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Zbroja M, Kuczyńska M, Drelich K, Mikos E, Zarajczyk A, Cheda M, Dąbrowska I, Drelich-Zbroja A. Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions. J Clin Med 2024; 13:3821. [PMID: 38999387 PMCID: PMC11242659 DOI: 10.3390/jcm13133821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.
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Affiliation(s)
- Monika Zbroja
- Department of Pediatric Radiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Katarzyna Drelich
- Students' Scientific Society at the Department of Pediatric Radiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Eryk Mikos
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Agata Zarajczyk
- Students' Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Mateusz Cheda
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Izabela Dąbrowska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
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Srivastava S, Dhyani M, Dighe M. Contrast-enhanced ultrasound (CEUS): applications from the kidneys to the bladder. Abdom Radiol (NY) 2024:10.1007/s00261-024-04388-4. [PMID: 38884782 DOI: 10.1007/s00261-024-04388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is an advanced ultrasound (US) technique utilizing ultrasound contrast agents (UCAs) to provide detailed visualization of anatomic and vascular architecture, including the depiction of microcirculation. CEUS has been well-established in echocardiography and imaging of focal hepatic lesions and recent studies have also shown the utility of CEUS in non-hepatic applications like the urinary system. The updated guidelines by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from 2018 describe the use of CEUS for non-hepatic applications. CEUS' excellent safety profile and spatial resolution make it a superior modality to conventional US and is often comparable and even superior to CECT in some instances. In comparison to other cross-sectional imaging modalities such as CECT or MRI, CEUS offers a safe (by virtue of non-nephrotoxic US contrast agents), accurate, cost-efficient, readily available, and a quick means of evaluation of multiple pathologies of the urinary system. CEUS also has the potential to reduce the overall economic burden on patients requiring long-term follow-up due to its low cost as compared to CT or MRI techniques. This comprehensive review focuses on the applications of CEUS in evaluating the urinary system from the kidneys to the urinary bladder. CEUS can be utilized in the kidney to evaluate complex cystic lesions, indeterminate lesions, pseudotumors (vs solid renal tumors), renal infections, and renal ischemic disorders. Additionally, CEUS has also been utilized in evaluating renal transplants. In the urinary bladder, CEUS is extremely useful in differentiating a bladder hematoma and bladder cancer when conventional US techniques show equivocal results. Quantitative parameters of time-intensity curves (TICs) of CEUS examinations have also been studied to stage and grade bladder cancers. Although promising, further research is needed to definitively stage bladder cancers and classify them as muscle-invasive or non-muscle invasive using quantitative CEUS to guide appropriate intervention. CEUS has been very effective in the classification of cystic renal lesions, however, further research is needed in differentiating benign from malignant renal masses.
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Affiliation(s)
- Saubhagya Srivastava
- Department of Radiology, University of Washington, Seattle, Washington, 98195, USA.
| | - Manish Dhyani
- Department of Radiology, University of Washington, Seattle, Washington, 98195, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, 98195, USA
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Fernández T, Sebastià C, Paño B, Corominas Muñoz D, Vas D, García-Roch C, Revuelta I, Musquera M, García F, Nicolau C. Contrast-enhanced US in Renal Transplant Complications: Overview and Imaging Features. Radiographics 2024; 44:e230182. [PMID: 38781089 DOI: 10.1148/rg.230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Renal transplant is the first-line treatment of end-stage renal disease. The increasing number of transplants performed every year has led to a larger population of transplant patients. Complications may arise during the perioperative and postoperative periods, and imaging plays a key role in this scenario. Contrast-enhanced US (CEUS) is a safe tool that adds additional value to US. Contrast agents are usually administered intravenously, but urinary tract anatomy and complications such as stenosis or leak can be studied using intracavitary administration of contrast agents. Assessment of the graft and iliac vessels with CEUS is particularly helpful in identifying vascular and parenchymal complications, such as arterial or venous thrombosis and stenosis, acute tubular injury, or cortical necrosis, which can lead to graft loss. Furthermore, infectious and malignant graft involvement can be accurately studied with CEUS, which can help in detection of renal abscesses and in the differentiation between benign and malignant disease. CEUS is also useful in interventional procedures, helping to guide percutaneous aspiration of collections with better delimitation of the graft boundaries and to guide renal graft biopsies by avoiding avascular areas. Potential postprocedural vascular complications, such as pseudoaneurysm, arteriovenous fistula, or active bleeding, are identified with CEUS. In addition, newer quantification tools such as CEUS perfusion are promising, but further studies are needed to approve its use for clinical purposes. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Tomás Fernández
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carmen Sebastià
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Blanca Paño
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Daniel Corominas Muñoz
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Daniel Vas
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carmen García-Roch
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Ignacio Revuelta
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Mireia Musquera
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Fernando García
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carlos Nicolau
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
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Moritz JD. [Imaging in children and adolescents with urinary tract infections]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:11-17. [PMID: 38095683 DOI: 10.1007/s00117-023-01244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 01/19/2024]
Abstract
CLINICAL/METHODOLOGICAL PROBLEM Urinary tract infections are among the most common infectious diseases in childhood. The task of imaging is to detect predisposing factors, such as urinary transport disorders, vesicoureteral reflux, as well as complications such as abscesses or pyonephrosis in addition to possible morphological changes of the kidneys and the draining urinary tract during an infection. STANDARD RADIOLOGICAL PROCEDURES The initial diagnostic imaging technique is generally sonography. For the diagnosis of vesicoureteral reflux, voiding urosonography or alternatively radiological voiding cystourethrography are used. Further diagnostic workup may include scintigraphy, magnetic resonance imaging (MRI) or, in exceptional cases, computed tomography (CT). RECOMMENDATION FOR PRACTICE In children and adolescents, it is of particular importance to avoid recurrent urinary tract infections and their sequelae. This requires precise imaging diagnostics, which must be performed with special consideration of radiation protection.
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Affiliation(s)
- J D Moritz
- Klinik für Radiologie und Neuroradiologie, Kinderradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 3, Haus C, 24105, Kiel, Deutschland.
