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Published in: European Radiology 11/2018

01-11-2018 | Ultrasound

Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis

Authors: Johannes Rübenthaler, G. Negrão de Figueiredo, K. Mueller-Peltzer, D. A. Clevert

Published in: European Radiology | Issue 11/2018

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Abstract

Objective

To investigate the usefulness of contrast-enhanced ultrasound (CEUS) in the evaluation of renal masses.

Methods

This study included 255 patients with renal masses. Ages ranged from 18–86 years. CEUS was used for determining malignancy or benignancy and findings were correlated with the histopathological outcome. Out of 255 lesions, 212 lesions were malignant (83.1%) and 43 were benign (16.9%). Diagnostic accuracy was tested using the histopathological diagnosis as the gold standard.

Results

CEUS showed a sensitivity of 99.1% [95% confidence interval (CI): 96.7%, 99.9%], a specificity of 80.5% (CI: 65.1%, 91.2%), a positive predictive value of 96.4% (CI: 93.0%, 98.4%) and a negative predictive value of 94.3% (CI: 80.8%, 99.3%). Kappa for diagnostic accuracy was κ = 0.85 (CI: 0.75, 0.94). Of 212 malignant lesions, 200 renal cell carcinomas and 12 other malignant lesions were diagnosed. Out of 43 benign lesions, 10 angiomyolipomas, 3 oncocytomas, 8 renal cysts and 22 other benign lesions were diagnosed.

Conclusion

CEUS is an useful method to differentiate between malignant and benignant renal lesions. To date, to our knowledge, this is the largest study in Europe for the evaluation of renal lesions using CEUS with a histopathological validation.

