCC tissues compared with normal tissues. The role of PTPN12 may provide new insights and evidence to aid the diagnosis and targeted therapy of ccRCC.     

Texture analysis as a radiomic marker for differentiating renal tumors

Purpose

To evaluate the utility of texture analysis for the differentiation of renal tumors, including the various renal cell carcinoma subtypes and oncocytoma.

Materials and methods

Following IRB approval, a retrospective analysis was performed, including all patients with pathology-proven renal tumors and an abdominal computed tomography (CT) examination. CT images of the tumors were manually segmented, and texture analysis of the segmented tumors was performed. A support vector machine (SVM) method was also applied to classify tumor types. Texture analysis results were compared to the various tumors and areas under the curve (AUC) were calculated. Similar calculations were performed with the SVM data.

Results

One hundred nineteen patients were included. Excellent discriminators of tumors were identified among the histogram-based features noting features skewness and kurtosis, which demonstrated AUCs of 0.91 and 0.93 (p < 0.0001), respectively, for differentiating clear cell subtype from oncocytoma. Histogram feature median demonstrated an AUC of 0.99 (p < 0.0001) for differentiating papillary subtype from oncocytoma and an AUC of 0.92 for differentiating oncocytoma from other tumors. Machine learning further improved the results achieving very good to excellent discrimination of tumor subtypes. The ability of machine learning to distinguish clear cell subtype from other tumors and papillary subtype from other tumors was excellent with AUCs of 0.91 and 0.92, respectively.

Conclusion

Texture analysis is a promising non-invasive tool for distinguishing renal tumors on CT images. These results were further improved upon application of machine learning, and support the further development of texture analysis as a quantitative biomarker for distinguishing various renal tumors.

     

Can diffusion-weighted magnetic resonance imaging of clear cell renal carcinoma predict low from high nuclear grade tumors

Objective

To assess the diagnostic performance of the apparent diffusion coefficient (ADC) in predicting the Fuhrman nuclear grading of clear cell renal cell carcinomas (ccRCC).

Materials and methods

A total of 129 patients who underwent partial and radical nephrectomies with pathology-proven ccRCC were retrospectively evaluated. Histopathological characteristics and nuclear grades were analyzed. In addition, conventional magnetic resonance imaging (MRI) features were assessed in consensus by two radiologists to discriminate nuclear grading. ADC values were obtained from a region of interest (ROI) measurement in the ADC maps calculated from diffusion-weighted imaging (DWI) using b values of 50, 500, and 800 s/mm². The threshold values for predicting and differentiating low-grade cancers (Fuhrman I–II) from high grade (Fuhrman III–IV) was obtained using binary logistic regression. The ADC cut-off value for differentiating low- and high-grade tumors was determined using classification analysis.

Results

Significant associations (P < 0.001) were found between nuclear grading, conventional MR features, and DWI. Hemorrhage, necrosis, perirenal fat invasion, enhancement homogeneity, and cystic component were identified as independent predictors of tumor grade. High-grade ccRCC had significantly lower mean ADC values compared to low-grade tumors. An ADC cut-off value of 1.6 × 10⁻³ mm²/s had an optimal predictive percentage of 65.5% for low-grade tumors above this threshold and 81% for high-grade ccRCC below this threshold. Overall predictive accuracy was 70.5%.

Conclusion

The addition of ADC values to a model based on MRI conventional features demonstrates increased sensitivity and high specificity improving the distinguishing accuracy between both high-grade and low-grade ccRCC.

