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Barkovich KJ, Gibson AC, Brahmbhatt S, Tadisetty S, Wilds EC, Nelson LW, Gupta M, Gedaly R, Khurana A. Contrast-enhanced ultrasound of renal masses in the pre-transplant setting: literature review with case highlights. Abdom Radiol (NY) 2024:10.1007/s00261-024-04366-w. [PMID: 38900316 DOI: 10.1007/s00261-024-04366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
With the rising incidence of chronic kidney disease worldwide, an increasing number of patients are expected to require renal transplantation, which remains the definitive treatment of end stage renal disease. Medical imaging, primarily ultrasonography and contrast-enhanced CT and/or MRI, plays a large role in pre-transplantation assessment, especially in the characterization of lesions within the native kidneys. However, patients with CKD/ESRD often have relative contraindications to CT- and MR-contrast agents, limiting their utilization within this patient population. Contrast-enhanced ultrasound (CEUS), which combines the high temporal and spatial resolution of ultrasonography with intravascular microbubble contrast agents, provides a promising alternative. This review aims to familiarize the reader with the literature regarding the use of CEUS in the evaluation of cystic and solid renal lesions and provide case examples of its use at our institution in the pre-transplant setting.
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Affiliation(s)
- Krister J Barkovich
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Amanda C Gibson
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Sneh Brahmbhatt
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Sindhura Tadisetty
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Emory C Wilds
- College of Medicine, University of Kentucky, Lexington, KY, 40506, USA
| | - Leslie W Nelson
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Meera Gupta
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Roberto Gedaly
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Aman Khurana
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA.
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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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Wang J, Shi J, Gao L, Hu W, Chen M, Zhang W. High-frame-rate contrast-enhanced ultrasound to differentiate between clear cell renal cell carcinoma and angiomyolipoma. BMC Cancer 2024; 24:659. [PMID: 38816725 PMCID: PMC11138005 DOI: 10.1186/s12885-024-12413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND To investigate the diagnostic efficacy of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in differentiating between clear cell renal cell carcinoma (CCRCC) and angiomyolipoma (AML). METHODS A retrospective study was performed on the clinical data of 79 patients diagnosed with CCRCC and 31 patients diagnosed with AML at the First Affiliated Hospital of Nanchang University between October 2022 and December 2023. Conventional ultrasound (US) and H-CEUS examinations were conducted on all patients prior to surgery, dynamic images were recorded from the US, and the qualitative and quantitative parameters of H-CEUS were collected. The t-test, χ² test and non-parametric Mann-Whitney test were employed to assess differences in clinical data, US characteristics, and qualitative and quantitative parameters of H-CEUS between the CCRCC and AML groups. The independent risk factors of CCRCC were identified using binary logistic regression. The receiver operator characteristic (ROC) curve was constructed to evaluate the diagnostic effectiveness of clinical + US and H-CEUS in differentiating between CCRCC and AML. RESULTS The CCRCC group and the AML group exhibited significant differences in patient gender, operation mode, nodular echo, and nodule blood flow (χ²=11.698, -, -,=10.582; P<0.001, <0.001, <0.001, and = 0.014, respectively). In addition, the H-CEUS qualitative analysis demonstrated significant differences between the AML group and the CCRCC group with respect to enhancement mode, regression mode, peak intensity, enhancement uniformity, no enhancement, and presence or absence of pseudocapsule (χ²=41.614, -, -, = 2.758, = 42.099, -; P<0.001, <0.001, <0.001, 0.097, <0.001, and <0.001, respectively). The Arrival time (AT) in the CCRCC group was significantly shorter than that in the AML group, as determined by quantitative analysis of H-CEUS (Z=-3.266, P = 0.001). Furthermore, the Peak intensity (PI), Ascent slope (AS), and The area under the curve (AUC) exhibited significantly higher values in the CCRCC group compared to the AML group (Z=-2.043,=-2.545,=-3.565; P = 0.041, = 0.011, and <0.001, respectively). Logistic regression analysis indicated that only gender, nodule echo, the pseudocapsule, AS, and AUC of H-CEUS were independent risk factors of CCRCC. The ROC curve revealed that combining gender and nodule echo yielded a sensitivity of 92.4%, specificity of 64.5%, and an AUC of 0.847 in distinguishing between CCRCC and AML. When combining the H-CEUS parameters of pseudocapsule, AS, and AUC, the sensitivity, specificity, and AUC for distinguishing between CCRCC and AML were 84.8%, 96.8%, and 0.918, respectively. No statistically significant difference was observed in the diagnostic effectiveness of the two methods (Z=-1.286, P = 0.198). However, H-CEUS demonstrated better AUC and specificity. CONCLUSIONS H-CEUS enhances the sensitivity and specificity of differentiating between CCRCC and AML by improving the temporal resolution, offering a more precise diagnostic foundation for identifying the most appropriate therapy for patients.
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Affiliation(s)
- JingLing Wang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - JiaYu Shi
- The First Clinical Medical College, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Long Gao
- School of Advanced Manufacturing, Nanchang University, Nanchang, China
| | - WeiHong Hu
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Miao Chen
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - WeiPing Zhang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Fu Y, Zhong J, Tan Y, Zheng T, Liu M, Wang G. Contrast-enhanced ultrasound for differentiating benign from malignant focal solid renal lesions in pediatric patients. Sci Rep 2024; 14:11409. [PMID: 38762673 PMCID: PMC11102535 DOI: 10.1038/s41598-024-62496-z] [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: 01/30/2024] [Accepted: 05/17/2024] [Indexed: 05/20/2024] Open
Abstract
The contrast-enhanced ultrasound (CEUS) has been mainly applied to adults to differentiate benign and malignant renal lesions, however, the characteristics of CEUS in pediatric has not been as well studied as in adults. In the present work, the eligible pediatric patients who underwent renal CEUS between March 2016 and February 2023 were retrospectively analyzed. It included 20 lesions (median diameter, 8.4 cm; range, 1.8-18.0 cm) from 20 patients (median age, 28.0 months; range, 3.0-212.0 months; 9 boys) in malignant group and 5 lesions (median diameter, 3.8 cm; range, 1.3-7.5 cm) from 5 patients (median age, 25.0 months; range, 0.7-216.0 months; 2 boys) in benign group. The diagnostic performance was assessed. Nonparametric and Chi-square tests were performed. With hyperenhancement plus wash-out, CEUS showed a sensitivity of 95.0% [95% confidence interval (CI): 75.1%, 99.9%], a specificity of 80.0% (CI: 28.4%, 99.5%), a positive predictive value of 95.0% (CI: 75.1%, 99.9%) and a negative predictive value of 80.0% (CI: 28.4%, 99.5%). It suggested that CEUS is a valuable technique for identifying between malignant and benign renal lesions in children.
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Affiliation(s)
- Yusi Fu
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Jia Zhong
- Department of Ultrasound, Mawangdui District of Hunan Provincial People's Hospital, Hunan Normal University, No 89, Guhan Road, Changsha, 410000, Hunan, People's Republic of China
| | - Yan Tan
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Taiqing Zheng
- Department of Pathology, Hunan Children's Hospital, No 86, Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Guotao Wang
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China.