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Boccatonda A, Venerato S, D’Ardes D, Cocco G, Schiavone C, Vicari S. Contrast-Enhanced Ultrasound Follow-Up for Acute Pyelonephritis Patients. Healthcare (Basel) 2023; 11:2899. [PMID: 37958043 PMCID: PMC10650446 DOI: 10.3390/healthcare11212899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is increasingly used in clinical practice as the first diagnostic method in patients with suspected pyelonephritis rather than abdominal CT with contrast medium, especially in young subjects. We performed a retrospective analysis on patients in for whom a CEUS examination was utilized as a follow-up method after acute pyelonephritis as normal clinical practice. Through evaluating all patients, in terms duration between CEUS examination and normalization (healing) of the renal disease, we found that the mean duration is 25.9 days. Our ultrasound findings did not induce any therapeutic modifications, not even in the cases in which the examination was repeated several times. Therefore, setting up a CEUS follow-up examination after 25 days from the first diagnosis can reduce the number of repeated tests, benefitting patients and the healthcare system in terms of reducing costs.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy; (S.V.); (S.V.)
| | - Stefano Venerato
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy; (S.V.); (S.V.)
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy;
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. D’Annunzio” University, 66100 Chieti, Italy; (G.C.); (C.S.)
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. D’Annunzio” University, 66100 Chieti, Italy; (G.C.); (C.S.)
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, 40010 Bentivoglio, Italy; (S.V.); (S.V.)
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Rinaldo C, Grimaldi D, Di Serafino M, Iacobellis F, Verde F, Caruso M, Sabatino V, Orabona GD, Schillirò ML, Vallone G, Cantisani V, Romano L. An update on pyelonephritis: role of contrast enhancement ultrasound (CEUS). J Ultrasound 2023; 26:333-342. [PMID: 36385692 PMCID: PMC10247636 DOI: 10.1007/s40477-022-00733-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Acute pyelonephritis (APN) is a bacterial infection causing inflammation of the kidneys. Diagnosis is usually based on clinical and laboratory findings. Imaging is required if a complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions and to detect underlying causes. CT represents the current imaging modality of choice in clinical practice. CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. CEUS allows us to distinguish small simple nephritic involvement from abscess complications and to follow their evolution over time during antibiotic therapy. The absence of ionizing radiation and the lack of nephrotoxicity make CEUS an ideal tool in the study of pyelonephritis.
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Affiliation(s)
- Chiara Rinaldo
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Dario Grimaldi
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
| | - Marco Di Serafino
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesca Iacobellis
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesco Verde
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Martina Caruso
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Vittorio Sabatino
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | | | - Maria Laura Schillirò
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Gianfranco Vallone
- Department of Life and Health, University of Molise "V. Tiberio", 86100, Campobasso, Italy
| | - Vito Cantisani
- Department of Radiology, Sapienza Rome University, Policlinico Umberto I, 00185, Rome, Italy
| | - Luigia Romano
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
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Incidence of renal scarring on technetium-99 m dimercaptosuccinic acid renal scintigraphy after acute pyelonephritis, acute focal bacterial nephritis, and renal abscess. Ann Nucl Med 2023; 37:176-188. [PMID: 36539646 DOI: 10.1007/s12149-022-01814-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the association between the incidence of renal scarring on technetium-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and the severity of renal parenchymal infections, such as acute pyelonephritis (APN), acute focal bacterial nephritis (AFBN), and renal abscess, based on computed tomography (CT) diagnosis. METHODS Sixty-one children with renal parenchymal infections were included and classified into two groups: those with (renal scarring group) and without renal scarring (non-renal scarring group) on chronic-phase DMSA renal scintigraphy. The severity of renal parenchymal infection was classified into three grades using CT: APN, AFBN, and renal abscess as grades 1, 2, and 3, respectively. The severity of renal parenchymal infection, vesicoureteral reflux (VUR) grade, and intrarenal reflux occurrence during voiding cystourethrography (VCUG) were evaluated between the renal and non-renal scarring groups. Fisher's exact test and Mann-Whitney U test were used for statistical analysis. RESULTS Renal scars were detected in 28 (45.9%) of the 61 patients. We found that 2/9 (22.2%), 18/41 (43.9%), and 8/11 (72.7%) patients with APN (grade 1), AFBN (grade 2), and renal abscess (grade 3) had renal scarring, respectively. There was a significant difference in the grade of severity of renal parenchymal infection between the renal (median = 2 [interquartile range, 2-3]) and non-renal (median = 2 [interquartile range, 2-2]) scarring groups (p = 0.023). There was a significant difference in the grade of VUR between the renal (median = 3 [interquartile range, 0-4]) and non-renal (median = 0 [interquartile range, 0-2]) scarring groups (p = 0.004). No significant difference in intrarenal reflux occurrence was observed between the renal (present/absent: 3/25) and non-renal (present/absent: 0/29) scarring groups (p = 0.112). CONCLUSION Our results showed that pediatric patients with renal scarring on chronic-phase DMSA renal scintigraphy tended to have a more severe renal infection.
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8
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Smith AD, Nikolaidis P, Khatri G, Chong ST, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Kwun R, Lyshchik A, Nicola R, Purysko AS, Savage SJ, Taffel MT, Yoo DC, Delaney EW, Lockhart ME. ACR Appropriateness Criteria® Acute Pyelonephritis: 2022 Update. J Am Coll Radiol 2022; 19:S224-S239. [PMID: 36436954 DOI: 10.1016/j.jacr.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Acute pyelonephritis (APN) is a severe urinary tract infection (UTI) that has the potential to cause sepsis, shock, and death. In the majority of patients, uncomplicated APN is diagnosed clinically and is responsive to treatment with appropriate antibiotics. In patients who are high risk or when treatment is delayed, microabscesses may coalesce to form an acute renal abscess. High-risk patients include those with a prior history of pyelonephritis, lack of response to therapy for lower UTI or for APN, diabetes, anatomic or congenital abnormalities of the urinary system, infections by treatment-resistant organisms, nosocomial infection, urolithiasis, renal obstruction, prior renal surgery, advanced age, pregnancy, renal transplant recipients, and immunosuppressed or immunocompromised patients. Pregnant patients and patients with renal transplants on immunosuppression are at an elevated risk of severe complications. Imaging studies are often requested to aid with the diagnosis, identify precipitating factors, and differentiate lower UTI from renal parenchymal involvement, particularly in high-risk individuals. Imaging is usually not appropriate for the first-time presentation of suspected APN in an uncomplicated patient. The primary imaging modalities used in high-risk patients with suspected APN are CT, MRI, and ultrasound, although CT was usually not appropriate for initial imaging in a pregnant patient with no other complications. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama.