     

Non‐invasive urine markers for the differentiation between RCCs and oncocytoma

BackgroundRecently, our group showed that Vim3 is overexpressed in tissue samples of renal oncocytomas and Mxi‐2 in clear cell renal carcinoma (ccRCC). The mechanism leading to the truncation of both proteins is known and involves with two miRs, both detectable in urine. Since the analysis of miRs is time‐consuming, our aim was to identify the truncated proteins in urine instead. Furthermore, urine samples from small renal masses (SRMs) (n = 45, <4 cm) were analyzed to get a pre‐surgical differentiation of the cancer subtypes.MethodsUrines were accessed from the urological biobank (n = 350). Proteins were isolated from urine samples, and Western blots were performed. Each sample was analyzed with ELISA for the expression of Vim3 and Mxi‐2. A lateral flow assay was established. For the detection of SRMs, the miRs were isolated and qRT‐PCR was performed.ResultsA significant increase of Vim3 in urines from patients with oncocytoma (n = 20) was detectable with ELISA compared to all other subtypes of RCCs (chromophobe (n = 50), papillary (n = 40), ccRCC (n = 200), and controls (n = 40) (***p < 0.0001)). Mxi‐2 was predominantly overexpressed in ccRCCs (***p < 0.0001). Lateral flow assay of Vim3 and Mxi‐2 shows two bands in the case of oncocytoma and ccRCC indicating the specificity of this test.For SRMs, an overexpression of miR‐15a/Mxi2 was detectable in urine samples from ccRCC and chromoRCC patients. In contrast to that, miR‐498/Vim3 were predominantly overexpressed in oncocytoma patients.ConclusionBoth proteins (Vim3 and Mxi‐2) were detectable in patients’ urines and can be used for the non‐invasive differentiation of kidney cancers.     

基于增强CT影像组学模型鉴别肾透明细胞癌与非透明细胞癌

目的 建立基于增强CT的影像组学模型,评估其鉴别肾透明细胞癌（ccRCC）与非透明细胞癌（non-ccRCC）的应用价值。方法 将147例ccRCC及32例non-ccRCC患者随机分为训练集125例和测试集54例。将所有患者的增强CT资料导入ITK-SNAP软件,手动勾画ROI,获得16个特征,分别建立基于特征的随机森林（RF）模型和逻辑回归（LR）模型,采用ROC曲线观察模型对ccRCC的诊断效能。结果 训练集RF模型诊断ccRCC的AUC为0.96（P<0.05）,特异度为1.00,敏感度0.83;LR模型诊断ccRCC的AUC为0.96（P<0.05）,特异度为1.00,敏感度为0.83。测试集RF模型诊断ccRCC的AUC为0.96（P<0.05）,特异度为1.00,敏感度为0.89;LR模型诊断ccRCC的AUC为0.88（P<0.05）,特异度为0.90,敏感度为0.77。结论 基于增强CT影像组学模型可用于鉴别ccRCC与non-ccRCC;RF模型诊断价值较LR模型更高。     

Renal Neoplasia in Tuberous Sclerosis: A Study of 41 Patients

ObjectiveTo study the clinical features and identify unique renal neoplasia subtypes and their prognostic implications in individuals with tuberous sclerosis complex (TSC).Patients and MethodsThe Mayo Clinic nephrectomy registry included 37 patients with TSC diagnosed between 1970 and 2018. Four additional patients were identified from the pathology consultation and autopsy files. All available renal tumors were further characterized using immunohistochemistry and fluorescence in situ hybridization. Clinicopathologic features and follow-up were obtained from the medical record. The American Association for Cancer Research Project GENIE registry was accessed using cBioPortal for molecular profiling of angiomyolipoma (AML).ResultsA total of 276 renal tumors from 41 patients were analyzed. Renal tumors were classified into 9 distinct morphological subtypes, with AML predominating (238 [86%]). Interestingly, all these tumors acted in a benign fashion except one renal cell carcinoma with clear cells and fibromyomatous stroma and one epithelioid AML that metastasized. Molecular profiling studies revealed that epithelioid AMLs were enriched for alterations of TP53, RB1, and ATRX. Eight patients died of direct complications of TSC, including 3 of end-stage renal disease. To date, none have died of a renal epithelial neoplasm.ConclusionThe identification of unique renal neoplasia subtypes may provide important clues to establish a diagnosis of TSC, and in the somatic setting, this finding has important implications for accurate prognostication. These tumors tend to be indolent, and only 2 of 276 tumors in our study exhibited metastatic behavior. Our results support multidisciplinary management with a focus on preservation of renal function.     

