Contrast enhanced ultrasound of renal masses. A reappraisal of EFSUMB recommendations and possible emerging applications.

Abstract

The main imagistic method for characterization of renal lesions is contrast enhanced computed tomography (CECT). Disadvantages of CECT are a contrast-induced nephropathy in patients with renal impairment, allergic reactions and high costs. Contrast-enhanced ultrasound (CEUS) evaluation of hepatic and non-hepatic lesions is a relatively new, but increasingly utilised, diagnostic method. In 2011 the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) updated the Guidelines and Recommendations on the Clinical Practice of CEUS and included in the recommendation the renal pathology. However, there are several possible new indications that have not been discussed (pyelocaliceal masses and renal vein thrombosis) and several issues that remain controversial such as the differentiation of benign and malignant tumours or the differentiation of lymphoma and metastasis.This study aims to review literature data, as well as reveal the latest findings in the field of renal CEUS.

Triparametric ultrasound in differentiating multicystic renal masses: a rare presentation of unilateral focal renal lymphangioma

“…This finding is in contrast to findings reported by Sparchez et al. and Dong et al., in which the majority of cases of RCC had a rapid wash-in or a rapid wash-out, or a rapid wash-in or a slow wash-out pattern of microbubble contrast [9] , [10] . Aoki et al.…”

“…and Dong et al. have found clear-cell RCC has rapid wash-in and wash-out patterns, whereas papillary and chromophobe RCCs have slow wash-in and rapid wash-out patterns [9] , [10] . One could postulate these findings may be seen in MCRCC; however, this would need further investigation.…”

Demonstration of Improved Renal Congestion After Heart Failure Treatment on Renal Perfusion Imaging With Contrast-Enhanced Ultrasonography

“…CEUS with Sonazoid ® allowed the non-invasive assessment of renal perfusion in the clinical setting. [25][26][27] Microbubbles are smaller than red blood cells and traverse the lungs from the venous to the arterial system and can be imaged within the capillary beds of the target organ. Parenchymal contrast imaging is based on the blood flow rate in the distal renal vessels.…”

Contrast-enhanced ultrasonography of cervical carcinoma: perfusion pattern and relationship with tumour angiogenesis

“…These data are in accordance with observations in many other hypervascular tumours. [27][28][29]34,35 Angiogenesis is a dynamic process that is defined as the growth and development of new microvessels required for solid tumours to expand in size beyond 1.0-2.0 mm in diameter. Angiogenesis is thought to be an independent prognostic factor for recurrence and poor outcomes in invasive cancer of the uterine cervix.…”