Evaluation of Cystic and Solid Renal Lesions with Contrast-Enhanced Ultrasound: A Retrospective Study
Purpose Renal lesions are frequent random findings on CT, MRI, and conventional ultrasound. Since they are usually found accidentally, the respective examinations have not been performed optimally to provide a conclusive diagnosis, making additional multiphase contrast-enhanced examinations necessary. The aim of the study is to correlate CEUS findings with the final diagnosis and to determine whether it is a suitable method for the conclusive characterization of undetermined renal lesions.
Materials and Methods All CEUS examinations of focal renal lesions performed at our institute between 2007 and 2014 were retrospectively examined. 437 patients with a total of 491 lesions and 543 examinations were included. 54 patients had bilateral lesions. One patient had three lesions in one kidney. Histology was available in 49 cases and follow-ups in 124 cases. The sensitivity, specificity, positive and negative predictive value as well as positive and negative likelihood ratios were calculated.
Results There were 54 malignant and 437 benign lesions. The sensitivity and specificity were 0.981/0.954 overall, 1.000/0.956 for cystic lesions, 0.977/0.906 for solid lesions, and 0.971/0.071 for the histologically confirmed lesions. Bosniak classification was consistent in 289 of 301 lesions (96%). Only 12 lesions (3.9%) were falsely assessed as malignant.
Conclusion CEUS is an appropriate method for the clarification of undetermined renal lesions. The characterization of cystic lesions according to Bosniak is adequately possible, especially for potentially malignant lesions (types III and IV).
Eingereicht: 16. Januar 2021
Angenommen: 15. April 2021
27. Juli 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Mazziotti S, Cicero G, D’Angelo T. et al. Imaging and Management of Incidental Renal Lesions. Biomed Res Int 2017; 2017: 1854027
- 2 Bosniak MA. The current radiological approach to renal cysts. Radiology 1986; 158: 1-10
- 3 Israel GM, Bosniak MA. An update of the Bosniak renal cyst classification system. Urology 2005; 66: 484-488
- 4 Silverman SG, Pedrosa I, Ellis JH. et al. Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019; 292: 475-488
- 5 Huber J, Hallscheidt P, Wagener N. et al. Raumforderungen der Niere: CT vs. MRT. Zwei fast gleichwertige Alternativen mit feinen Unterschieden [Tumours of the Kidney: CT vs. MRI. Nearly equal alternatives with minor differences]. Urologe A 2010; 49: 345-350 German
- 6 Smith-Bindman R, Lipson J, Marcus R. et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009; 169: 2078-2086
- 7 Di Vece F, Tombesi P, Ermili F. et al. Management of incidental renal masses: Time to consider contrast-enhanced ultrasonography. Ultrasound 2016; 24: 34-40
- 8 Claudon M, Dietrich CF, Choi BI. et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
- 9 Piscaglia F, Bolondi L. Italian Society for Ultrasound in Medicine and Biology (SIUMB) Study Group on Ultrasound Contrast Agents. The safety of Sonovue in abdominal applications: Retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
- 10 Ascenti G, Gaeta M, Magno C. et al. Contrast-enhanced second-harmonic sonography in the detection of pseudocapsule in renal cell carcinoma. AJR Am J Roentgenol 2004; 182: 1525-1530
- 11 Park BK, Kim B, Kim SH. et al. Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 2007; 61: 310-314
- 12 Tamai H, Takiguchi Y, Oka M. et al. Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med 2005; 24: 1635-1640
- 13 Ascenti G, Mazziotti S, Zimbaro G. et al. Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 2007; 243: 158-165
- 14 Clevert DA, Minaifar N, Weckbach S. et al. Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 2008; 39: 171-178
- 15 Piscaglia F, Nolsøe C, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med 2012; 33: 33-59
- 16 Mazziotti S, Zimbaro F, Pandolfo A. et al. Usefulness of contrast-enhanced ultrasonography in the diagnosis of renal pseudotumors. Abdom Imaging 2010; 35: 241-245
- 17 Correas JM, Claudon M, Tranquart F. et al. The kidney: imaging with microbubble contrast agents. Ultrasound Q 2006; 22: 53-66
- 18 Sidhu PS, Cantisani V, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in Med 2018; 39: e2-e44
- 19 Harvey CJ, Alsafi A, Kuzmich S. et al. Role of US Contrast Agents in the Assessment of Indeterminate Solid and Cystic Lesions in Native and Transplant Kidneys. Radiographics 2015; 35: 1419-1430
- 20 Bertolotto M, Cicero C, Perrone R. et al. Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound. AJR Am J Roentgenol 2015; 204: W557-W565
- 21 Lan D, Qu HC, Li N. et al. The Value of Contrast-Enhanced Ultrasonography and Contrast-Enhanced CT in the Diagnosis of Malignant Renal Cystic Lesions: A Meta-Analysis. PLoS One 2016; 11: e0155857 DOI: 10.1371/journal.pone.0155857.
- 22 Bertolotto M, Cicero C, Catalano O. et al. Solid Renal Tumors Isoenhancing to Kidneys on Contrast-Enhanced Sonography: Differentiation From Pseudomasses. J Ultrasound Med 2018; 37: 233-242