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Nearly 25% of solid renal tumors are indolent cancer or benign and can be managed conservatively in selected patients. This prospective study was performed to determine whether preoperative IV microbubble contrast-enhanced ultrasound can be used to differentiate indolent and benign renal tumors from more aggressive clear cell carcinoma.
Thirty-four...
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Purpose:
To compare superb microvascular imaging (SMI) with contrast-enhanced ultrasonography (CEUS) for evaluating the ablation of benign thyroid nodules.
Methods:
225 Patients with 256 benign thyroid nodules underwent conventional ultrasound, color Doppler flow imaging (CDFI), CEUS, and SMI before and after laser ablation. They were routinely...
Citations
... Early detection of RCC becomes crucial for improving the prognosis and survival of patients. [7][8][9][10] In this context, a CT scan emerges as the preferred imaging choice. It not only provides vital information to radiologists but also serves as a guiding tool for planning surgery. ...
Objective: The aim of this study is to assess the validity of Computed Tomography (CT) in evaluating solid renal masses by comparing CT findings with histopathological results. Methodology: This cross-sectional study involved 210 patients at the Department of Radiology PESSI Hospital Islamabad, spanning July 2022 to June 2023. Patients were selected based on predefined inclusion criteria, and their detailed medical histories were examined. Each patient underwent both non-contrast and contrast CT scans, and the radiological diagnoses were confirmed. The CT-based diagnoses were then compared with histopathological results, and measures such as positive predictive value (PPV), accuracy, sensitivity, specificity, and negative predictive value (NPV) of CT in diagnosing renal masses were calculated. Results: The mean age of the study participants was 48.00±810 years. Male to female ratio was 2:1. The majority of the study participants were belonging from the urban area and were under graduate. The results of the study further revealed the frequency of renal masses which was more in male (71.90%, n=151) as compared to female (28.09%, n=59). The study found that the right kidney was affected in 58.09% (n=122) of cases, the left kidney in 36.19% (n=76), and both kidneys in 5.71% (n=12). In our study, we observed variations in density among patients, with 39.06% exhibiting mixed density, followed by 23.80% with hypo-dense, 20.95% with hyper-dense, and 16.19% with iso-dense lesions. When it comes to enhancement, we found that 40.01% had a moderate degree, 24.76% had mild enhancement, 21.90% had intense enhancement, and 13.33% showed no enhancement. Conclusion: In this study, we found a strong correlation between histopathological diagnosis and computed tomography (CT) in identifying solid renal masses, with notably high validity test results. Given these robust validity parameters, we can confidently conclude that CT scans serve as an effective and reliable diagnostic modality for identifying and diagnosing renal masses.
... However some benign lesions like oncocytoma also show hyper enhancement making it difficult to differentiate it from RCC on CEUS. However, RCC exhibits delayed contrast washout compared to adjacent renal parenchyma [13]. Marked enhancement and delayed washout of contrast medium are findings associated with clear cell RCC (ccRCC) (Figure 3). ...
... Strain elastography helps to aid in the discrimination of benign from malignant lesions, RCC from AML and RCC from transitional cell carcinoma (TCC). SWE also has potential value in differentiating 19 seconds after contrast injection it shows uniform enhancement [13]. DOI: http://dx.doi.org ...
... Blood flow was 116 (±84.12) ml/100 ml/min and blood volume is13.79 (± 7.79) ml/100 ml. ...
Renal cancers are one of the 10 most commonly seen cancers in both sexes. The incidence of renal cancers is high in Western developed countries and lower in Eastern and developing countries. The overall incidence of malignancy has been increasing in recent times. Ultrasound (USG) is very commonly used imaging technique; however recent advances like contrast enhanced ultrasound helps to differentiate various cystic renal masses. Availability of newer imaging techniques such as Computed tomography scan (CT scan) and Magnetic resonance imaging (MRI) and their various applications may play a role in better and early diagnosis of such lesions. Due to its highly metastatic nature, accurate staging is more important to facilitate proper treatment. Fluoro-deoxyglucose positron emission tomography (FDG PET) is widely applied in detection, staging/restaging and surveillance of such lesions. In this chapter, we will try to cover the recent advances in various modalities for detection of renal cancers, particularly renal cell carcinoma (RCC).