| | - Paul Nikolaidis
- Vice-Chair, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gaurav Khatri
- UT Southwestern Medical Center, Dallas, Texas; Chief, Division of Body MRI; Interim Chief, Division of Abdominal Imaging; Program Director, Body MRI Fellowship
| | - Suzanne T Chong
- Indiana University, Indianapolis, Indiana; Committee on Emergency Radiology-General, Small, Emergency and/or Rural Practice
| | | | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Richard Kwun
- Swedish Medical Center, Issaquah, Washington; American College of Emergency Physicians
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | - Andrei S Purysko
- Cleveland Clinic, Cleveland, Ohio; ACR Learning Network, Prostate MR Image Quality Improvement Collaborative, Physician Leader
| | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association; Professor and Vice Chairman of Urology
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York; Associate Section of Body Imaging
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Commission on Nuclear Medicine and Molecular Imaging
| | - Erin W Delaney
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama; Primary care physician
| | - Mark E Lockhart
- University of Alabama at Birmingham, Birmingham, Alabama; Chair UAB Department Appointments, Promotions, and Tenure Committee
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Davis L, Back SJ. Microbubbles in the belly: optimizing the protocol for contrast-enhanced ultrasound of the pediatric abdomen. Pediatr Radiol 2022:10.1007/s00247-022-05464-x. [PMID: 36006474 DOI: 10.1007/s00247-022-05464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/20/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
Intravenous contrast-enhanced ultrasound (CEUS) can serve as a diagnostic or problem-solving tool in pediatric imaging. CEUS of abdominal solid organs has been reported for a number of indications. The approach to the examination broadly falls into two categories: evaluation of a focal lesion or surveillance of an organ or organs for lesions or perfusion abnormalities. A consistent, technical imaging protocol for both of these clinical scenarios facilitates integration of routine use of CEUS in an imaging department. Here we review the CEUS imaging protocols for abdominal organs in children, including technical and solid-organ-specific considerations.
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Affiliation(s)
- Lauramay Davis
- Institute of Nuclear Medicine, University College Hospital, London, UK
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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10
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Aggarwal A, Das CJ, Sharma S. Recent advances in imaging techniques of renal masses. World J Radiol 2022; 14:137-150. [PMID: 35978979 PMCID: PMC9258310 DOI: 10.4329/wjr.v14.i6.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/04/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Multiphasic multidetector computed tomography (CT) forms the mainstay for the characterization of renal masses whereas magnetic resonance imaging (MRI) acts as a problem-solving tool in some cases. However, a few of the renal masses remain indeterminate even after evaluation by conventional imaging methods. To overcome the deficiency in current imaging techniques, advanced imaging methods have been devised and are being tested. This review will cover the role of contrast-enhanced ultrasonography, shear wave elastography, dual-energy CT, perfusion CT, MR perfusion, diffusion-weighted MRI, blood oxygen level-dependent MRI, MR spectroscopy, positron emission tomography (PET)/prostate-specific membrane antigen-PET in the characterization of renal masses.
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Affiliation(s)
- Ankita Aggarwal
- Department of Radiology, Vardhman Mahavir Medical College& Safdarjung Hospital, Delhi 110029, India
| | - Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Delhi 110029, India
| | - Sanjay Sharma
- Department of Radiology (RPC), All India Institute of Medical Sciences, New Delhi 110029, India
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Contrast-enhanced ultrasound of the kidneys: principles and potential applications. Abdom Radiol (NY) 2022; 47:1369-1384. [PMID: 35150315 DOI: 10.1007/s00261-022-03438-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is an extension and an enhanced form of ultrasound that allows real-time evaluation of the various structures in different vascular phases. The last decade has witnessed a widespread expansion of CEUS applications beyond the liver. It has shown fair potential in kidneys and its diagnostic efficacy is comparable to CT and MRI. Ultrasound is the well-accepted screening modality for renal pathologies, however, it underperforms in the characterization of the renal masses. CEUS can be beneficial in such cases as it can help in the characterization of such incidental masses in the same sitting. It has an excellent safety profile with no risk of radiation or contract-related nephropathy. It can aid in the correct categorization of renal cysts into one of the Bosniak classes and has proven its worth especially in complex cysts or indeterminate renal masses (especially Bosniak Category IIF and III). Few studies also describe its potential role in solid masses and in differentiating benign from malignant masses. Other areas of interest include infections, infarctions, trauma, follow-up of local ablative procedures, and VUR. Through this review, the readers shall get an insight into the various applications of CEUS in kidneys, with imaging examples.
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12
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Felipe VB, Ananya B, Ying T, Qiang L, Ji-Bin L, John RE. Renal Contrast-enhanced Ultrasound: Clinical Applications and Emerging Researc. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022; 6:129. [DOI: 10.37015/audt.2022.220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
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13
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Back SJ, Acharya PT, Bellah RD, Cohen HL, Darge K, Deganello A, Harkanyi Z, Ključevšek D, Ntoulia A, Paltiel HJ, Piskunowicz M. Contrast-enhanced ultrasound of the kidneys and adrenals in children. Pediatr Radiol 2021; 51:2198-2213. [PMID: 33978799 DOI: 10.1007/s00247-020-04849-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/19/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
Pediatric applications of contrast-enhanced ultrasound (CEUS) are growing. Evaluation of the kidneys and adrenal glands in children using intravenous administration of US contrast agents, however, is still an off-label indication. Pediatric CEUS applications for kidneys are similar to those in adults, including ischemic disorders, pseudo- versus real tumors, indeterminate lesions, complex cystic lesions, complicated pyelonephritis, and abscesses. CEUS applications for evaluation of adrenal glands in children are limited, mainly focusing on the assessment and follow-up of adrenal trauma and the differentiation between an adrenal hemorrhage and a mass. This review addresses the current experience in pediatric CEUS of the kidneys and adrenal glands. By extrapolating the established knowledge for US contrast evaluations in the adult kidney to the pediatric context we can note opportunities for CEUS clinical use in children.
