Renal Masses as Characterized by Ultrasound Contrast

Bertolotto, Michele; Derchi, Lorenzo E.; Cicero, Calogero Edoardo; Iannelli, Mariano

doi:10.1016/j.cult.2013.07.003

Cited by 12 publications

(9 citation statements)

References 45 publications

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“…Indeed, this technique can be performed during the same examination session of color Doppler US, thus acting as first-line and problem-solving imaging modality at the same time[9,11]. …”

Section: Discussionmentioning

confidence: 99%

“…However, there are well-known limitations of conventional Doppler modes in evaluating these patients, including difficult detection of perfusion abnormalities in globally hypoperfused kidneys, and unreliable characterization of renal masses other than simple cysts[5-8]. In particular, conventional Doppler modes do not allow differentiation between hypovascular tumors and complicated cysts[9,10], both of common occurrence in patients with RFI, nor can reliably assess the risk of malignancy of complex cystic masses.…”

Section: Introductionmentioning

confidence: 99%

“…Contrast-enhanced ultrasound (CEUS) has been advocated as the imaging modality of choice to evaluate patients with RFI, given the absence of nephrotoxicity and the ability of representing renal vascularization with excellent sensitivity and high spatial resolution[9,11]. According to the European federation of societies for ultrasound in medicine and biology (EFSUMB) guidelines, imaging with CEUS should be considered in every patient with RFI, when able to provide the clinically necessary information[1].…”

Section: Introductionmentioning

confidence: 99%

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Impact of contrast-enhanced ultrasound in patients with renal function impairment

Girometti¹,

Stocca²,

Serena³

et al. 2017

WJR

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AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.

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“…Indeed, this technique can be performed during the same examination session of color Doppler US, thus acting as first-line and problem-solving imaging modality at the same time[9,11]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of contrast-enhanced ultrasound in patients with renal function impairment

Girometti¹,

Stocca²,

Serena³

et al. 2017

WJR

Self Cite

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“…As concerning CEUS, PPV, SE, SP, NPV are 86.8%, 63.6%, 89.2%, 58.3% and 81.6% respectively, for RCC diagnostic efficacy [4] . CEUS advantages include safety, patient tolerance, real-time imaging capability, and costs [5] .…”

Section: Ceusmentioning

confidence: 99%

Imaging

Cicero¹,

Casarin²,

Curr��³

et al. 2019

MIS

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The incidence of renal cell carcinoma is rising and its represents the 2%, 3% of all cancers. The increased use of ultrasonography, contrast enhanced ultrasonography, computed tomography and magnetic resonance imaging have resulted in incidentally detected small renal masses (SRMs). SRMs represent a heterogeneous group of tumors that included metastatic lesions, benign, malignant, and cystic lesions. With the increase number of renal incidentalomas, we have seen an increase in therapeutic choices (surgery, ablation therapies and active surveillance). The role of imaging has progressively grown over the decades and became currently a cornerstone that is needed to perform diagnosis, treatment and follow-up of SRMs after ablation treatment. Hence, in this review, we critically assess recent literature on the role of imaging in the context of ablation management of SRMs with a focus on the diagnosis and follow-up protocol.

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“…Differences in enhancement are the clues for differentiation. In most cases, enhancement of renal tumors differs from that of the surrounding renal cortex in at least 1 vascular phase, whereas pseudomasses are isoenhancing to kidneys in all phases . Renal tumors, however, do not show a specific perfusion pattern .…”

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confidence: 93%

Solid Renal Tumors Isoenhancing to Kidneys on Contrast‐Enhanced Sonography: Differentiation From Pseudomasses

Bertolotto

Cicero

Catalano

et al. 2017

J of Ultrasound Medicine

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Objectives-To estimate the prevalence of solid renal tumors isoenhancing to kidneys in all vascular phases on contrast-enhanced sonography and to investigate whether they can be differentiated from pseudomasses.Methods-A computer search of the databases of 3 institutions identified 31 patients with pseudomasses and 380 patients with solid tumors investigated with contrast-enhanced sonography. Nineteen of 380 (5%) patients had tumors isoenhancing in all phases. Images and clips of these 19 tumors and the 31 pseudomasses were blindly assessed by 2 radiologists. They were asked to differentiate tumors from pseudomasses based on echogenicity, vascular architecture, and the presence of the medulla.Results-Isoenhancing tumors were clear cell carcinomas (n 5 7), angiomyolipomas (n 5 3), papillary tumors (n 5 3), metastasis (n 5 1), and oncocytoma (n 5 1). In the 4 nonoperated tumors, the diagnosis was confirmed by progression during the follow-up. There were 3 markedly hyperechoic, 11 mildly hypo/hyperechoic, and 5 isoechoic masses. Most pseudomasses were isoechoic to kidneys (23 of 31), with the medulla identified in 22 of 31 and 15 of 31 by radiologists 1 and 2, respectively. One and 2 pseudomasses were considered tumors by radiologists 1 and 2, respectively. One isoechoic isoenhancing tumor was not identified on contrast-enhanced sonography. Isoenhancing tumors in all phases were differentiated from pseudomasses by combining grayscale and contrast-enhanced sonography (areas under the receiver operating characteristic curve, 0.997 for reader 1; 0.969 for reader 2), with very good inter-reader agreement (weighted j 5 0.81).Conclusions-In our retrospective study, 5% of solid renal lesions were isoenhancing to kidneys in all phases. Differentiation from pseudomasses was possible by looking at baseline sonographic features and vascular characteristics.

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Renal Masses as Characterized by Ultrasound Contrast

Cited by 12 publications

References 45 publications

Impact of contrast-enhanced ultrasound in patients with renal function impairment

Impact of contrast-enhanced ultrasound in patients with renal function impairment

Imaging

Solid Renal Tumors Isoenhancing to Kidneys on Contrast‐Enhanced Sonography: Differentiation From Pseudomasses

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