Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound

Bertolotto, Michele; Cicero, Calogero Edoardo; Perrone, R.; Degrassi, Ferruccio; Cacciato, Francesca; Cova, Maria Assunta

doi:10.2214/ajr.14.13375

Cited by 65 publications

(58 citation statements)

References 34 publications

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“…While MRI has its own advantages such as no ionizing radiation, better contrast resolution and functional information, it is more susceptible to artifacts, and most community-acquired MR scans have less image resolution [14] . It is also reported that CEUS is effective for characterizing renal tumors presenting with equivocal enhancement at CT [15] . CEUS is well suited to help in the evaluation of the enhancement curve over time, which aids in preoperative differentiation of renal tumors [16] .…”

Section: Discussionmentioning

confidence: 98%

Does Computed Tomography Still Have Limitations to Distinguish Benign from Malignant Renal Tumors for Radiologists?

Shin¹,

Duddalwar

Ukimura³

et al. 2017

Urol Int

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Objectives: To evaluate the current accuracy of CT for diagnosing benign renal tumors. Materials and Methods: We retrospectively reviewed 905 patients who underwent preoperative CT followed by surgical resection. The final pathology was benign in 156 patients (17%). After exclusions, 140 patients with 163 benign tumors were included and 3 sets of the CT interpretations by radiologists with varying levels of experience were analyzed. Results: The histological breakdown was as follows: oncocytomas (54.6%), angiomyolipomas (AMLs; 30.7%), renal cysts (8.0%), other miscellaneous benign tumors (6.7%). The sensitivities of diagnosing oncocytomas were 3.4, 9.0, and 13.5% in primary radiological reports, second blinded reviews, and third non-blinded reviews, respectively (p = 0.055). The sensitivities of diagnosing AMLs were 46.0, 58.0, and 62.0% in the 3-sets of CT interpretations, respectively (p = 0.246). As for renal cysts, the sensitivities were 69.2, 92.3, and 100% in the 3-sets of CT interpretations, respectively (p = 0.051). In primary reports, the positive predictive values were 95.8% in lipid poor (lp)-AMLs, 60.0% in oncocytomas, 69.2% in renal cysts, respectively (p < 0.05). Conclusions: Current conventional CT imaging still has limitations in differentiating oncocytomas and lp-AMLs from renal cell carcinomas, even when images were re-examined by experienced radiologists.

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Section: Discussionmentioning

confidence: 98%

Does Computed Tomography Still Have Limitations to Distinguish Benign from Malignant Renal Tumors for Radiologists?

Shin¹,

Duddalwar

Ukimura³

et al. 2017

Urol Int

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“…Indeed, the ability of CEUS to identify renal infarction and to characterize complex cystic masses, pseudolesions, and hypovascular lesions has been mostly demonstrated in patients with well-functioning kidneys[10,12,13,21]. To our knowledge, no specific studies focused on patients with renal failure.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning CEUS, we used the following diagnostic criteria: (1) infarction was diagnosed in presence of at least one well-defined, wedge-shaped non-enhancing area within an otherwise normal-appearing kidney[12]; (2) cortical ischemia was diagnosed in presence of enhancing interlobar and arcuate arteries with non-enhancing portions of the cortex[11]; and (3) a lesion was considered solid if more than half of the volume was represented by enhancing solid tissue, and cystic if composed predominantly of nonenhancing spaces[10,20]. Cystic lesions were graded according to the Bosniak criteria as previously described[13,14].…”

Section: Methodsmentioning

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%

“…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]. CEUS has the potential to compensate for limitations of conventional Doppler modes with a diagnostic performance comparable or superior to CT in the detection of perfusion abnormalities, lesion characterization (cystic vs solid), and categorization of cysts according to Bosniak criteria[10,12-14]. To our knowledge, however, evidence supporting the above indications results from reports on patients with normal renal function and experts opinion rather than specifically addressed studies, which currently lack.…”

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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Contrast‐Enhanced Ultrasound Classification of Previously Indeterminate Renal Lesions

Zarzour

Lockhart

West

et al. 2017

J of Ultrasound Medicine

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Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound

Abstract: Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.

Cited by 65 publications

References 34 publications

Does Computed Tomography Still Have Limitations to Distinguish Benign from Malignant Renal Tumors for Radiologists?

Does Computed Tomography Still Have Limitations to Distinguish Benign from Malignant Renal Tumors for Radiologists?

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

Contrast‐Enhanced Ultrasound Classification of Previously Indeterminate Renal Lesions

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