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Zhao QX, Wu C, Tan S, Yang Y, Cui XW, Dietrich CF, Yang B, Xu CL, Gao YY, Xie MX, Wu CJ, Liu LP, Wang XH, Ling-Hu RZ, Wang N, Wang F, Wang XL, Liu GY, Yu XL, Yu J, Cheng ZG, Liang P. Comparing Sonazoid contrast-enhanced ultrasound to contrast-enhanced CT and MRI for differentially diagnosing renal lesions: a prospective multicenter study. World J Urol 2024; 42:302. [PMID: 38720010 DOI: 10.1007/s00345-024-04885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE To evaluate the diagnostic performance of contrast-enhanced (CE) ultrasound using Sonazoid (SNZ-CEUS) by comparing with contrast-enhanced computed tomography (CE-CT) and contrast-enhanced magnetic resonance imaging (CE-MRI) for differentiating benign and malignant renal masses. MATERIALS AND METHODS 306 consecutive patients (from 7 centers) with renal masses (40 benign tumors, 266 malignant tumors) diagnosed by both SNZ-CEUS, CE-CT or CE-MRI were enrolled between September 2020 and February 2021. The examinations were performed within 7 days, but the sequence was not fixed. Histologic results were available for 301 of 306 (98.37%) lesions and 5 lesions were considered benign after at least 2 year follow-up without change in size and image characteristics. The diagnostic performances were evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and compared by McNemar's test. RESULTS In the head-to-head comparison, SNZ-CEUS and CE-MRI had comparable sensitivity (95.60 vs. 94.51%, P = 0.997), specificity (65.22 vs. 73.91%, P = 0.752), positive predictive value (91.58 vs. 93.48%) and negative predictive value (78.95 vs. 77.27%); SNZ-CEUS and CE-CT showed similar sensitivity (97.31 vs. 96.24%, P = 0.724); however, SNZ-CEUS had relatively lower than specificity than CE-CT (59.09 vs. 68.18%, P = 0.683). For nodules > 4 cm, CE-MRI demonstrated higher specificity than SNZ-CEUS (90.91 vs. 72.73%, P = 0.617) without compromise the sensitivity. CONCLUSIONS SNZ-CEUS, CE-CT, and CE-MRI demonstrate desirable and comparable sensitivity for the differentiation of renal mass. However, the specificity of all three imaging modalities is not satisfactory. SNZ-CEUS may be a suitable alternative modality for patients with renal dysfunction and those allergic to gadolinium or iodine-based agents.
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Affiliation(s)
- Qin-Xian Zhao
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chong Wu
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuilian Tan
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yongfeng Yang
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | | | - Bin Yang
- Central hospital of eastern theater command, Nanjing, China
| | - Chao-Li Xu
- Central hospital of eastern theater command, Nanjing, China
| | - Yong-Yan Gao
- The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Ming-Xing Xie
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Jun Wu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li-Ping Liu
- First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xing-Hua Wang
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Run-Ze Ling-Hu
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ning Wang
- MianYang Central Hospital, MianYang, China
| | - Fei Wang
- XU Chang Central Hospital, Xuchang, China
| | - Xiu-Li Wang
- The 940th Hospital of Joint Logistics Support force of Chinese people's Liberation Army, Lanzhou, China
| | - Guo-Yan Liu
- The First Affiliated Hospital of USTC, Hefei, China
| | - Xiao-Ling Yu
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Ping Liang
- Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
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Zhang W, Wang J, Chen L. Characteristics of high frame frequency contrast-enhanced ultrasound in renal tumors. BMC Med Imaging 2024; 24:71. [PMID: 38528467 DOI: 10.1186/s12880-024-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE This study aims to analyze the characteristics of high frame rate contrast-enhanced ultrasound (H-CEUS) in renal lesions and to improve the ability for differential diagnosis of renal tumors. METHODS A total of 140 patients with renal lesions underwent contrast-enhanced ultrasound (CEUS) examination in the First Affiliated Hospital of Nanchang University from July 2022 to July 2023. Based on the tumor pathology and the results of enhanced CT, tumor patients were divided into malignant and benign groups. All subjects were examined using gray-scale ultrasound, conventional contrast-enhanced ultrasound (C-CEUS), and H-CEUS, and their dynamic images were recorded. Two radiologists independently analyzed and recorded the results of ultrasound, C-CEUS, and H-CEUS images and statistically analyzed the features of C-CEUS and H-CEUS images. The independent sample t-test was used to compare the difference in age and maximum diameter of nodules between the benign and malignant groups. The χ2 test was used to compare the sex, mode of operation, gray-scale ultrasound characteristics, and enhancement characteristics of the two CEUS modes (enhancement mode, regression mode, enhancement degree, enhancement uniformity, enhancement or not, enhancement direction, post-enhancement boundary and range, and pseudocapsule) between the benign and malignant groups. The difference in vascular morphology of malignant nodules of varying sizes under two angiographic modes. RESULTS There were significant differences in gender (χ2 = 10.408, P = 0.001), mode of operation (χ2 = 47.089, P < 0.001), nodule composition (χ2 = 7.481, P = 0.003), nodule echo (χ2 = 20.926, P < 0.001), necrosis (χ2 = 31.343, P < 0.001) and nodule blood flow (χ2 = 9.006, P = 0.029) between the benign and malignant groups. There were significant differences in the regression model (χ2 = 6.782, P = 0.034) and enhancement direction (χ2 = 13.771, P = 0.001) between the two radiographic techniques in the malignant group. There was a significant difference in the enhancement uniformity between the two CEUS techniques in the benign group (χ2 = 8.264, P = 0.004). There was a significant difference between the two CEUS techniques in displaying the vascular morphology in the malignant group with the maximum diameter of nodules ≤ 4.0 cm (χ2 = 11.421, P < 0.022). However, there was no significant difference between the two techniques in the malignant group with the maximum diameter of nodules > 4.0 cm. CONCLUSION Increasing the frame rate of ultrasound images is helpful to accurately display the enhanced features and vascular morphology of renal tumors, especially for malignant tumors with a maximum diameter of ≤ 4.0 cm. Thus, H-CEUS can make up for the limitation of CEUS with regard to the display of vascular morphology.
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Affiliation(s)
- WeiPing Zhang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - JingLing Wang
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Chen
- Department of Ultrasound, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Fan X, Fu F, Liang R, Xue E, Zhang H, Zhu Y, Ye Q. Associations between contrast-enhanced ultrasound features and WHO/ISUP grade of clear cell renal cell carcinoma: a retrospective study. Int Urol Nephrol 2024; 56:1157-1164. [PMID: 37670195 DOI: 10.1007/s11255-023-03774-z] [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: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Clear cell renal cell carcinoma (CCRCC) comprises 70%-80% of RCCs. The World Health Organization/International Society of Urology Pathology (WHO/ISUP) classification is the most important prognostic factor for CCRCC. By evaluating the variations of tumor microvascular density, contrast-enhanced ultrasound (CEUS) can noninvasively predict the WHO/ISUP grade of CCRCC, and provide the appropriate treatment plan before clinical operation. METHODS In this study, we used CEUS features to analyze 116 CCRCC cases and assess the value of correlation between each indicator and CCRCC WHO/ISUP grading. RESULTS When compared to high-grade (WHO/ISUP grade III/IV) tumors, low-grade (WHO/ISUP grade I/II) tumors had reduced relative peak intensity (ΔPI) (P = 0.021), relative area under the curve (ΔAUC) (P = 0.019). However, the frequency of incomplete pseudocapsule (P = 0.021) was significantly higher in high-grade tumors. A cut-off value of mean diameter > 5.5 cm, ΔPI > 304 × 10-3, ΔAUC > 350 × 10-3 allowed identification of high-grade tumors with an area under the curve (AUC) of 74.6%, 71.7%, 70.7%, respectively (95% confidence interval). CONCLUSIONS The features of CEUS are effective for differentiating high-grade tumors from low-grade tumors, thus CEUS can be considered an acceptable method for the preoperative assessment of tumor grade.
