To assess the clinical value of ultrasound-guided attenuation parameter (UGAP) in the differentiation of benign and malignant renal lesions.

This study prospectively included 42 consecutive patients hospitalized at the Department of Urology of our hospital for renal lesions from June 1, 2021 to August 31, 2021. All patients underwent conventional ultrasound, contrast-enhanced ultrasound (CEUS), and UGAP measurement, and were divided into either a benign group (n=13) or a malignant group (n=29) according to the surgical pathology results. The differences of conventional ultrasound, CEUS, and UGAP between the two groups were analyzed by univariate and logistic multifactor analyses. The receiver operating curve of the UGAP value was plotted to calculate the cutoff value, area under the curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value.

Univariate analysis showed that there was a statistical difference in the homogeneity of internal echo of renal lesions on conventional ultrasound between the benign group and malignant group (6/23 vs 7/6, P=0.032). There was no significant difference in maximum diameter, echo, margin, regularity, or blood flow (P＞0.05). Compared with the control group, the percetages of patients with earlier enhancement of renal mass than the renal cortex (27/29 vs 6/13, χ²=6.606, P=0.010), hyperenhancement (27/29 vs 5/13, χ²=6.439, P=0.037), annular enhancement (24/29 vs 6/13, χ²=5.521, P=0.019), and non-perfusion area (24/29 vs 5/13, χ²=8.241, P=0.004) were significantly higher and the UGAP value [(0.45±0.13) vs (0.64±0.17), t=3.807, P＜0.001] was significantly lower in the malignant group. Multivariate analysis showed that lower average value of UGAP (odds ratio [OR]=0.260, P=0.017, 95% confidence interval [CI]: 0.086-0.788) and earlier enhancement of renal lesion than the renal cortex (OR=0.029, P=0.032, 95%CI: 0.001-0.728) were independent risk factors for malignancy. When 0.545 was used as the cutoff value for UGAP diagnosis, the diagnostic sensitivity, specificity, accuracy, positive prediction value, negative prediction value, and area under the curve were 72.41%, 69.23%, 71.43%, 84.00%, 52.94%, and 0.801, respectively.

UGAP has appreciated clinical value in the differentiation of benign and malignant renal lesions.