... Therefore, it does not deteriorate renal function in patients with chronic kidney disease. Initially, this US technique was frequently used for differentiating renal masses [57][58][59][60][61]. The use of US contrast is expanding to assess renal microcirculation for the detection of chronic ischemia [62][63][64][65]. ...
Renal artery stenosis (RAS) is increasingly being detected in elderly patients as life expectancy increases. RAS induces hypertension or reduces renal function. Computed tomography or magnetic resonance angiography are objective in detecting RAS but may cause iodine-induced nephrotoxicity or nephrogenic systemic fibrosis in patients with RAS. Ultrasound (US) is, by contrast, a noninvasive and real-time imaging modality useful in patients with reduced renal function. Renal US is not as sensitive for detecting RAS because this technique indirectly assesses the renal artery by analyzing intrarenal hemodynamic changes. Although, ideally, US would be used to directly evaluate the renal artery, its current utility for RAS detection remains unclear. The purpose of this review is to introduce how to assess renal artery with US, to describe imaging features of renal artery US, to compare renal artery US and renal US, and to show how to perform work-up in patients in whom RAS is suspected.
... Thus, its benign entity still is debatable [26]. The sonomorphological overlap between renal oncocytoma and renal cell carcinoma was previously demonstrated [27][28][29]. So far, no The remaining 20/49 did not undergo any urological treatment in our University Hospital, so final histopathological analysis is lacking. ...
... Thus, its benign entity still is debatable [26]. The sonomorphological overlap between renal oncocytoma and renal cell carcinoma was previously demonstrated [27][28][29]. So far, no sonomorphological feature has been established allowing for valid differentiation between oncocytoma and renal cell carcinoma. ...
Background and objectives: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. Materials and Methods: 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010–2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Results: CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. Conclusions: CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future
... RCC [4,5]. In recent years, contrast-enhanced ultrasound (CEUS) has been widely used to diagnose renal masses [6]. Compared with contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), there are many unique advantages of CEUS, such as cost-effectiveness, noninvasive, real-time imaging ability, no ionizing radiation, and the use of microbubble-based contrast agents with no nephrotoxicity, which make CEUS very valuable in the diagnosis of renal lesions. ...
Abstract Background To investigate the contrast-enhanced ultrasound (CEUS) findings of renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusion (Xp11.2/TFE3) in adult patients by comparison with those of clear cell RCC (ccRCC) and papillary RCC (pRCC). Methods In total, 110 patients (110 renal masses) who underwent CEUS examinations were enrolled in this study. The cases included 18 Xp11.2/TFE3 RCCs, 60 ccRCCs and 32 pRCCs. All masses were confirmed by operative pathology. The CEUS imaging data of these patients were retrospectively analysed by two readers. The conventional US and CEUS features of Xp11.2/TFE3 RCC were compared with those of ccRCC and pRCC. Results The age of the patients with Xp11.2/TFE3 RCC ranged from 20 to 68 years, with a mean age of 38.3 ± 16.3 years and a slight female predominance. The weighted kappa value that interprets the concordance between the interobserver agreement of the US and CEUS features ranged from 0.61 to 0.89. On conventional US and CEUS imaging of Xp11.2/TFE3 RCCs, the tumours were hypoechoic (6/18, 33.3%), isoechoic (8/18, 44.4%), and hyperechoic (4/18, 22.2%). The cystic component was present in 5 cases (27.8%), calcification was present in 9 cases (50.0%), and colour flow signal was present in 7 cases (38.9%). Most cases showed simultaneous wash-in (11/18, 61.1%); the peak enhancement showed hypoenhancement (6/18, 33.3%), isoenhancement (10/18, 55.6%), and hyperenhancement (2/18, 11.1%); most cases exhibited heterogeneous enhancement (12/18, 66.7%) and fast- or simultaneous-out (16/18, 88.9%); and a pseudocapsule was present in 6 cases (33.3%). In the multivariate logistic regression analysis, calcification and lower peak enhancement were more likely to be present in Xp11.2/TFE3 RCC than in ccRCC (P
... Haendl et al. [21] described the contrast-enhancement patterns of three oncocytomas: two lesions showed arterial hypervascularization followed by venous wash-out, whereas one lesion was hypovascular during the arterial and late phase. Tamai et al. [22] evaluated 29 patients with solid renal lesions using CEUS: two patients had an oncocytoma showing arterial hypervascularization which made them difficult to differentiate from RCC. Gerst et al. [23] prospectively evaluated the imaging characteristics of benign and malignant renal lesions by CEUS, and all three oncocytomas included in this study presented as hyperechoic. Two lesions showed rapid contrast-enhancement and venous wash-out, whereas one oncocytoma showed a continuing hypoenhancement. ...