Key Points

• CEUS helps clinicians detect and characterise unclear solid and cystic renal lesions
• CEUS shows a high diagnostic accuracy in the characterization of these lesions
• Proper surgical treatment or follow-up can be given with better diagnostic confidence
Literature
1.
go back to reference Motzer RJ, Hutson TE, Tomczak P et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356(2):115–124CrossRef Motzer RJ, Hutson TE, Tomczak P et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356(2):115–124CrossRef
2.
go back to reference Hock LM, Lynch J, Balaji KC (2002) Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 167(1):57–60CrossRef Hock LM, Lynch J, Balaji KC (2002) Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 167(1):57–60CrossRef
3.
go back to reference Wallen EM, Pruthi RS, Joyce GF, Wise M, Urologic Diseases in America P (2007) Kidney cancer. J Urol 177(6):2006–2018 discussion 18–9CrossRef Wallen EM, Pruthi RS, Joyce GF, Wise M, Urologic Diseases in America P (2007) Kidney cancer. J Urol 177(6):2006–2018 discussion 18–9CrossRef
4.
go back to reference Woldrich JM, Mallin K, Ritchey J, Carroll PR, Kane CJ (2008) Sex differences in renal cell cancer presentation and survival: an analysis of the National Cancer Database, 1993–2004. J Urol 179(5):1709–1713 discussion 13CrossRef Woldrich JM, Mallin K, Ritchey J, Carroll PR, Kane CJ (2008) Sex differences in renal cell cancer presentation and survival: an analysis of the National Cancer Database, 1993–2004. J Urol 179(5):1709–1713 discussion 13CrossRef
5.
go back to reference Kazmierski B, Deurdulian C, Tchelepi H, Grant EG (2018) Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol (NY) 43(4):880–898CrossRef Kazmierski B, Deurdulian C, Tchelepi H, Grant EG (2018) Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol (NY) 43(4):880–898CrossRef
6.
go back to reference Sidhu PS, Cantisani V, Dietrich CF et al (2018) The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (Long version). Ultraschall Med 39(2):e2–e44CrossRef Sidhu PS, Cantisani V, Dietrich CF et al (2018) The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (Long version). Ultraschall Med 39(2):e2–e44CrossRef
7.
go back to reference Bosniak MA (1991) The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 179(2):307–317CrossRef Bosniak MA (1991) The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 179(2):307–317CrossRef
8.
go back to reference Rübenthaler J, Bogner F, Reiser M, Clevert DA (2016) Contrast-enhanced ultrasound (CEUS) of the kidneys by using the Bosniak classification. Ultraschall Med 37(3):234–251CrossRef Rübenthaler J, Bogner F, Reiser M, Clevert DA (2016) Contrast-enhanced ultrasound (CEUS) of the kidneys by using the Bosniak classification. Ultraschall Med 37(3):234–251CrossRef
9.
go back to reference Rübenthaler J, Paprottka K, D'Anastasi M, Reiser M, Clevert DA (2017) Diagnosis of perinephric retroperitoneal lymphangioma supported by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 65(1):43–47CrossRef Rübenthaler J, Paprottka K, D'Anastasi M, Reiser M, Clevert DA (2017) Diagnosis of perinephric retroperitoneal lymphangioma supported by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 65(1):43–47CrossRef
10.
go back to reference Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924CrossRef Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924CrossRef
11.
go back to reference Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43(1–2):1–9PubMed Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43(1–2):1–9PubMed
12.
go back to reference Greis C (2011) Summary of technical principles of contrast sonography and future perspectives. Radiologe 51(6):456–461CrossRef Greis C (2011) Summary of technical principles of contrast sonography and future perspectives. Radiologe 51(6):456–461CrossRef
13.
go back to reference Rübenthaler J, Reiser M, Clevert DA (2016) Diagnostic vascular ultrasonography with the help of color Doppler and contrast-enhanced ultrasonography. Ultrasonography 35(4):289–301CrossRef Rübenthaler J, Reiser M, Clevert DA (2016) Diagnostic vascular ultrasonography with the help of color Doppler and contrast-enhanced ultrasonography. Ultrasonography 35(4):289–301CrossRef
14.
go back to reference Piscaglia F, Bolondi L, Italian Society for Ultrasound in M, Biology Study Group on Ultrasound Contrast A (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32(9):1369–1375CrossRef Piscaglia F, Bolondi L, Italian Society for Ultrasound in M, Biology Study Group on Ultrasound Contrast A (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32(9):1369–1375CrossRef
15.
go back to reference ter Haar G (2009) Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 47(8):893–900CrossRef ter Haar G (2009) Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 47(8):893–900CrossRef
16.
go back to reference Escudier B, Porta C, Schmidinger M et al (2014) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii49–iii56CrossRef Escudier B, Porta C, Schmidinger M et al (2014) Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(Suppl 3):iii49–iii56CrossRef