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Affiliation(s)
- Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Patricia T Acharya
- Department of Radiology, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard D Bellah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harris L Cohen
- Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Annamaria Deganello
- Department of Radiology, King's College Hospital, King's College London, London, UK
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
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14
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Granata A, Campo I, Lentini P, Pesce F, Gesualdo L, Basile A, Cantisani V, Zeiler M, Bertolotto M. Role of Contrast-Enhanced Ultrasound (CEUS) in Native Kidney Pathology: Limits and Fields of Action. Diagnostics (Basel) 2021; 11:1058. [PMID: 34201349 PMCID: PMC8226824 DOI: 10.3390/diagnostics11061058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) in daily clinical practice has significantly reduced the use of contrast enhancement computed tomography (CECT) and contrast enhancement magnetic resonance (CEMR), especially in patients with renal disease. Although there are many situations in which CECT and CEMRI are primarily indicated, their use may be limited by the administration of the contrast medium, which may involve a risk of renal function impairment, especially in the elderly, and in patients with acute kidney injury (AKI) and moderate to severe chronic kidney disease (CKD). In these cases, CEUS can be a valid diagnostic choice. To date, numerous publications have highlighted the role of CEUS in the study of parenchymal micro-vascularization and renal pathology by full integration with second level imaging methods (CECT and CEMRI) both in patients with normal renal function and with diseased kidneys. The aim of this review is to offer an updated overview of the limitations and potential applications of CEUS in native kidney disease.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, “Cannizzaro” Hospital, 95026 Catania, Italy;
| | - Irene Campo
- Department of Radiology, “Civile di Conegliano” Hospital, ULSS 2 Marca Trevigiana, 31015 Conegliano, Italy
| | - Paolo Lentini
- Nephrology and Dialysis Unit, San Bassiano Hospital, 36061 Bassano del Grappa, Italy;
| | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (F.P.); (L.G.)
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (F.P.); (L.G.)
| | - Antonio Basile
- Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy;
| | - Vito Cantisani
- Department of Radiology, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Matthias Zeiler
- Nephrology and Dialysis Unit, “Carlo Urbani” Hospital, 60035 Jesi, Italy;
| | - Michele Bertolotto
- Department of Radiology, “Cattinara” Hospital, University of Trieste, 34149 Trieste, Italy;
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15
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Clinical Value of Contrast-Enhanced Ultrasound in Atypical Wilms Tumor. Indian J Pediatr 2021; 88:517-518. [PMID: 33651306 DOI: 10.1007/s12098-021-03700-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
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16
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Abstract
When used correctly, modern ultrasound diagnostics are helpful for the nephrologist especially in emergency situations on the ward, in dialysis and in the emergency admission to quickly make the correct diagnosis or as a diagnostic gatekeeper to initiate the correct next diagnostic and therapeutic steps in a time-saving manner. In addition to conventional B‑mode/gray scale sonography and Doppler sonography, new ultrasound transducers with higher spatial resolution and above all contrast agent sonography have significantly expanded the technical possibilities and help nephrologists and internists to answer diagnostic and clinical questions. This particularly applies to the kidneys, which up to now could only be clarified by means of contrast-enhanced computed tomography or magnetic resonance imaging. This will allow the nephrologist in 2021 to amalgamate the clinical symptoms, imaging results and pathophysiological knowledge in an ideal, time-saving manner for the benefit of the patient.
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Affiliation(s)
- Konrad Friedrich Stock
- Abteilung für Nephrologie, Nephrologischer Ultraschall, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 München, Deutschland
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17
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Contrast-Enhanced Ultrasound (CEUS) in Non-Traumatic Abdominal Emergencies. Ultrasound Int Open 2021; 6:E76-E86. [PMID: 33728394 PMCID: PMC7954641 DOI: 10.1055/a-1347-5875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/01/2021] [Indexed: 02/08/2023] Open
Abstract
Conventional ultrasound imaging (US) is the first-line investigation in acute
non-traumatic abdominal emergencies, but sometimes it needs further
examinations, such as computed tomography (CT), to reach a certain
diagnosis. Contrast-enhanced ultrasound (CEUS), through injection of
contrast medium, may provide the radiologist with additional information
that could not be investigated with baseline US. It could help reach a
diagnosis and rapidly determine the proper therapy in an emergency setting.
The purpose of this review is to explain and illustrate the various
possibilities and limitations of CEUS in acute non-traumatic abdominal
diseases, in particular acute inflammation, parenchymal infarcts, and
hemorrhages.
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18
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García Prieto J, Alonso Sánchez J, Martínez Chamorro E, Ibáñez Sanz L, Borruel Nacenta S. Puerperal complications: Pathophysiological mechanisms and main imaging findings. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Kazmierski BJ, Sharbidre KG, Robbin ML, Grant EG. Contrast-Enhanced Ultrasound for the Evaluation of Renal Transplants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2457-2468. [PMID: 32412688 DOI: 10.1002/jum.15339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
Contrast-enhanced ultrasound has emerged as a useful imaging modality for the evaluation of the transplant kidney. Advantages over traditional imaging modalities such as computed tomography and magnetic resonance imaging include the ability to visualize a lesion's enhancement pattern in real time, the lack of nephrotoxicity, and relatively low cost. Potential uses of contrast-enhanced ultrasound include characterization of solid and cystic transplant renal masses, assessment for pyelonephritis and identification of its complications, and evaluation of transplant complications in immediate and delayed settings. Contrast-enhanced ultrasound will likely play an increasing role for evaluating the transplant kidney, as an accurate diagnosis based on imaging can direct treatment and prevent unnecessary interventions.
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Affiliation(s)
| | - Kedar G Sharbidre
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michelle L Robbin
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edward G Grant
- Department of Radiology, Keck USC School of Medicine, Los Angeles, California, USA
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20
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Venkatesan AM, Oto A, Allen BC, Akin O, Alexander LF, Chong J, Froemming AT, Fulgham PF, Goldfarb S, Gettle LM, Maranchie JK, Patel BN, Schieda N, Schuster DM, Turkbey IB, Lockhart ME. ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females. J Am Coll Radiol 2020; 17:S487-S496. [PMID: 33153559 DOI: 10.1016/j.jacr.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Urinary tract infections (UTIs) in women are common, with an overall lifetime risk over >50%. UTIs are considered recurrent when they follow complete clinical resolution of a previous UTI and are usually defined as at least three episodes of infection within the preceding 12 months. An uncomplicated UTI is classified as a UTI without structural or functional abnormalities of the urinary tract and without relevant comorbidities. Complicated UTIs are those occurring in patients with underlying structural or medical problems. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used. In women suspected of having a recurrent complicated UTI, cystoscopy and imaging should be considered. CT urography or MR urography are usually appropriate for the evaluation of recurrent complicated lower urinary tract infections or for women who are nonresponders to conventional therapy, develop frequent reinfections or relapses, or have known underlying risk factors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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21
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García Prieto J, Alonso Sánchez J, Martínez Chamorro E, Ibáñez Sanz L, Borruel Nacenta S. Puerperal complications: pathophysiological mechanisms and main imaging findings. RADIOLOGIA 2020; 63:22-31. [PMID: 33008619 DOI: 10.1016/j.rx.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/26/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Puerperium is the period during which the physiological changes that have taken place during pregnancy revert and the uterus involutes until it reaches its normal size. This is a period of intense systemic changes, and diagnosing complications in this period is a challenge for both gynecologists and radiologists. This paper reviews the complications that can occur during puerperium, classifying them according to the pathophysiological mechanisms involved: the prothrombotic state, hemodynamic and hormonal changes, rapid uterine growth, changes associated with endothelial damage (preeclampsia, eclampsia, and HELLP syndrome), and postoperative complications in patients undergoing cesarean sections. CONCLUSION Puerperal complications represent a diagnostic challenge. Understanding the pathophysiological mechanisms underlying these complications is fundamental for choosing the most appropriate imaging technique to ensure the correct diagnosis in each case.