Background:
The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses.
Methods:
18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent.
Results:
Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%).
Conclusions:
In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.
... This retrospective study demonstrated that CEUS was shown to have a high PPV (96.4 %), good specificity (80.5 %) and excellent sensitivity (99.1 %) for determination of the tumor characteristics of an ambiguous renal lesion. Overall, this is comparable with other imaging procedures such as CT or MRT, and these results are consonant with several earlier studies on this topic [21,[26][27][28]. Based on these study results, ambiguous renal lesions can already be classified with extremely high accuracy with regard to PPV and NPV on the basis of the morphological character in CEUS imaging, which with respect to NPV can spare the patient an FNA/ biopsy or surgery and their attendant risks. ...
Purpose To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome.
Materials and methods A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included. Patient ages ranged from 18 to 86 with (mean age 62 years; SD ± 13). CEUS (255 patients), CT (88 out of 255 patients; 34.5 %) and MRI (36 out of 255 patients; 14.1 %) were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome.
Results CEUS showed a sensitivity of 99.1 % (95 % confidence interval (CI): 96.7 %, 99.9 %), a specificity of 80.5 % (95 % CI: 65.1 %, 91.2 %), a positive predictive value (PPV) of 96.4 % (95 % CI: 93.0 %, 98.4 %) and a negative predictive value (NPV) of 94.3 % (95 % CI: 80.8 %, 99.3 %). CT showed a sensitivity of 97.1 % (95 % CI: 89.9 %, 99.6 %), a specificity of 47.4 % (95 % CI: 24.4 %, 71.1 %), a PPV of 87.0 % (95 % CI: 77.4 %, 93.6 %) and a NPV of 81.8 % (95 % CI: 48.2 %, 97.7 %). MRI showed a sensitivity of 96.4 % (95 % CI: 81.7 %, 99.9 %), a specificity of 75.0 % (95 % CI: 34.9 %, 96.8 %), a PPV of 93.1 % (95 % CI: 77.2 %, 99.2 %) and a NPV of 85.7 % (95 % CI: 42.1 %, 99.6 %). Out of the 212 malignant lesions a total of 130 clear cell renal carcinomas, 59 papillary renal cell carcinomas, 7 chromophobe renal cell carcinomas, 4 combined clear cell and papillary renal cell carcinomas and 12 other malignant lesions, e. g. metastases, were diagnosed. Out of the 43 benign lesions a total 10 angiomyolipomas, 3 oncocytomas, 8 benign renal cysts and 22 other benign lesions, e. g. renal adenomas were diagnosed. Using CEUS, 10 lesions were falsely identified as malignant or benign, whereas 8 lesions were false positive and 2 lesions false negative.
Conclusion CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to CT and MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method.
Key Points:
Citation Format
... In the prospective study of Gerst et al. [27], all three included oncocytomas presented as hyperechoic lesions, with two of them showing contrast enhancement with delayed venous wash-out. Haendl et al. [26] described heterogeneous echogenicity of three oncocytomas: one of them showing hypoenhancement during early and late phase, while the other lesions showed rapid contrast enhancement Figure 2. Venous wash-out in solitary oncocytoma of the right kidney. ...
Purpose: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the evaluation of renal oncocytoma.
Method: Thirteen patients with histopathologically confirmed renal oncocytoma and 26 patients with histopathologically confirmed renal cell carcinoma were included in this retrospective single-center study on whom CEUS was performed between 2005 and 2015. The applied contrast agent was a second-generation blood pool agent. CEUS examinations were performed and interpreted by a single radiologist with more than 15 years of experience (EFSUMB Level 3).
