Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System

Abstract

Purpose To perform a single-center study of contrast material-enhanced ultrasonography (US)-assisted percutaneous nephrostomy (PCN) for patients with nondilated renal collecting system. Materials and Methods An international review board approved this retrospective study with waiver of informed consent for participation, and the study was approved by the Ethical Committee. From November 2011 to September 2015, 47 patients (mean age, 51.9 years ± 16.2 [standard deviation]; range, 18-80 years) with clinical necessity of urinary drainage, urinary diversion, or provision of access to the collecting system and with nondilated renal collecting system who underwent contrast-enhanced US-assisted PCN for 48 kidneys were included. US contrast agent was injected through the puncture needle and the drainage catheter to confirm successful PCN. The technical success rate and complications were evaluated. Relative frequencies with 95% confidence intervals (CIs) were calculated. Results The technical success rate was 100% (47 of 47, 95% CI: 93.8%, 100%) per patient and 100% (48 of 48, 95% CI: 94.0%, 100%) per kidney. For each kidney, the mean number of needle passes was 1.4 ± 0.5 (range, 1-3). The mean duration of the complete procedure was 18.9 minutes ± 4.8 (range, 8-30 minutes). The mean dose of contrast agent was 12.9 mL ± 3.2 (range, 8-25 mL). No major complications were observed. After a follow-up of 1-30 days (mean, 18.4 days ± 10.3), only four patients (four of 47, 8.5%, 95% CI: 2.37%, 20.4%) had minor complications, including one perirenal hematoma seen at US 9 days after the procedure and three patients with transient macroscopic hematuria that lasted 1-2 days. Conclusion Contrast-enhanced US-assisted PCN in patients with nondilated renal collecting system is valuable with high technical success rate. RSNA, 2017.

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

“…A total of 12 studies (all case series) fall into this miscellaneous section, which includes 4 categories of CEUS assisted procedures: (1) US‐guided abscess drainage; (2) US‐guided percutaneous nephrostomy; (3) US‐guided biliary interventions; and (4) hepatic and splenic hemorrhage. In the first 3 categories, a diluted contrast solution (ie, 0.1 mL of SonoVue in 20 mL of saline) is injected directly in the catheter or needle to visualize the exact location of the cavity or tissue around the catheter or needle tip: so‐called intracavitary CEUS.…”

“…In 2 series of 45 and 47 CEUS‐guided percutaneous nephrostomies, respectively, successful catheter placement was reported in 100% . Very remarkable and with great clinical potential, the latter study included only patients with nondilated pelvises, whereas the former study reported that CEUS could show the site of obstruction (renal pelvis, ureter, or urinary bladder) in all cases.…”

Contrast‐Enhanced Ultrasound Guidance for Interventional Procedures

“…Ultrasound contrast agents can be inserted into a nephrostomy tube/access catheter to verify the location of the tip. So far, CEUS‐guided nephrostomy has been used mainly in difficult cases, especially when the urinary system is not dilated . A CEUS nephrostogram can also be useful in cases in which radiation and contrast minimization are paramount, such as children, pregnant women, and patients with chronic kidney disease .…”

Contrast enhanced ultrasound (CEUS) in Pregnancy: Is this the last frontier for microbubbles?

“…The ability to add to the baseline ultrasound examination and to perform a CEUS examination safely would be advantageous. The intravenous application of UCA allows the safe and rapid cannulation of the dilated pelvicalyceal system [8] and insertion of a nephrostomy drainage catheter, even if the system is not prominently dilated [9]. This can be followed by a UCA catheter injection (intra-cavitary CEUS) to demonstrate the correct positioning of the drainage tube, without the need for fluoroscopy [10,11].…”

“…Die Möglichkeit, CEUS ergänzend zur Basisultraschalluntersuchung sicher durchzuführen, wäre von Vorteil. Die intravenöse UCA-Gabe ermöglicht die sichere und schnelle Kanülierung des erweiterten Nierenbeckenkelchsystems [8] und die Anlegung eines Nephrostomie-Drainagekatheters, auch wenn das System nicht markant dilatiert ist [9]. Anschließend kann eine UCA-Katheter-Injektion (intrakavitäre CEUS) durchgeführt werden, um die korrekte Positionierung des Drainageschlauchs ohne Einsatz der Fluoroskopie darzustellen [10,11].…”