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Affiliation(s)
- Xiaoqing Fan
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Fen Fu
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Rongxi Liang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Ensheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Huiping Zhang
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Yifan Zhu
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Qin Ye
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China.
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Elbanna KY, Krishna S, Finelli A, Atri M. Contrast-Enhanced Ultrasound of the Indeterminate Renal Mass, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024. [PMID: 38415576 DOI: 10.2214/ajr.24.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is distinguished from CT and MRI by the use of microbubble ultrasound contrast agents (UCAs) with intravascular blood pool distribution. When performing CEUS, low-intensity ultrasound allows real-time tissue subtraction imaging, whereas high-intensity ultrasound leads to microbubble destruction, enabling visualization of the contrast inflow pattern. CEUS has exceptional contrast resolution that enables the detection of even minimal blood flow, achieving very high NPV for ruling out vascular perfusion and providing high frame rates in the evaluation of tissue perfusion dynamics. UCAs undergo hepatic metabolism and pulmonary clearance, ensuring safety in patients with renal impairment. CEUS excels in distinguishing solid from cystic renal masses, with higher sensitivity than CT or MRI for detection of lesion enhancement. CEUS can aid the further characterization of both solid and cystic lesions and may have particular applications in the surveillance of cystic masses and surveillance after renal cell carcinoma ablation. This review describes the use of CEUS to help characterize indeterminate renal masses, based on the authors' institutional experience. The article highlights key differences between CEUS and CT or MRI, and provides practical insights for performing and interpreting CEUS of renal masses.
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Affiliation(s)
- Khaled Y Elbanna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Satheesh Krishna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
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Clingan MJ, Zhang Z, Caserta MP, Cox KL, Gupta V, Baumgarten DA, Zhai QJ, Alexander LF. Imaging Patients with Kidney Failure. Radiographics 2023; 43:e220116. [PMID: 37053100 DOI: 10.1148/rg.220116] [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: 04/14/2023]
Abstract
The approach to imaging a patient with kidney failure continues to evolve. Overstatement of the risk of iodinated contrast material-induced (ie, contrast-induced) acute kidney injury and new guidelines for administration of gadolinium-based contrast media affect screening and the choice of contrast material. Treatment of kidney failure requires dialysis or a kidney transplant. Pretransplant imaging includes assessment for the feasibility of performing a transplant and evaluation for underlying malignancy and peripheral vascular disease. Patients with kidney failure are at high risk for renal cell carcinoma. Subtypes that occur exclusively or more commonly in patients with kidney failure, such as acquired cystic kidney disease, renal cell carcinoma, and clear cell papillary renal cell carcinoma, have specific clinical-pathologic characteristics, with indolent behavior. Performing US for dialysis planning increases the success of placement of an arteriovenous fistula, while postoperative US evaluation is essential in assessment of access dysfunction. Systemic manifestations in patients with kidney failure are multifactorial and may relate to the underlying cause of renal failure or may be secondary to treatment effects. Disturbances in mineral and bone metabolism and soft-tissue and vascular calcifications are seen in patients with chronic kidney disease and mineral bone disorder. Neurologic and cardiothoracic complications are also common. The authors provide a comprehensive overview of imaging considerations for patients with kidney failure, including the appropriate use of CT, MRI, and US with their respective contrast agents; the use of imaging in transplant workup and dialysis assessment; and the common renal and extrarenal manifestations of kidney failure. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mary Jennings Clingan
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Zhao Zhang
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Melanie P Caserta
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Kelly L Cox
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Vivek Gupta
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Deborah A Baumgarten
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Qihui Jim Zhai
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Lauren F Alexander
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
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Intra- and Inter-Observer Variability of Quantitative Parameters Used in Contrast-Enhanced Ultrasound of Kidneys of Healthy Cats. Animals (Basel) 2022; 12:ani12243557. [PMID: 36552476 PMCID: PMC9774712 DOI: 10.3390/ani12243557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging technique which allows qualitative and quantitative assessment of tissue perfusion. Although CEUS offers numerous advantages, a major challenge remains the variability in tissue perfusion quantification. This study aimed to assess intra- and inter-observer variability for quantification of renal perfusion. Two observers with different levels of expertise performed a quantitative analysis of 36 renal CEUS studies, twice. The CEUS data were collected from 12 healthy cats at 3 different time points with a 7-day interval. The inter- and intra-observer agreement was assessed by the intraclass correlation coefficient. Within and between observers, a good agreement was demonstrated for intensity-related parameters in the cortex, medulla, and interlobular artery. For some parameters, ICCinter was considerably lower than ICCintra, mostly when the ROI encompassed the entire kidney or medulla. With the exception of time to peak (TTP) and mean transit time (mTTI), time-related and slope-related parameters showed poor agreement among observers. In conclusion, it may be advised against having the quantitative assessment of renal perfusion performed by different observers, especially if their experience levels differ. The cortical mTTI seemed to be the most appropriate parameter as it showed a favorable inter-observer agreement and inter-period agreement.
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11
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Huang MF, Zhang Z, Xia QQ, Zhou XL, Yuan XC, Zhou ZY. Application of Contrast-enhanced Ultrasound and Bosniak Classification to the Diagnosis of Cystic Renal Masses. Curr Med Imaging 2022; 18:1470-1478. [PMID: 35579142 DOI: 10.2174/1573405618666220509120959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Bosniak classification system based on contrast-enhanced computed tomography (CECT) is commonly used for the differential diagnosis of cystic renal masses. Contrastenhanced ultrasound (CEUS) is a relatively novel technique, which has gradually played an important role in the diagnosis of cystic renal cell carcinoma (CRCC) due to its safety and lowest price. OBJECTIVE The aim of the study is to investigate the application value of CEUS and Bosniak classification into the diagnosis of cystic renal masses. METHODS 32 cystic masses from January 2018 to December 2019 were selected. The images of conventional ultrasound (US), CEUS and CECT from subjects confirmed by surgical pathology were retrospectively analyzed. The Bosniak classification system of cystic renal masses was implemented using CEUS and CECT, and the diagnostic ability was compared. RESULTS For the 32 cystic masses, postoperative pathology confirmed 11 cases of multilocular CRCC, 15 cases of clear cell carcinoma with hemorrhage, necrosis and cystic degeneration, 5 cases of renal cysts, and 1 case of renal tuberculosis. The Bosniak classification based on CEUS was higher than that based on CECT, and the difference was statistically significant (P = .024). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were comparable to CECT. There was no significant difference observed in the diagnosis of CRCC (P >.05). CONCLUSION CEUS combined with Bosniak classification greatly improves the diagnosis of CRCC. CEUS shows a comparable diagnostic ability to CECT. In daily clinical routine, patients who require multiple examinations and present contraindications for CECT can particularly benefit from CEUS.