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Affiliation(s)
| | | | | | - L Ibáñez Sanz
- Hospital Universitario 12 de Octubre, Madrid, España
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22
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Como G, Da Re J, Adani GL, Zuiani C, Girometti R. Role for contrast-enhanced ultrasound in assessing complications after kidney transplant. World J Radiol 2020; 12:156-171. [PMID: 32913562 PMCID: PMC7457161 DOI: 10.4329/wjr.v12.i8.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/30/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation (KT) is an effective treatment for end-stage renal disease. Despite their rate has reduced over time, post-transplant complications still represent a major clinical problem because of the associated risk of graft failure and loss. Thus, post-KT complications should be diagnosed and treated promptly. Imaging plays a pivotal role in this setting. Grayscale ultrasound (US) with color Doppler analysis is the first-line imaging modality for assessing complications, although many findings lack specificity. When performed by experienced operators, contrast-enhanced US (CEUS) has been advocated as a safe and fast tool to improve the accuracy of US. Also, when performing CEUS there is potentially no need for further imaging, such as contrast-enhanced computed tomography or magnetic resonance imaging, which are often contraindicated in recipients with impaired renal function. This technique is also portable to patients' bedside, thus having the potential of maximizing the cost-effectiveness of the whole diagnostic process. Finally, the use of blood-pool contrast agents allows translating information on graft microvasculature into time-intensity curves, and in turn quantitative perfusion indexes. Quantitative analysis is under evaluation as a tool to diagnose rejection or other causes of graft dysfunction. In this paper, we review and illustrate the indications to CEUS in the post-KT setting, as well as the main CEUS findings that can help establishing the diagnosis and planning the most adequate treatment.
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Affiliation(s)
- Giuseppe Como
- Institute of Radiology, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Jacopo Da Re
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Gian Luigi Adani
- Department of Medicine, General Surgery and Transplantation, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
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23
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Diagnostic performance of contrast-enhanced ultrasound for acute pyelonephritis in children. Sci Rep 2020; 10:10715. [PMID: 32612243 PMCID: PMC7330043 DOI: 10.1038/s41598-020-67713-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022] Open
Abstract
The objective of our study was to evaluate the performance of renal contrast-enhanced ultrasound (CEUS) against the 99m-labeled dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) in children for the diagnosis of acute pyelonephritis. We included children who underwent both renal CEUS and the DMSA scan or CT. A total of 33 children (21 males and 12 females, mean age 26 ± 36 months) were included. Using the DMSA scan as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 86.8%, 71.4%, 80.5%, and 80.0%, respectively. When CT was used as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS was 87.5%, 80.0%, 87.5%, and 80.0%, respectively. The diagnostic accuracy of CEUS for the diagnosis of acute pyelonephritis was 80.3% and 84.6% compared to the DMSA scan and CT, respectively. Inter-observer (kappa = 0.54) and intra-observer agreement (kappa = 0.59) for renal CEUS was moderate. In conclusion, CEUS had good diagnostic accuracy for diagnosing acute pyelonephritis with moderate inter- and intra-observer agreement. As CEUS does not require radiation or sedation, it could play an important role in the future when diagnosing acute pyelonephritis in children.
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Abstract
An introduction to the expanding modality of contrast-enhanced ultrasound is provided, along with basics on contrast agents and technique. The contrast ultrasound findings of multiple renal tumors are reviewed with examples, including clear cell renal cell carcinoma, papillary renal cell carcinoma, chromophobe renal cell carcinoma, other rare renal cell carcinoma subtypes, oncocytoma, upper tract urothelial carcinoma, lymphoma, and angiomyolipoma, followed also by brief discussions of renal infections and pseudolesions.
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Affiliation(s)
- Kevin G King
- Keck School of Medicine, University of Southern California, Norris Cancer Center, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA 90033, USA.
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25
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Contrast-Enhanced Ultrasound-Guided Interventions-The New Sheriff in Town?: A Case-Based Review of Problem Solving With Ultrasound Contrast. Ultrasound Q 2020; 36:91-101. [PMID: 32515928 DOI: 10.1097/ruq.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound (US)-guided intervention is a well-established medical procedure and offers advantages such as real-time guidance, portability, reduced cost, shortened procedure time compared with computed tomography, and lack of ionizing radiation. Ultrasound contrast agents (UCAs) are a useful adjunct to US-guided procedures. The addition of microbubble UCAs during US-guided interventions can assist with biopsy planning and lesion selection, aid in identification of target lesions, and direct the biopsy toward viable tissue. Ultrasound contrast agents have been in use outside of the United States for many years and have been used off label at select institutions across the United States before the Food and Drug Administration approval of Lumason (Bracco Diagnostics) for liver lesion evaluation in April 2016. After Food and Drug Administration approval, the use of UCAs has expanded rapidly, and UCAs are being used for a variety of clinical applications. Ultrasound contrast agents have been shown to be safe, and there is no renal toxicity. In this article, we will discuss the indications and techniques for using contrast-enhanced ultrasound during US-guided interventions, and we will present case examples where contrast-enhanced ultrasound added value.
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26
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Hosokawa T, Tanami Y, Sato Y, Oguma E. Comparison of imaging findings between acute focal bacterial nephritis (acute lobar nephronia) and acute pyelonephritis: a preliminary evaluation of the sufficiency of ultrasound for the diagnosis of acute focal bacterial nephritis. Emerg Radiol 2020; 27:405-412. [DOI: 10.1007/s10140-020-01771-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
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27
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European Society of Paediatric Radiology abdominal imaging task force: recommendations for contrast-enhanced ultrasound and diffusion-weighted imaging in focal renal lesions in children. Pediatr Radiol 2020; 50:297-304. [PMID: 31776600 DOI: 10.1007/s00247-019-04552-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/17/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) and diffusion-weighted imaging (DWI) are safe, repeatable imaging techniques. The aim of this paper is to discuss the advantages, technical factors and possible clinical applications of these imaging tools in focal renal lesions in children.