Differential expression profiling of microRNAs and their potential involvement in renal cell carcinoma pathogenesis

ObjectiveWe seek to identify the differentially expressed miRNAs in the clear cell subtype (ccRCC) of kidney cancer.Design and methodsWe performed a miRNA microarray analysis to compare the miRNA expression levels between ccRCC tissues and their normal counterpart. The top dysregulated miRNAs were validated by quantitative RT-PCR analysis. Bioinformatics analysis was also performed.ResultsA total of 33 dysregulated miRNAs were identified in ccRCC, including 21 upregulated miRNAs and many of these miRNAs have been reported to be dysregulated in other malignancies and have a potential role in cancer pathogenesis. The miRNAs showed a significant correlation with reported chromosomal aberration sites. We also utilized target prediction algorithms to identify gene targets. Preliminary analyses showed these targets can be directly involved in RCC pathogenesis.ConclusionWe identified miRNAs that are dysregulated in ccRCC and bioinformatics analysis suggests that these miRNAs may be involved in cancer pathogenesis and have the potential to be biomarkers.     

Quantitative multiparametric MR analysis of small renal lesions: correlation with surgical pathology

Purpose

The purpose of the study is to evaluate the utility of apparent diffusion coefficient (ADC), chemical shift signal intensity index (SII), and contrast enhancement in distinguishing between benign lesions and renal cell carcinoma (RCC) and between subtypes of renal lesions.

Methods

This retrospective study included 98 renal lesions (≤ 3 cm) on MRI with correlative surgical pathology. Scanner field strength, lesion location, and size were recorded. Two readers blinded to surgical pathology independently measured ADC ratio (ADC lesion/ADC non-lesion kidney), SII, and absolute/relative enhancement in the corticomedullary and nephrographic phases of contrast.

Results

There were 76 malignant and 22 benign lesions. 42 RCC were clear cell (ccRCC), 19 papillary (pRCC), 5 chromophobe (cbRCC). Benign lesions included both solid and cystic lesions. Interreader agreement for all variables was good–excellent (ICC 0.70–0.91). There was no difference in ADC or SII between benign and malignant lesions. There was greater absolute corticomedullary enhancement of benign versus malignant lesions (150.0 ± 111.5 vs. 81.1 ± 74.8, p = 0.0115), which did not persist when excluding pRCC. For lesion subtype differentiation, ADC_ratio for pRCC was lower than benign lesions (0.74 ± 0.35 vs. 1.03 ± 0.46, p = 0.0246). ccRCC demonstrated greater SII than other RCC (0.09 ± 0.22 vs. 0.001 ± 0.26, p = 0.0412). Oncocytomas and angiomyolipoma (AML) showed greater absolute corticomedullary enhancement than ccRCC and pRCC (145.6 ± 65.2 vs. 107.2 ± 85.3, p = 0.043 and 186.2 ± 93.9 vs. 37.6 ± 35.3, p = 0.0108), respectively.

Conclusions

While corticomedullary-phase enhancement was a differentiating feature, quantitative metrics from diffusion and chemical shift imaging cannot reliably differentiate benign from malignant lesions. Quantitative assessment may be useful in differentiating some benign and malignant lesion subtypes.

     

Small (&lt;4 cm) clear cell renal cell carcinoma: correlation between CT findings and histologic grade

Purpose

To evaluate the correlation between CT findings and histologic grade of small clear cell renal cell carcinoma (ccRCC).

Methods

CT scans of 101 patients with small ccRCC were reviewed independently by two radiologists for tumor size, shape, margin, encapsulation, enhancement pattern, and visual relative enhancement. Enhancement patterns were defined according to the percentage of uniform enhancement [pattern 1, homogeneous (≥90%); pattern 2, relatively homogeneous (≥75 and <90%); and pattern 3, heterogeneous (<75%)]. Quantitative parameters representing attenuation and degree of enhancement were calculated. Histologic grade was classified as low (Fuhrman grade I or II) and high (Fuhrman grade III or IV). CT imaging variables were analyzed using univariate and multivariate analyses.