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Affiliation(s)
- Mei-Feng Huang
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhi Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Qing-Qing Xia
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xi-Ling Zhou
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xin-Chun Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhi-Yu Zhou
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
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12
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Pšeničny E, Glušič M, Pokorn M, Ključevšek D. Contrast-enhanced ultrasound in detection and follow-up of focal renal infections in children. Br J Radiol 2022; 95:20220290. [DOI: 10.1259/bjr.20220290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: Focal renal infections in children have to be diagnosed early in order to enable an appropriate antibiotic treatment. The purpose of this paper was to investigate the efficacy and clinical utility of intravenous renal contrast-enhanced ultrasound (CEUS) as an alternative imaging method for the diagnosis and follow-up of focal renal infections in children. Methods: Fourteen children aged from 6 months to 17 years (mean 6.5 years) in whom focal renal infection was suspected were included in this retrospective study. All data were obtained from medical and imaging records of the patients. Results: CEUS was performed for the diagnosis in all 14 children and then also for follow-up in seven children with renal abscess. In three children enhancement pattern was concordant with focal nephritis and in four children CEUS excluded focal renal infection and the diagnosis of pseudolesion was confirmed. Conclusion: Renal CEUS was proven to be an efficient and self-sufficient imaging in diagnosis and further follow-up of focal renal infections in children. CEUS patterns of focal renal infections are described as well as relevant CEUS enhancement patterns important for differential diagnosis. Renal abscess follow-up algorithm with CEUS is suggested. Advances in knowledge: All clinically relevant imaging data was obtained by CEUS and no other imaging was necessary for the diagnosis and follow-up.
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Affiliation(s)
- Evita Pšeničny
- Department of Radiology, University Children’s Hospital Ljubljana, Bohoričeva 20, Ljubljana, Slovenia
| | - Mojca Glušič
- Department of Radiology, University Children’s Hospital Ljubljana, Bohoričeva 20, Ljubljana, Slovenia
| | - Marko Pokorn
- University Children’s Hospital Ljubljana, Bohoričeva 20, Ljubljana, Slovenia
- Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Department of Radiology, University Children’s Hospital Ljubljana, Bohoričeva 20, Ljubljana, Slovenia
- University Children’s Hospital Ljubljana, Bohoričeva 20, Ljubljana, Slovenia
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13
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Yang JW, Liang C, Yang L. Advancements in the diagnosis and treatment of renal epithelioid angiomyolipoma: A narrative review. Kaohsiung J Med Sci 2022; 38:925-932. [PMID: 36056704 DOI: 10.1002/kjm2.12586] [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: 03/29/2022] [Revised: 06/19/2022] [Accepted: 07/31/2022] [Indexed: 11/12/2022] Open
Abstract
Renal epithelioid angiomyolipoma (EAML) is a unique subtype of angiomyolipoma that contains a variety of cytoplasmic-rich, eosinophilic cytoplasm epithelioid cells in addition to mature adipocytes, hyaline thick-walled vessels, and smooth muscle-like spindle cells. In recent years, increasing evidence has shown that EAML is a potentially malignant tumor. Due to the lack of typical clinical manifestations and imaging features, it is difficult to diagnose before surgery, and the diagnosis mainly depends on postoperative histopathological examination. With the advancement of pathological diagnostic techniques, more EAML cases has been discovered, but clinicians still lack a comprehensive understanding of EAML. This review comprehensively describes some pathological and clinical features of EAML, with special attention to the pathogenesis and treatment of malignant EAML in order to assist with clinical diagnosis and treatment.
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Affiliation(s)
- Jian-Wei Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.,Clinical Center of Gansu Province for Nephron-urology, Lanzhou, China
| | - Cheng Liang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.,Clinical Center of Gansu Province for Nephron-urology, Lanzhou, China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.,Clinical Center of Gansu Province for Nephron-urology, Lanzhou, China
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14
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Cao H, Fang L, Chen L, Zhan J, Diao X, Liu Y, Lu C, Zhang Z, Chen Y. The Value of Contrast-Enhanced Ultrasound in Diagnosing Small Renal Cell Carcinoma Subtypes and Angiomyolipoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1415-1423. [PMID: 34499770 DOI: 10.1002/jum.15824] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To retrospectively explore the value of contrast-enhanced ultrasound (CEUS) in differentiating small renal cell carcinomas (RCCs) from angiomyolipomas (AMLs), and distinguishing between clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). METHODS A total of 151 patients with small renal masses (110 ccRCCs, 12 pRCCs, 9 chRCCs, and 20 AMLs) were enrolled between August 2016 and October 2019. RESULTS There were significant differences in terms of enhancement intensity (EI), enhancement homogeneity, perilesional rim-like enhancement (PRE), wash in, and wash out (WO) between RCC and AML (P = .000, .011, .000, .001, .000, respectively). Although there was no significant difference in EI between pRCC and chRCC (P = .272), EI of ccRCC was higher than that of pRCC (P = .000) and chRCC (P = .010). Multivariate regression analysis showed PRE and fast WO were related to RCC (OR = 18.189, 15.141, respectively). Although there were no significant differences in the sensitivity and area under the curve (AUC) between PRE and fast WO (95.0% vs. 95.0%, P = 1.000 and .880 vs. 0.799, P = .123, respectively), the specificity of PRE in predicting RCC was higher than that of fast WO (80.92% vs. 64.89%, P = .011). The sensitivity, specificity, and AUC of the two characteristics combination for differentiating RCC from AML were 95.0%, 90.8%, and 0.920, respectively, and that of EI for differentiating between ccRCC, pRCC, and chRCC were 81.0%, 78.2%, and 0.796, respectively. CONCLUSIONS CEUS has value in differentiating small RCCs from AMLs and distinguishing ccRCC, a subtype associated with a greater likelihood of malignant behavior from pRCC and chRCC.
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Affiliation(s)
- Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Chen Lu
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhengwang Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Department of Urology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
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15
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Contrast-Enhanced Ultrasonography for Differential Diagnosis of Benign and Malignant Thyroid Lesions: Single-Institutional Prospective Study of Qualitative and Quantitative CEUS Characteristics. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8229445. [PMID: 35542754 PMCID: PMC9056255 DOI: 10.1155/2022/8229445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objectives To extend and revise the diagnostic value of contrast-enhanced ultrasonography (CEUS) for differentiation between malignant and benign thyroid nodules. Methods This single-institution prospective study aims to compare CEUS qualitative and objective quantitative parameters in benign and malignant thyroid nodules. Consecutive cohort of 100 patients was examined by CEUS, 68 out of them were further analysed in detail. All included patients underwent cytological and/or histopathological verification of the diagnosis. Results Fifty-five (81%) thyroid nodules were benign, and 13 (19%) were malignant. Ring enhancement pattern was strongly associated with a benign aetiology (positive predictive value 100%) and heterogeneous enhancement pattern with malignant aetiology (positive predictive value 72.7%). The shape of the TIC (time-intensity curve) was more often identical in the benign lesion (98.2%) than in malignant lesions (69.2%), p=0.004. Conclusions This study indicates that CEUS enhancement patterns were significantly different in benign and malignant lesions. Ring enhancement was a very strong indicator of benign lesions, whereas heterogeneous enhancement was valuable to detect malignant lesions.
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16
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Atri M, Jang HJ, Kim TK, Khalili K. Contrast-enhanced US of the Liver and Kidney: A Problem-solving Modality. Radiology 2022; 303:11-25. [PMID: 35191740 DOI: 10.1148/radiol.211347] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced US (CEUS) has an important role as a supplement to CT or MRI in clinical practice. The main established utilizations are in the liver and the kidney. The primary advantages of CEUS compared with contrast-enhanced CT or MRI relate to its superior contrast resolution, real-time continuous scanning, pure intravascular nature, portability, and safety-especially in patients with renal impairment or CT or MRI contrast agent allergy. This article focuses on the use of CEUS in the liver and kidney.