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28
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Stock KF, Slotta-Huspenina J, Kübler H, Autenrieth M. Innovative Ultraschalldiagnostik bei Nierentumoren. Urologe A 2019; 58:1418-1428. [DOI: 10.1007/s00120-019-01066-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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29
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Abstract
PURPOSE OF REVIEW In recent years, there has been renewed interest in the use of contrast-enhanced ultrasound (CEUS) in abdominal imaging and intervention. The goal of this article is to review the practical applications of CEUS in the kidney, including renal mass characterization, treatment monitoring during and after percutaneous ablation, and biopsy guidance. RECENT FINDINGS Current evidence suggests that CEUS allows accurate differentiation of solid and cystic renal masses and is an acceptable alternative to either computed tomography (CT) or magnetic resonance imaging (MRI) for characterization of indeterminate renal masses. CEUS is sensitive and specific for diagnosing residual or recurrent renal cell carcinoma (RCC) following percutaneous ablation. Furthermore, given its excellent spatial and temporal resolution, CEUS is well suited to demonstrate tumoral microvascularity associated with malignant renal masses and is an effective complement to conventional grayscale ultrasound (US) for percutaneous biopsy guidance. Currently underutilized, CEUS is an important problem-solving tool in renal imaging and intervention whose role will continue to expand in coming years.
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30
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Nikolaidis P, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, Heller MT, Khatri G, Purysko AS, Savage SJ, Smith AD, Taffel MT, Wang ZJ, Wolfman DJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME. ACR Appropriateness Criteria ® Acute Pyelonephritis. J Am Coll Radiol 2019; 15:S232-S239. [PMID: 30392592 DOI: 10.1016/j.jacr.2018.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/21/2022]
Abstract
Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patients, uncomplicated pyelonephritis is diagnosed clinically and responds quickly to appropriate antibiotic treatment. If treatment is delayed, the patient is immunocompromised, or for other reasons, microabscesses that form during the acute phase of pyelonephritis may coalesce, forming a renal abscess. Patients with underlying diabetes are more vulnerable to complications, including emphysematous pyelonephritis in addition to abscess formation. Additionally, diabetics may not have the typical flank tenderness that helps to differentiate pyelonephritis from a lower urinary tract infection. Additional high-risk populations may include those with anatomic abnormalities of the urinary tract, vesicoureteral reflux, obstruction, pregnancy, nosocomial infection, or infection by treatment-resistant pathogens. Treatment goals include symptom relief, elimination of infection to avoid renal damage, and identification of predisposing factors to avoid future recurrences. The primary imaging modalities used in patients with pyelonephritis are CT, MRI, and ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | | | | | | | | | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | | | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Darcy J Wolfman
- Johns Hopkins University School of Medicine, Washington, District of Columbia
| | | | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Auer T, Heidegger I, DE Zordo T, Junker D, Jaschke W, Steinkohl F, Aigner F. Fusion Imaging of Contrast-enhanced Ultrasound With CT or MRI for Kidney Lesions. In Vivo 2019; 33:203-208. [PMID: 30587624 DOI: 10.21873/invivo.11460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
AIM To evaluate the feasibility of ultrasound (US) computed tomography (CT) or magnetic resonance imaging (MRI) fusion imaging (FI) for localization and assessment of kidney lesions. MATERIALS AND METHODS Twenty-eight patients with kidney lesions previously detected on CT or MRI were included in this retrospective study. All 28 patients with kidney lesions, which were indefinable (42.9%) or hard to localize (57.1%) on gray-scale US alone, underwent FI of US with CT/MRI datasets. In 23 (82%) patients with indeterminate kidney lesions, FI including contrast-enhanced US was conducted. RESULTS FI was successfully performed in 25 out of 28 (89.3%) patients. FI with contrast-enhanced US was able to clarify the previously detected kidney lesions in 21 out of 23 patients (91.3%). CONCLUSION FI is a feasible technique for localizing kidney lesions that are hard to define by grayscale US alone and the additional application of contrast-enhanced US is useful in clarifying indeterminate CT or MRI findings.
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Affiliation(s)
- Thomas Auer
- Department of Radiology, Landeskrankenhaus Hall, Hall in Tirol, Austria.,Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Tobias DE Zordo
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.,Department of Radiology, Brixana Private Clinic, Brixen, Italy
| | - Daniel Junker
- Department of Radiology, Landeskrankenhaus Hall, Hall in Tirol, Austria.,Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Steinkohl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Zhang F, Li R, Li G, Jin L, Shi Q, Du L. Value of Contrast-Enhanced Ultrasound in the Diagnosis of Renal Cancer and in Comparison With Contrast-Enhanced Computed Tomography: A Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:903-914. [PMID: 30203542 DOI: 10.1002/jum.14769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this meta-analysis was to assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in renal cancer and to compare it with contrast-enhanced computed tomography (CECT). METHODS A systematic search was performed to recruit eligible original studies published until December 2017. Two reviewers independently extracted data. A meta-analysis was performed, and the pooled sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, diagnostic odds ratio, summary receiver operating characteristic curve, and area under the curve were calculated. The extent and potential sources of heterogeneity were further explored. Moreover, a head-to-head comparison was also performed to compare the diagnostic value between CEUS and CECT in renal cancer. RESULTS Twenty-two studies were included in this meta-analysis. The summary sensitivity and specificity of CEUS for detecting renal cancer were 0.96 (95% confidence interval [CI], 0.94-0.97) and 0.82 (95% CI, 0.74-0.88), respectively. The summary diagnostic odds ratio was 102.04 (95% CI, 49.55-210.13). The area under the summary receiver operating characteristic curve was 0.97 (95% CI, 0.95-0.98). In the head-to-head comparison, CEUS showed higher diagnostic sensitivity than CECT (0.94 versus 0.85) for renal cancer, whereas the specificities were comparable between CEUS and CECT (0.77 versus 0.75). CONCLUSIONS Contrast-enhanced US has high sensitivity and moderate specificity in the differential diagnosis of renal cancer. The diagnostic sensitivity of CEUS in renal cancer was higher than that of CECT, suggesting that CEUS could be used as a preferred diagnostic tool for renal cancer.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Li
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Gang Li
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pierce C, Keniston A, Albert RK. Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management. South Med J 2019; 112:118-124. [DOI: 10.14423/smj.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Morgan TA, Jha P, Poder L, Weinstein S. Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow. Abdom Radiol (NY) 2018; 43:2604-2614. [PMID: 29632989 DOI: 10.1007/s00261-018-1585-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound is routinely used as the first imaging exam for evaluation of renal transplants and can identify most major surgical complications and evaluate vascularity with color Doppler. Ultrasound is limited, however, in the detection of parenchymal disease processes and Doppler evaluation is also prone to technical errors. Multiple new ultrasound applications have been developed and are under ongoing investigation which could add additional diagnostic capability to the routine ultrasound exam with minimal additional time, cost, and patient risk. Contrast-enhanced ultrasound (CEUS) can be used off-label in the transplant kidney, and can assist in detection of infection, trauma, and vascular complications. CEUS also can demonstrate perfusion of the transplant assessed quantitatively with generation of time-intensity curves. Future directions of CEUS include monitoring treatment response and microbubble targeted medication delivery. Elastography is an ultrasound application that can detect changes in tissue elasticity, which is useful to diagnose diffuse parenchymal disease, such as fibrosis, otherwise unrecognizable with ultrasound. Elastography has been successfully applied in other organs including the liver, thyroid, and breast; however, it is still under development for use in the transplant kidney. Unique properties of the transplant kidney including its heterogeneity, anatomic location, and other technical factors present challenges in the development of reference standard measurements. Lastly, B-flow imaging is a flow application derived from B-mode. This application can show the true lumen size of a vessel which is useful to depict vascular anatomy and bypasses some of the pitfalls of color Doppler such as demonstration of slow flow.