Results: CEUS examinations were successfully performed in all included patients without any adverse effects. Renal oncocytomas showed varying echogenicity (46% hypoechoic, 23% hyperechoic, 8% iso-/hyperechoic, 8% isoechoic). In two cases renal oncocytoma only demarcated upon i.v. application of contrast medium. In bilateral oncocytosis, lesions presented as hyperechoic. Only 23% of renal oncocytomas showed slight vascularization using Color Doppler. No oncocytoma-specific pattern of microperfusion could be elucidated: 85% of the oncocytomas presented hyperenhancing, of whom 50% also showed delayed venous wash-out; 8% of renal oncocytomas showed venous wash-out without early arterial hyperenhancement.
Conclusions: Within the frame of the present study and in line with the recent state of knowledge, no specific sonomorphological feature – including CEUS – could be detected allowing for adequate discrimination between oncocytoma and renal cell carcinoma.
Keywords: Renal oncocytoma, solid renal mass, benign renal tumor, contrast-enhanced ultrasound, CEUS
... CEUS can also be useful in characterization of indeterminate renal lesions. Malignant renal lesions such as clear cell renal cell carcinoma (RCC) typically exhibit early and avid enhancement at CEUS with heterogeneous and early washout (21)(22)(23). A perilesion rim of enhancement during the late parenchymal phase has also been described with the clear cell subtype (21,24,25). ...
... A perilesion rim of enhancement during the late parenchymal phase has also been described with the clear cell subtype (21,24,25). Quantitative CEUS has been shown to be helpful in distinguishing clear cell RCC from other histologic subtypes (23,26). ...
US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, transarterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymphangiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures. Online supplemental material is available for this article.©RSNA, 2020.
... The results of histopathology revealed that the CECT results were correct; chromophobe RCC was found in one patient, and oncocytoma was found in 12 patients. These results were consistent with the results of a previous prospective study (21). Chromophobe RCC is a sharp lesion with lobes, resembles oncocytoma, and has contrast enhancement that is similar to that of oncocytomas (4), which was why sonographers considered oncocytoma for a RCC and observed oncocytomas in 13 patient images, while histopathologists had observed only 12 oncocytoma slides. ...
... When diagnosing clear cell RCC, CEUS, CECT, and histopathology (n=104) had equal efficiency and accuracy. These results were consistent with the results of previous prospective studies (21,22) and retrospective studies (23). This might be because clear cell RCC is the most common and well-studied type of kidney lesion. ...
... Twelve cases of oncocytomas were reported via histopathology and CECT each, but CEUS reported 13 cases. These results were consistent with the results of other prospective studies (21,22). One case of chromophobe RCC was detected through histopathology and CECT each, but CEUS failed to detect chromophobe RCC. ...
Objectives:
Histopathology is the 'gold standard' for diagnosing renal cell carcinoma but is limited by sample size. Contrast-enhanced ultrasound can differentiate malignant and benign lesions, but the Chinese guidelines on the management of renal cell carcinoma do not include this method. The purpose of this study was to compare the diagnostic parameters of contrast-enhanced ultrasound against those of contrast-enhanced computed tomography for detecting kidney lesions, with histopathology considered the reference standard.
Methods:
Patients with suspected kidney lesions from prior grayscale ultrasonography and computed tomography were included in the analysis (n=191). The contrast-enhanced ultrasound, contrast-enhanced computed tomography, and histopathology data were collected and analyzed. A solid, enhanced mass was considered a malignant lesion, and an unenhanced mass or cyst was considered a benign lesion. The Bosniak criteria were used to characterize the lesions.
Results:
Contrast-enhanced ultrasound and contrast-enhanced computed tomography both detected that 151 patients had malignant tumors and 40 patients had benign tumors. No significant differences in the tumors and their subtypes were reported between contrast-enhanced ultrasound and histopathology (p=0.804). Chromophobe renal cell carcinoma was detected through contrast-enhanced computed tomography (n=1), but no such finding was reported by contrast-enhanced ultrasound. A total of 35 cases of papillary renal cell carcinoma were reported through contrast-enhanced ultrasound while 32 were reported through histopathology.
Conclusions:
Contrast-enhanced ultrasound might be safe and as accurate as histopathology in diagnosing kidney lesions, especially renal cell carcinoma. Additionally, this study provides additional information over histopathology and has an excellent safety profile.
Level of evidence:
III.