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Affiliation(s)
- Mostafa Atri
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Tae Kyoung Kim
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Korosh Khalili
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
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17
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Chen S, Lin D, Liu P, Liu Q, Li M, Han W, Wang X, Zhang W, Song H, Li Z, Sun N. Quantitative assessment of renal perfusion in children with UPJO by contrast enhanced ultrasound: A pilot study. J Pediatr Urol 2022; 18:75.e1-75.e7. [PMID: 34924295 DOI: 10.1016/j.jpurol.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/08/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of a parenchymal organ. OBJECTIVE To prospectively and quantitatively analyse the role of CEUS in evaluating renal perfusion for assessing renal function in children with ureteropelvic junction obstruction (UPJO). METHODS The study protocol was approved by the local ethics committee, and written informed consent was obtained from the patients' parents or guardians. Ultrasonography, CEUS, and radioisotope renography were performed for 51 children (42 boys, 9 girls; mean age, 6.75 ± 4.14 years) with unilateral UPJO. The slope of the ascending curve (A), time to peak (TTP), peak intensity (PI), and area under the curve (AUC) were recorded during CEUS; quantitative data were calculated by QLab system (semiautomated border tracking, Philips Healthcare) software. Sensitivity and specificity values were determined for CEUS with respect to radioisotope renography. RESULTS CEUS was used to evaluate 102 kidneys in 51 patients, for which the perfusion time-intensity curve (TIC) was determined. The TIC of renal cortical perfusion in all groups showed an asymmetrical single-peak curve, which could be clearly distinguished between the experimental group and the control group. Compared with the control group, the experimental group showed a markedly prolonged TTP but a significantly decreased A (P < 0.05). There was no significant correlation between the AUC, PI and differential renal function (DRF), but the correlation coefficient between TTP, A and DRF remained significant (p < 0.001).The receiver operating characteristic (ROC) curves drawn to differentiate DRF using the TTP value yielded an area under the ROC curve (AUROC) of 0.86. For a quantitative assessment of DRF less than 40% by CEUS, the sensitivity and specificity values were 92.86% and 76.14%, respectively. DISCUSSION Unlike in previous studies, no significant difference in the AUC or PI was found between the control group and the experimental group in this study (P > 0.05). Renal blood perfusion could not be evaluated overall by CEUS. Parenchymal thinning may be considered a limitation to CEUS. CONCLUSIONS This preliminary experience represents the first report of evaluating the diagnostic value of CEUS in assessing renal function in children with UPJO. CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal function noninvasively.
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Affiliation(s)
- Shuofan Chen
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Defu Lin
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Qinglin Liu
- Department of u ltrasound, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Minglei Li
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wenwen Han
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaoman Wang
- Department of u ltrasound, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zhenwu Li
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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18
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Liu H, Cao H, Chen L, Fang L, Liu Y, Zhan J, Diao X, Chen Y. The quantitative evaluation of contrast-enhanced ultrasound in the differentiation of small renal cell carcinoma subtypes and angiomyolipoma. Quant Imaging Med Surg 2022; 12:106-118. [PMID: 34993064 DOI: 10.21037/qims-21-248] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Background Contrast-enhanced ultrasound (CEUS) has been widely used for renal lesion diagnosis and differential diagnosis. However, qualitative analysis of CEUS is subject to examinations with low reproducibility. This study aims to investigate the diagnostic value of CEUS quantitative parameters in differentiating small renal cell carcinoma (RCC) subtypes and angiomyolipoma (AML). Methods A retrospective analysis was performed on 97 cases of a small renal mass undergoing a CEUS before a radical or partial nephrectomy procedure. A region of interest (ROI) was placed in the tumor's maximum enhanced region (ROImax) as much as possible, and adjacent renal cortex (ROIrefer) was selected from normal renal tissue around a mass of the same depth. The time-intensity curve (TIC) was used to analyze the ROImax and the ROIrefer of the tumors quantitatively. Then the parameters of the ROImax and the ROIrefer, including the differences between the parameters of the ROImax and the ROIrefer, were analyzed statistically. Results In RCC and clear cell renal cell carcinoma (ccRCC), the peak intensity (PI), slope (SL), area under the curve (AUC), area under the wash-in curve (AWI), area under the wash-out curve (AWO), time to peak intensity (TTP) and the mean transit time (MTT) were statistically significant between ROImax and ROIrefer (all P=0.000). The △PI (△PI = PImax - PIrefer), △SL (△SL = SLmax - SLrefer), △AUC (△AUC = AUCmax - AUCrefer), △AWI (△AWI = AWImax - AWIrefer) and △AWO (△AWO = AWOmax - AWOrefer) of RCC were significantly higher than in AML (P=0.007, 0.000, 0.003, 0.048, 0.009, respectively), while the TTP (△TTP = TTPmax - TTPrefer) and △MTT (△MTT = MTTmax - MTTrefer) of RCC were significantly lower (both P=0.000). In comparison with papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC), the △PI, △SL, △AUC and △AWO of ccRCC were all larger (all P<0.05). The sensitivity, specificity, and AUC of the combination of parameter difference for differentiating RCC from AML were 100%, 81.2%, and 0.965, respectively, and for differentiating ccRCC from pRCC and chRCC, 85.71%, 85.92% and 0.911, respectively. Conclusions CEUS quantitative parameters have value in differentiating small RCC from AML and distinguishing ccRCC from pRCC and chRCC.
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Affiliation(s)
- Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
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19
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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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20
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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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21
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Values of Contrast-Enhanced Ultrasound in Classification and Diagnosis of Common Bile Duct and Superficial Organ Lesions under Compression Algorithm. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9577440. [PMID: 34631000 PMCID: PMC8494555 DOI: 10.1155/2021/9577440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
This work aimed to investigate values of contrast-enhanced ultrasound (CEUS) under DEFLATE in the classification and diagnosis of the common bile duct and superficial lymphoid lesions. 88 patients with lower common bile duct lesions and 126 patients with superficial lymphoid lesions were selected as the subjects investigated and examined by CEUS under DEFLATE to compare characteristics and diagnostic efficiency of CEUS in different types of lesions. The time-intensity curve (TIC) was for quantitative analysis on CEUS results. The results showed that there were statistically significant differences in the comparison of time to peak (TTP), area under the curve (AUC), and gradient (Grad) of common bile duct walls in patients from the malignant group (P < 0.05), while the comparison of three indicators of patients in the benign group was not statistically remarkable (P > 0.05). In addition, there were statistically great differences in TTP, AUC, and Grad among patients in the benign and malignant groups (P < 0.05). The sensitivity, specificity, accuracy, and positive/negative predictive value of CEUS + ultrasound (US) in the diagnosis of benign and malignant lymph nodes were 92.83%, 87.14%, 89.54%, 91.23%, and 86.43%, respectively. The values of maximal intensity (Imax) in the reactive hyperplasia group (group A), lymphoma group (group B), and metastatic lymph nodes group (group C) were compared, showing statistical differences (P < 0.05). The TTP and AUC of group B were higher than those of groups A and C, respectively (P < 0.05), and the base-to-peak ascending slope (KUP) and the absolute value of the semidescending slope (KDOWN) in group C increased hugely compared to group A (P < 0.05). It indicated that CEUS examination under DEFLATE could be applied in the qualitative diagnosis of lower common bile duct lesions and superficial lymphoid lesions, which was worthy of clinical application.