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Bertolotto M, Bucci S, Valentino M, Currò F, Sachs C, Cova MA. Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol 2018; 105:41-48. [PMID: 30017297 DOI: 10.1016/j.ejrad.2018.05.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy.
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale Sant'Antonio Abate, Via Giobatta Morgagni 18, 33028 Tolmezzo, UD, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Camilla Sachs
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
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Kazmierski B, Deurdulian C, Tchelepi H, Grant EG. Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol (NY) 2018; 43:880-898. [PMID: 28856401 DOI: 10.1007/s00261-017-1307-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Incidental discovery of renal lesions on cross-sectional imaging studies performed for other indications is not uncommon. With the increased reliance on medical imaging, the number of incidentally detected renal lesions has also grown over time. While simple cysts account for the majority of these lesions, the presence of complex features within a cystic lesion, such as septations and solid components, can present a confusing picture. Solid lesions, too, can be indeterminate, and distinguishing between benign solid masses (like lipid-poor angiomyolipomas and oncocytomas) and renal cell carcinoma affects patient management and can prevent unnecessary interventions. Indeterminate renal lesions are traditionally further characterized by multiphase imaging, such as contrast-enhanced computed tomography and magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) is a new, relatively inexpensive technique that has become increasingly employed in the diagnostic workup of indeterminate renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real-time, CEUS has unique advantages over traditional imaging modalities. This article provides an overview of the current clinical applications of CEUS in characterizing renal lesions, both cystic and solid. Additional applications of CEUS in the kidney, including its roles in renal transplant evaluation and guidance for percutaneous biopsy, will also be briefly discussed.
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Faletti R, Gatti M, Bassano S, Finocchietti D, Fiore S, Colla L, Bergamasco L, Cassinis MC, Fonio P. Follow-up of acute pyelonephritis: what causes the diffusion-weighted magnetic resonance imaging recovery to lag clinical recovery? Abdom Radiol (NY) 2018; 43:639-646. [PMID: 28660334 DOI: 10.1007/s00261-017-1242-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze with diffusion-weighted magnetic resonance imaging (DW-MRI) the evolution and progress to resolution of acute pyelonephritis (APN) foci over a period of 3 months after onset. METHODS 30 women (age 22-51 years) with clinical, laboratory (white blood cell and C-reactive protein), and DW-MRI (4b-values 0, 50, 600, 1000 s/mm2) diagnosis of APN were prospectively enrolled. Two double-blinded radiologists evaluated the number of APN foci, and for each of them dimension (D), absolute diffusion coefficient (ADC), and its ratio R to the ADC of unaffected parenchyma. Signature of radiological recovery was focus no longer visible (DW-) and ADC of its site not inferior to the ADC of the unaffected parenchyma, i.e., R ≥ 0.9. Clinical and DW-MRI follow-ups (FU) were performed at 1 and 3 months. RESULTS At the acute stage (t 0), 187 APN foci were found, with ADC0 = 1.3 ± 0.2 × 10-3 mm2/s, R 0 = 0.65 ± 0.12, and D 0 = 14 ± 7.5 mm. By the 1-month FU (t 1), all patients had no symptoms and physiological laboratory values; despite this, only 80 (43%) foci were solved, increasing to 138 (74%) by at the 3-month FU. The ROC curve (AUC ≥ 0.80) identified R 0 ≤ 0.6 and D 0 > 15 mm as forecast of slow radiologic resolution. About 80% of foci unsolved at 1 month but with R 1 ≥ 0.8 and D 1 ≤ 10 mm reached solution at 3 months. CONCLUSIONS DW-MRI recovery of APN foci does not always coincide with clinical recovery. The evolution of an APN focus is shaped by its initial values R 0 and D 0. About half of the foci still visible at 1 month reached radiological resolution in the two following months.
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Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Serena Bassano
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Daniela Finocchietti
- SCDU Nephrology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Fiore
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Loredana Colla
- SCDU Nephrology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria Carla Cassinis
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy
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Correas JM, Anglicheau D, Joly D, Gennisson JL, Tanter M, Hélénon O. Ultrasound-based imaging methods of the kidney-recent developments. Kidney Int 2016; 90:1199-1210. [PMID: 27665116 DOI: 10.1016/j.kint.2016.06.042] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/05/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
In recent years, several novel ultrasound (US)-based techniques have emerged for kidney diagnostic imaging, including tissue stiffness assessment with elastography, Ultrasensitive Doppler techniques, and contrast-enhanced ultrasonography to assess renal microvascularization. Renal elastography has become available with the development of noninvasive quantitative techniques, following the rapidly growing field of liver fibrosis diagnosis. With the increased incidence of chronic kidney disease, noninvasive diagnosis of renal fibrosis can be of critical value. However, it is difficult to simply extend the application of US elastography from one organ to the other due to anatomic and technical issues. Today, renal elastography appears to be a promising application that, however, still requires optimization and validation. New ultrasensitive Doppler techniques improve the detection of slow blood flow and can be used alone or after administration of US contrast agents. These microbubble-based agents are extremely well tolerated and can be administered even in cases of impaired renal function. Despite the lack of approval, they improve the characterization of atypical renal masses, complex cystic renal masses, and peripheral vascular disorders. Dynamic contrast-enhanced US is based on quantification of the signal intensity from region of interest and mathematical fits of the time-intensity curves. Perfusion-related parameters can be extracted for the monitoring of vascular changes in the renal parenchyma and in tumors in order to evaluate drug response. This estimation of renal perfusion depends on many parameters that should be kept constant for follow-up studies, and, when possible, an internal reference should be used to normalize the measurements.