Results

A total of 63 low-grade and 38 high-grade small ccRCCs were assessed. Low-grade tumors differed from high-grade tumors with respect to enhancement pattern 1 or 2 (p < 0.001 and p < 0.001), smaller size (p = 0.002 and p = 0.001), and lower attenuation on unenhanced scan (p < 0.001 and p = 0.008). In multivariate analysis, enhancement pattern 1 or 2 and low attenuation (≤30 HU) were identified as independent predictors of low-grade ccRCC. Accuracy derived from logistic regression analysis was 79.2% for reader 1 and 70.3% for reader 2.

Conclusions

CT imaging features including tumor attenuation and enhancement pattern can be useful to predict the biologic behavior of small ccRCC for adequate treatment strategy.

     

探究PODXL在肾透明细胞癌中的表达及相关意义

目的：研究PODXL在透明细胞肾细胞癌(ccRCC)组织与正常组织中的表达差异,并初步分析PODXL对肾透明细胞癌的临床诊断和患者预后的关系。实验方法：运用癌症基因组图谱(TCGA)数据库收集RNA-Seq数据和临床数据,观察ccRCC患者组织与正常组织中PODXL基因表达量的差异,同时分析PODXL与临床病理学之间的关系及与预后之间的关系。结果：在TCGA数据库中总体526例ccRCC样本的癌和癌旁组织中的PODXL的表达水平分别为6.42±1.42和3.61±1.31,差异有统计学意义(P<0.001)。72例配对的ccRCC和癌旁组织中的PODXL表达水平分别为6.55±1.23和3.53±1.35,有统计学意义(P<0.001)。PODXL的表达在患者性别、肾肿瘤分级、T分期、M分期、临床分期等均有不同差异(P<0.001)。生存分析发现PODXL低表达量组和高表达量组的生存时间分别为(1446.75±956.32)d和(1253.81±939.57)d,差异有统计学意义(Log-rank=14.38,P<0.001)。ROC曲线结果显示,PODXL基因可作为一个灵敏度和特异度较高的ccRCC诊断指标：其中AUC为0.805,敏感性为67.26%,特异性为78.17%。结论：PODXL在ccRCC中高表达与临床病理特征呈正相关,是预后不良因素,有望作为肾透明细胞癌患者的生存预后及诊断的潜在生物学标志。     

肾细胞癌常规超声及超声造影特征

目的 观察肾细胞癌（RCC）及其常见病理亚型的常规超声及超声造影（CEUS）特征。方法 纳入94例RCC（恶性组）及34例肾脏良性病变患者（良性组）,将恶性组分为肾透明细胞癌（ccRCC）亚组（n=74）和肾乳头状细胞癌（pRCC）及肾嫌色细胞癌（cRCC）亚组（n=16）;比较良、恶性组及恶性组2亚组病灶常规超声及CEUS特征。结果 恶性组主要表现为低回声（63/94,67.02%）、快进（84/94,89.36%）、快退（58/94,61.70%）及高增强（68/94,72.34%）,良性组主要表现为高回声（20/34,58.82%）、快进（22/34,64.71%）、慢退（16/34,47.06%）及高增强（15/34,44.12%）;组间病灶回声、CEUS增强方式、消退方式及增强强度差异均有统计学意义（P均<0.05）。恶性组内2亚组病灶增强程度差异具有统计学意义（P<0.05）,ccRCC主要表现为高增强（61/74,82.43%）,pRCC及cRCC主要表现为低增强（10/16,62.50%）。结论 RCC,尤其ccRCC超声多表现为低回声、快进、快退及高增强;常规超声及CEUS对术前诊断RCC有一定价值。