17.
go back to reference Clevert DA, Sterzik A, Braunagel M, Notohamiprodjo M, Graser A (2013) Modern imaging of kidney tumors. Urologe A 52(4):515–526CrossRef Clevert DA, Sterzik A, Braunagel M, Notohamiprodjo M, Graser A (2013) Modern imaging of kidney tumors. Urologe A 52(4):515–526CrossRef
18.
go back to reference Rübenthaler J, Reimann R, Hristova P, Staehler M, Reiser M, Clevert DA (2015) Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 63(2):89–97CrossRef Rübenthaler J, Reimann R, Hristova P, Staehler M, Reiser M, Clevert DA (2015) Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 63(2):89–97CrossRef
19.
go back to reference Reimann R, Rübenthaler J, Hristova P, Staehler M, Reiser M, Clevert DA (2015) Characterization of histological subtypes of clear cell renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 63(1):77–87CrossRef Reimann R, Rübenthaler J, Hristova P, Staehler M, Reiser M, Clevert DA (2015) Characterization of histological subtypes of clear cell renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 63(1):77–87CrossRef
20.
go back to reference Houtzager S, Wijkstra H, de la Rosette JJ, Laguna MP (2013) Evaluation of renal masses with contrast-enhanced ultrasound. Curr Urol Rep 14(2):116–123CrossRef Houtzager S, Wijkstra H, de la Rosette JJ, Laguna MP (2013) Evaluation of renal masses with contrast-enhanced ultrasound. Curr Urol Rep 14(2):116–123CrossRef
21.
go back to reference Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271(1):133–142CrossRef Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271(1):133–142CrossRef
22.
go back to reference Gerst S, Hann LE, Li D et al (2011) Evaluation of renal masses with contrast-enhanced ultrasound: initial experience. AJR Am J Roentgenol 197(4):897–906CrossRef Gerst S, Hann LE, Li D et al (2011) Evaluation of renal masses with contrast-enhanced ultrasound: initial experience. AJR Am J Roentgenol 197(4):897–906CrossRef
23.
go back to reference Clevert DA, Minaifar N, Weckbach S et al (2008) Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 39(1–4):171–178PubMed Clevert DA, Minaifar N, Weckbach S et al (2008) Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 39(1–4):171–178PubMed
24.
go back to reference Sanz E, Hevia V, Arias F et al (2015) Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation. Curr Urol Rep 16(1):469CrossRef Sanz E, Hevia V, Arias F et al (2015) Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation. Curr Urol Rep 16(1):469CrossRef
25.
go back to reference Haendl T, Strobel D, Legal W, Frieser M, Hahn EG, Bernatik T (2009) Renal cell cancer does not show a typical perfusion pattern in contrast-enhanced ultrasound. Ultraschall Med 30(1):58–63CrossRef Haendl T, Strobel D, Legal W, Frieser M, Hahn EG, Bernatik T (2009) Renal cell cancer does not show a typical perfusion pattern in contrast-enhanced ultrasound. Ultraschall Med 30(1):58–63CrossRef
26.
go back to reference Fan L, Lianfang D, Jinfang X, Yijin S, Ying W (2008) Diagnostic efficacy of contrast-enhanced ultrasonography in solid renal parenchymal lesions with maximum diameters of 5 cm. J Ultrasound Med 27(6):875–885CrossRef Fan L, Lianfang D, Jinfang X, Yijin S, Ying W (2008) Diagnostic efficacy of contrast-enhanced ultrasonography in solid renal parenchymal lesions with maximum diameters of 5 cm. J Ultrasound Med 27(6):875–885CrossRef
27.
go back to reference Tamai H, Takiguchi Y, Oka M et al (2005) Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med 24(12):1635–1640CrossRef Tamai H, Takiguchi Y, Oka M et al (2005) Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med 24(12):1635–1640CrossRef
28.
go back to reference Siegel CL, Middleton WD, Teefey SA, McClennan BL (1996) Angiomyolipoma and renal cell carcinoma: US differentiation. Radiology 198(3):789–793CrossRef Siegel CL, Middleton WD, Teefey SA, McClennan BL (1996) Angiomyolipoma and renal cell carcinoma: US differentiation. Radiology 198(3):789–793CrossRef
29.
go back to reference Sim JS, Seo CS, Kim SH et al (1999) Differentiation of small hyperechoic renal cell carcinoma from angiomyolipoma: computer-aided tissue echo quantification. J Ultrasound Med 18(4):261–264CrossRef Sim JS, Seo CS, Kim SH et al (1999) Differentiation of small hyperechoic renal cell carcinoma from angiomyolipoma: computer-aided tissue echo quantification. J Ultrasound Med 18(4):261–264CrossRef
30.
go back to reference Reuter VE, Presti JC Jr (2000) Contemporary approach to the classification of renal epithelial tumors. Semin Oncol 27(2):124–137PubMed Reuter VE, Presti JC Jr (2000) Contemporary approach to the classification of renal epithelial tumors. Semin Oncol 27(2):124–137PubMed
Metadata
Title
Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis
Authors
Johannes Rübenthaler
G. Negrão de Figueiredo
K. Mueller-Peltzer
D. A. Clevert
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5504-1

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