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Skjøt-Arkil H, Heltborg A, Lorentzen MH, Cartuliares MB, Hertz MA, Graumann O, Rosenvinge FS, Petersen ERB, Østergaard C, Laursen CB, Skovsted TA, Posth S, Chen M, Mogensen CB. Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study. BMJ Open 2021; 11:e049606. [PMID: 34593497 PMCID: PMC8487181 DOI: 10.1136/bmjopen-2021-049606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The major obstacle in prescribing an appropriate and targeted antibiotic treatment is insufficient knowledge concerning whether the patient has a bacterial infection, where the focus of infection is and which bacteria are the agents of the infection. A prerequisite for the appropriate use of antibiotics is timely access to accurate diagnostics such as point-of-care (POC) testing.The study aims to evaluate diagnostic tools and working methods that support a prompt and accurate diagnosis of hospitalised patients suspected of an acute infection. We will focus on the most common acute infections: community-acquired pneumonia (CAP) and acute pyelonephritis (APN). The objectives are to investigate (1) patient characteristics and treatment trajectory of the different acute infections, (2) diagnostic and prognostic accuracy of infection markers, (3) diagnostic accuracy of POC urine flow cytometry on diagnosing and excluding bacteriuria, (4) how effective the addition of POC analysis of sputum to the diagnostic set-up for CAP is on antibiotic prescriptions, (5) diagnostic accuracy of POC ultrasound and ultralow dose (ULD) computerized tomography (CT) on diagnosing CAP, (6) diagnostic accuracy of specialist ultrasound on diagnosing APN, (7) diagnostic accuracy of POC ultrasound in diagnosing hydronephrosis in patients suspected of APN. METHODS AND ANALYSIS It is a multifaceted multicentre diagnostic study, including 1000 adults admitted with suspicion of an acute infection. Participants will, within the first 24 hours of admission, undergo additional diagnostic tests including infection markers, POC urine flow cytometry, POC analysis of sputum, POC and specialist ultrasound, and ULDCT. The primary reference standard is an assigned diagnosis determined by a panel of experts. ETHICS, DISSEMINATION AND REGISTRATION Approved by Regional Committees on Health Research Ethics for Southern Denmark, Danish Data Protection Agency and clinicaltrials.gov. Results will be presented in peer-reviewed journals, and positive, negative and inconclusive results will be published. TRIAL REGISTRATION NUMBERS NCT04661085, NCT04681963, NCT04667195, NCT04652167, NCT04686318, NCT04686292, NCT04651712, NCT04645030, NCT04651244.
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Affiliation(s)
- Helene Skjøt-Arkil
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Anne Heltborg
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Internal Medicine, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Morten Hjarnø Lorentzen
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mariana Bichuette Cartuliares
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mathias Amdi Hertz
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Graumann
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Eva Rabing Brix Petersen
- Blood Samples, Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Claus Østergaard
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Thor Aage Skovsted
- Blood Samples, Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Stefan Posth
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Emergency Department, Odense University Hospital, Odense, Denmark
| | - Ming Chen
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Microbiology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Zhu D, Zhu L, Wu J, Wu L, Li J, Luo H, Yang K, Liu G, Quo X, Dong F, Xu J. Metanephric adenoma: association between the imaging features of contrast-enhanced ultrasound and clinicopathological characteristics. Gland Surg 2021; 10:2490-2499. [PMID: 34527561 DOI: 10.21037/gs-21-437] [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: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 11/06/2022]
Abstract
Background This study aimed to improve the understanding of metanephric adenoma (MA) by retrospective analysis of contrast-enhanced ultrasound (CEUS) findings and clinicopathological characteristics of MAs. Methods Gray-scale ultrasound (US) and CEUS findings of 7 adult MA patients, confirmed by postoperative pathology, were summarized via collection of clinicopathological and ultrasonographic imaging data, including tumor location, size, echo intensity, color flow, presence or absence of calcification, and liquefactive necrosis, contrast-enhanced pattern, enhancement characteristics, and contrast wash-out compared with adjacent parenchyma, and the presence or absence of a pseudocapsule. Histopathological analyses, including hematoxylin and eosin (HE) and immunohistochemical (IHC) staining, were conducted with the EnVision method. Results All 7 participants were female, aged 29-73 years (mean age, 54 years), with flank pain (3/7). All tumors were solid (7/7) with sizes of 2.0-5.0 cm (mean diameter, 3.07 cm), including 4 in the left kidney, 3 in the right kidney, 2 in the renal pelvis, and 5 in the renal parenchyma. On the gray-scale US, MA was shown as hypoechoic (4/7), slightly hyperechoic (2/7), isoechoic (1/7), and with a defined border. The morphology was regular and rounded (7/7), internal echogenicity was homogeneous (5/7), and no calcification was seen (7/7). The CEUS showed clear boundaries (7/7), homogeneous isodensity (5/7), with calcification (0/7), necrosis (2/11), heterogeneous hyperattenuation (2/7), pseudocapsule (2/7), and medullary phase fast wash-out (7/7). The surgical methods were radical nephrectomy (4/7) and partial nephrectomy (3/7). The duration of follow-up period for all participants was 3-74 months, and no local or distant recurrences were found. The IHC staining showed that most tumor cells were positive for WT1, cytokeratins AE1/AE3, vimentin, and CD57, and exhibited focal positivity for CK7, while negative for CD10, AMACR, and CK720. The proliferative index (Ki-67) was 2-3%. Conclusions On gray-scale US, MA appears as a solid nodule with a well-defined boundary, regular morphology, and homogeneous echogenicity; CEUS shows slow progression and slightly lower homogeneous enhancement and fast wash-out in the medullary phase. These findings may provide insight into the progression of MA and aid in the development of diagnostic and therapeutic strategies.
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Affiliation(s)
- Dongmei Zhu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.,Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Lin Zhu
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Department of Geriatric General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ji Wu
- Department of Urology Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Linghu Wu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Jian Li
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Hao Luo
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Keen Yang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Gang Liu
- Department of Ultrasound, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaoguang Quo
- Department of Pathology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China
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Hongo F, Ohashi M, Ueda T, Okihara K, Ukimura O. Usefulness of intraoperative contrast-enhanced color Doppler ultrasonography for selective renal artery clamping in robot-assisted partial nephrectomy. J Med Ultrason (2001) 2021; 48:651-652. [PMID: 34347219 DOI: 10.1007/s10396-021-01112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Munehiro Ohashi
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Ueda
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto, 602-8566, Japan
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Yang J, Cherin E, Yin J, Newsome IG, Kierski TM, Pang G, Carnevale CA, Dayton PA, Foster FS, Demore CEM. Characterization of an Array-Based Dual-Frequency Transducer for Superharmonic Contrast Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2419-2431. [PMID: 33729934 PMCID: PMC8459708 DOI: 10.1109/tuffc.2021.3065952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Superharmonic imaging with dual-frequency imaging systems uses conventional low-frequency ultrasound transducers on transmit, and high-frequency transducers on receive to detect higher order harmonic signals from microbubble contrast agents, enabling high-contrast imaging while suppressing clutter from background tissues. Current dual-frequency imaging systems for superharmonic imaging have been used for visualizing tumor microvasculature, with single-element transducers for each of the low- and high-frequency components. However, the useful field of view is limited by the fixed focus of single-element transducers, while image frame rates are limited by the mechanical translation of the transducers. In this article, we introduce an array-based dual-frequency transducer, with low-frequency and high-frequency arrays integrated within the probe head, to overcome the limitations of single-channel dual-frequency probes. The purpose of this study is to evaluate the line-by-line high-frequency imaging and superharmonic imaging capabilities of the array-based dual-frequency probe for acoustic angiography applications in vitro and in vivo. We report center frequencies of 1.86 MHz and 20.3 MHz with -6 dB bandwidths of 1.2 MHz (1.2-2.4 MHz) and 14.5 MHz (13.3-27.8 MHz) for the low- and high-frequency arrays, respectively. With the proposed beamforming schemes, excitation pressure was found to range from 336 to 458 kPa at its azimuthal foci. This was sufficient to induce nonlinear scattering from microbubble contrast agents. Specifically, in vitro contrast channel phantom imaging and in vivo xenograft mouse tumor imaging by this probe with superharmonic imaging showed contrast-to-tissue ratio improvements of 17.7 and 16.2 dB, respectively, compared to line-by-line micro-ultrasound B-mode imaging.