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Affiliation(s)
- Jean-Michel Correas
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France; Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France.
| | - Dany Anglicheau
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Nephrology and Transplantation, Necker University Hospital, Paris, France; Necker - Sick Children Institute, INSERM U1151, Paris, France
| | - Dominique Joly
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Nephrology and Transplantation, Necker University Hospital, Paris, France
| | - Jean-Luc Gennisson
- Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
| | - Mickael Tanter
- Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
| | - Olivier Hélénon
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France
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Gulati M, King KG, Gill IS, Pham V, Grant E, Duddalwar VA. Contrast-enhanced ultrasound (CEUS) of cystic and solid renal lesions: a review. ACTA ACUST UNITED AC 2016; 40:1982-96. [PMID: 25588715 DOI: 10.1007/s00261-015-0348-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Incidentally detected renal lesions have traditionally undergone imaging characterization by contrast-enhanced computer tomography (CECT) or magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) of renal lesions is a relatively novel, but increasingly utilized, diagnostic modality. CEUS has advantages over CECT and MRI including unmatched temporal resolution due to continuous real-time imaging, lack of nephrotoxicity, and potential cost savings. CEUS has been most thoroughly evaluated in workup of complex cystic renal lesions, where it has been proposed as a replacement for CECT. Using CEUS to differentiate benign from malignant solid renal lesions has also been studied, but has proven difficult due to overlapping imaging features. Monitoring minimally invasive treatments of renal masses is an emerging application of CEUS. An additional promising area is quantitative analysis of renal masses using CEUS. This review discusses the scientific literature on renal CEUS, with an emphasis on imaging features differentiating various cystic and solid renal lesions.
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Affiliation(s)
- Mittul Gulati
- Department of Radiology, Keck USC School of Medicine, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033, USA,
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Fiore M, Andreana L. Contrast-enhanced ultrasound as imaging technique for patients with acute flank pain into the ED. Am J Emerg Med 2016; 34:324-5. [PMID: 26639455 DOI: 10.1016/j.ajem.2015.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Marco Fiore
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, 80138 Naples, Italy.
| | - Lorenzo Andreana
- Department of Emergency Medicine, Ospedale di Palmanova, 33057 Palmanova, Italy.
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Nicolau C, Aldecoa I, Bunesch L, Mallofre C, Sebastia C. The Role of Contrast Agents in the Diagnosis of Renal Diseases. Curr Probl Diagn Radiol 2015; 44:346-59. [DOI: 10.1067/j.cpradiol.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/03/2015] [Indexed: 12/19/2022]
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Abstract
US has a relevant role in the initial assessment of non-traumatic emergencies of the abdomen, sometimes being conclusive and some other times for selecting the patients for further imaging with CT. Injection of a contrast medium may give to the radiologist additional information to that obtained at baseline US and Doppler examination, since real-time, contrast-enhanced US (CEUS) may allow observing findings in the abdomen not recognizable at baseline US or even at color Doppler imaging. Extravascular use of microbubbles may also be useful in clinical practice to rapidly solve a number of unclear aspects. CEUS has a number of distinct advantages in acute patients, including its quickness, low invasiveness, and its possible bedside use. The information based on contrast enhancement is useful for initial diagnosis, therapeutic decision making, and follow-up of the critically ill patients. The purpose of this review is to illustrate the possibilities and limitations of abdominal CEUS in the acute setting, with special emphasis on the detection and characterization of acute inflammatory processes, infarcts, and hemorrhages.
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Drozdov D, Thomer A, Meili M, Schwarz S, Kouegbe RB, Regez K, Guglielmetti M, Schild U, Conca A, Schäfer P, Reutlinger B, Ottiger C, Buchkremer F, Litke A, Schuetz P, Huber A, Bürgi U, Fux CA, Bock A, Müller B, Albrich WC. Procalcitonin, pyuria and proadrenomedullin in the management of urinary tract infections--'triple p in uti': study protocol for a randomized controlled trial. Trials 2013; 14:84. [PMID: 23522152 PMCID: PMC3614534 DOI: 10.1186/1745-6215-14-84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background Urinary tract infections (UTIs) are among the most common infectious diseases and drivers of antibiotic use and in-hospital days. A reduction of antibiotic use potentially lowers the risk of antibiotic resistance. An early and adequate risk assessment combining medical, biopsychosocial and functional risk scores has the potential to optimize site-of-care decisions and thus allocation of limited health-care resources. The aim of this factorial design study is twofold: first, for Intervention A, it investigates antibiotic exposure of patients treated with a protocol based on the type of UTI, procalcitonin (PCT) and pyuria. Second, for Intervention B, it investigates the usefulness of the prognostic biomarker proadrenomedullin (ProADM) integrated into an interdisciplinary assessment bundle for site-of-care decisions. Methods and design This randomized controlled open-label trial has a factorial design (2 × 2). Randomization of patients will be based on a pre-specified computer-generated randomization list and independent for the two interventions. Adults with UTI presenting to the emergency department (ED) will be screened and enrolled after providing informed consent. For our first Intervention (A), we developed a protocol based on previous observational research to recommend initiation and duration of antibiotic use based on the clinical presentation of UTI, pyuria and PCT levels. For our second intervention (B), an algorithm was developed to support site-of care decisions based on the prognostic marker ProADM and distinct nursing factors on days 1 and 3. Both interventions will be compared with a control group conforming to the guidelines. The primary endpoints for the two interventions will be: (A) overall exposure to antibiotics and (B) length of physician-led hospitalization within a follow-up of 30 days. Endpoints are assessed at discharge from hospital, and 30 and 90 days after admission. We plan to screen 300 patients and enroll 250 for an anticipated estimated loss of follow-up of 20%. This will provide adequate power for the two interventions. Discussion This trial investigates two strategies for improved individualized medical care in patients with UTI. The minimally effective duration of antibiotic therapy is not known for UTIs, which is important for reducing the selection pressure for antibiotic resistance, costs and drug-related side effects. Triage decisions must be improved to reflect the true medical, biopsychosocial and functional risks in order to allocate patients to the most appropriate care setting and reduce hospital-acquired disability. Trial registration Trial registration number:
ISRCTN13663741
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Affiliation(s)
- Daniel Drozdov
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland
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