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The Application Value of Contrast-Enhanced Ultrasound in Testicular Occupied Lesions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:9962970. [PMID: 34194540 PMCID: PMC8214501 DOI: 10.1155/2021/9962970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
Objective To discuss the clinical application value of contrast-enhanced ultrasound (CEUS) in testicular occupied lesions. Methods Nine conventional-ultrasound-found testicular occupied lesions which underwent CEUS meantime were analyzed retrospectively. The CEUS perfusion pattern was compared with the surgical pathological result or follow-up findings. Results Among all the 9 testicular occupied lesions, there were 5 testicular malignant tumors, 1 testicular benign tumor, 1 testicular tuberculosis, and 2 testicular hematomas. CEUS diagnosed 6 testicular malignant tumors, 1 testicular benign tumor, and 2 testicular hematomas, and its diagnostic accuracy was about 88.9%. Conclusion CEUS has high clinical application value in the differential diagnoses of benign and malignant testicular occupied lesions.
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Elbanna KY, Jang HJ, Kim TK, Khalili K, Guimarães LS, Atri M. The added value of contrast-enhanced ultrasound in evaluation of indeterminate small solid renal masses and risk stratification of cystic renal lesions. Eur Radiol 2021; 31:8468-8477. [PMID: 33912992 DOI: 10.1007/s00330-021-07964-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/09/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate accuracy of contrast-enhanced ultrasound (CEUS) to characterize indeterminate small solid renal masses (sSRMs), excluding lipid-rich AMLs, and cystic renal masses (CRMs) according to the proposed Bosniak Classification 2019 MATERIALS AND METHODS: CEUS of pathology-proven CRMs and sSRMs (without definite enhancement or macroscopic fat on CT/MRI), and CRMs with ≥18 months follow-up were retrospectively reviewed. Two radiologists blindly categorized CRMs according to new Bosniak Classification on CT/MRI. On CEUS, two other radiologists evaluated arterial-phase enhancement of sSRMs relative to renal cortex and categorized CRMs following new Bosniak Classification. Fisher's exact/chi-squared test was used to compare categorical variables, and Cohen κ statistics for inter-observer agreement RESULTS: A total of 237 patients had 241 lesions: 161 pathology-proven sSRMs (122 malignant and 39 benign), 29 pathology-proven CRMs, 51 CRMs with adequate follow-up. Arterial-phase enhancement < renal cortex predicted malignancy with specificity of 97.4% (38/39) (CI 85.6-99.9%), and positive predictive value (PPV) of 98.2% (54/55) (CI 90.4-99.9%). Inter-observer kappa was 0.95. In pathology-proven CRMS, sensitivity of CEUS vs CT/MRI was 100% (15/15) (CI 79.6-100%) vs 60% (9/15) (CI 35.8-80.1%) (p value = .002) and negative predictive value (NPV) 100% (2/2) (CI 17.8-100%) vs 25% (2/8 ) (CI 4.4-59.1%) (p value < 0.0001), with similar specificity (50%) and PPV- 88.2% (15/17) (CI 65.7-97.9%) vs 81.8% (9/11) (CI 52.3-96.8%) ( p value = 0.586). Bosniak Classification inter-observer kappa was 0.92 for CEUS vs 0.68 for CT/MRI (p value = 0.009). CONCLUSION In our cohort, CEUS had high specificity and PPV to diagnose RCC in sSRMs excluding lipid-rich AML. CEUS had significantly higher sensitivity/NPV to diagnose malignancy in CRMs as compared to CT/MRI. KEY POINTS • Once lipid-rich AML is excluded by the other modalities, sSRM arterial phase hypo-enhancement relative to renal cortex on CEUS yielded high specificity (97.4%) and PPV (98.2%) to diagnose RCC. • When applying the proposed Bosniak Classification 2019, CEUS showed higher sensitivity compared to CT/MRI (100% vs 60%), p value=.0024, in the stratification of cystic renal masses to diagnose malignancy. • CEUS may reduce the number of CT/MRI Bosniak IIF lesions by assigning them to either II or III/IV categories.
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Affiliation(s)
- Khaled Y Elbanna
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Hyun-Jung Jang
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Korosh Khalili
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Luís S Guimarães
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Mostafa Atri
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada.
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Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications. AJR Am J Roentgenol 2021; 217:1217-1231. [PMID: 33908269 DOI: 10.2214/ajr.21.25713] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) utilization is expanding rapidly, particularly in children, in whom the modality offers important advantages of dynamic evaluation of the vasculature, portability, lack of ionizing radiation, and lack of need for sedation. Accumulating data establish an excellent safety profile of ultrasound contrast agents in children. Although only FDA-approved for IV use in children for characterizing focal liver lesions and for use during echocardiography, growing off-label applications are expanding the diagnostic potential of ultrasound. Focal liver lesion evaluation is the most common use of CEUS, and the American College of Radiology Pediatric LI-RADS Working Group recommends including CEUS for evaluation of a newly discovered focal liver lesion in many circumstances. Data also support the role of CEUS in hemodynamically stable children with blunt abdominal trauma, and CEUS is becoming a potential alternative to CT in this setting. Additional potential applications that require further study include evaluation of pathology in the lung, spleen, brain, pancreas, bowel, kidney, female pelvis, and scrotum. This review explores the implementation of CEUS in children, describing basic principles of ultrasound contrast agents and CEUS technique and summarizing current and potential IV diagnostic applications based on pediatric-specific supporting evidence.
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Malone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics 2021; 40:562-588. [PMID: 32125955 DOI: 10.1148/rg.2020190183] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, transarterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymphangiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Christopher D Malone
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - David T Fetzer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Wayne L Monsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Philip A Velez
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Michalakis A Averkiou
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Raja S Ramaswamy
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
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Cantisani V, Bertolotto M, Clevert DA, Correas JM, Drudi FM, Fischer T, Gilja OH, Granata A, Graumann O, Harvey CJ, Ignee A, Jenssen C, Lerchbaumer MH, Ragel M, Saftoiu A, Serra AL, Stock KF, Webb J, Sidhu PS. EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:154-166. [PMID: 33307594 DOI: 10.1055/a-1300-1727] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.
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Affiliation(s)
- Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, IT
| | - Dirk-André Clevert
- Department of Clinical Radiology, University of Munich-Großhadern Campus, Munich, Germany
| | - Jean-Michel Correas
- Service de Radiologie adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | | | - Thomas Fischer
- Department of Radiology, University Berlin, Charité, Berlin, Germany
| | - Odd Helge Gilja
- Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| | - Antonio Granata
- Nephrology and Dialysis Unit, Emergency Hospital "Cannizzaro", Catania - Italy
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense C, Denmark
| | - Christopher J Harvey
- Department of Imaging, Imperial College NHS Healthcare Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Andre Ignee
- Innere Medizin 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | - Markus Herbert Lerchbaumer
- Department of Radiology, Charité Centrum 6 - Diagnostische und interventionelle Radiologie und Nuklearmedizin, Berlin, Germany
| | - Matthew Ragel
- Radiology Department, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | - Andreas L Serra
- Department of Internal Medicine and Nephrology, Klinik Hirslanden, Zürich, Switzerland
| | | | - Jolanta Webb
- Radiology Department, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital London, United Kingdom of Great Britain and Northern Ireland
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Fang L, Bai K, Chen Y, Zhan J, Zhang Y, Qiu Z, Chen L, Wang L. A comparative study of contrast-enhanced ultrasound and contrast-enhanced CT for the detection and characterization of renal masses. Biosci Trends 2021; 15:24-32. [PMID: 33642452 DOI: 10.5582/bst.2021.01026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aims to compare the value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT (CECT) in the differential diagnosis of benign and malignant renal masses. Included in this retrospective study were 143 renal masses in 141 patients using histopathological findings as the gold standard. A comparison was made of the two modalities in image characteristics for their accuracy in the differential diagnosis of renal masses. CEUS and CECT were both used for 39 masses in 37 patients, with 31 (79.5%) being malignant and 8 (20.5%) benign. The differences between the benign and malignant groups in perfusion intensity, perfusion uniformity and entry and exit of the contrast agent were not statistically significant (P > 0.05). However, CEUS could better display the circular perfusion of renal cell carcinoma than CECT (P < 0.05). CECT alone detected 109 masses in 107 patients, with 93 (85.3%) being malignant and 16 (14.7%) benign. CEUS detected 73 masses in 71 patients, with 56 (76.7%) being malignant and 17 (23.3%) benign. No statistically significant differences were observed between CEUS and CECT in the diagnosis of renal cell carcinoma (92.8% vs. 90.3%), with a specificity of 52.9% vs. 31.2%, an accuracy of 83.5% vs. 81.6%, and a positive predictive value of 86.7% vs. 88.4% or a negative predictive value of 69.2% vs. 35.7% (P > 0.05 for all). These results suggested both CEUS and CECT are highly valuable in the differential diagnosis of renal masses, and CEUS can be used as an important supplement for CECT in diagnosis of renal cancer.
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Affiliation(s)
- Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Kun Bai
- Department of Ultrasound, Jiading Central Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Yinjia Zhang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Zhiying Qiu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai, China
| | - Ling Wang
- Department of Reproductive Immunology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Selby NM, Williams JP, Phillips BE. Application of dynamic contrast enhanced ultrasound in the assessment of kidney diseases. Curr Opin Nephrol Hypertens 2021; 30:138-143. [PMID: 33186215 DOI: 10.1097/mnh.0000000000000664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Many forms of acute and chronic disease are linked to changes in renal blood flow, perfusion, vascular density and hypoxia, but there are no readily available methods to assess these parameters in clinical practice. Dynamic contrast enhanced ultrasound (DCE-US) is a method that provides quantitative assessments of organ perfusion without ionising radiation or risk of nephrotoxicity. It can be performed at the bedside and is suitable for repeated measurements. The purpose of this review is to provide updates from recent publications on the utility of DCE-US in the diagnosis or assessment of renal disease, excluding the evaluation of benign or malignant renal masses. RECENT FINDINGS DCE-US has been applied in clinical studies of acute kidney injury (AKI), renal transplantation, chronic kidney disease (CKD), diabetic kidney disease and to determine acute effects of pharmacological agents on renal haemodynamics. DCE-US can detect changes in renal perfusion across these clinical scenarios and can differentiate healthy controls from those with CKD. In sepsis, reduced DCE-US measures of perfusion may indicate those at increased risk of developing AKI, but this requires confirmation in larger studies as there can be wide individual variation in perfusion measures in acutely unwell patients. Recent studies in transplantation have not provided robust evidence to show that DCE-US can differentiate between different causes of graft dysfunction, although it may show more promise as a prognostic indicator of graft function 1 year after transplant. DCE-US can detect acute haemodynamic changes in response to medication that correlate with changes in renal plasma flow as measured by para-aminohippurate clearance. SUMMARY DCE-US shows promise and has a number of advantages that make it suitable for the assessment of patients with various forms of kidney disease. However, further research is required to evidence its reproducibility and utility before clinical use can be advocated.
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Affiliation(s)
- Nicholas M Selby
- Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, University of Nottingham, Royal Derby Hospital Centre
- Department of Renal Medicine, Royal Derby Hospital
| | - John P Williams
- Division of Medical Sciences and Graduate Entry Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre
- Department of Anaesthesia and Critical Care, Royal Derby Hospital, Derby, UK
| | - Bethan E Phillips
- Division of Medical Sciences and Graduate Entry Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre
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Shan K, FU ABUDULIAIZEZIHALI, Liu N, Cai Q, Fu Q, Liu L, Sun X, Zhang Z. Contrast-enhanced Ultrasound (CEUS) vs contrast-enhanced computed tomography for multilocular cystic renal neoplasm of low malignant potential: A retrospective analysis for diagnostic performance study. Medicine (Baltimore) 2020; 99:e23110. [PMID: 33181678 PMCID: PMC7668474 DOI: 10.1097/md.0000000000023110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022] Open
Abstract
Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) might be benefited from nephron-sparing surgery. Contrast-enhanced computed tomography is used for the diagnosis of MCRNLMP but contrast-enhanced ultrasound has lack of nephrotoxicity and several advantages over contrast-enhanced computed tomography and contrast-enhanced magnetic resonance. The purpose of the study was to compare diagnostic parameters of preoperative contrast-enhanced ultrasound against contrast-enhanced computed tomography for the detection of MCRNLMP in patients who faced curative surgery for complex cystic renal mass.Data regarding contrast-enhanced ultrasound, contrast-enhanced computed tomography, and clinicopathological results of 219 patients who underwent curative surgery for complex cystic renal mass (Bosniak classification III or IV) were retrospectively collected and analyzed. Bosniak classification for imaging modality and the 2016 WHO criteria for clinic pathology were used for detection of MCRNLMP.Contrast-enhanced ultrasound, contrast-enhanced computed tomography, and clinicopathology were detected 68, 66, and 67 as a MCRNLMP respectively. Contrast-enhanced ultrasound and contrast-enhanced computed tomography had 30.37% and 29.27% sensitivities for the detection of MCRNLMP. While 60% and 50% specificities respectively. Bosniak classification III (P = .045) and lower mean Hounsfield unit (P = .049) were associated with the prevalence of MCRNLMP. Contrast-enhanced computed tomography was detected 6 and 7, while contrast-enhanced ultrasound detected 3 and 2 complex cystic renal mass as false positive and false negative MCRNLMP respectively. A contrast-enhanced ultrasound had 0.011 to 1.0 diagnostic confidence and contrast-enhanced computed tomography had 0.045 to 0.983 diagnostic confidence for decision making of nephron-sparing surgeries.Contrast-enhanced ultrasound may have better visualization of MCRNLMP than contrast-enhanced computed tomography.Level of Evidence: III.
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Affiliation(s)
| | - A BU DU LI AI ZE ZI HA LI FU
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | | | - Qiliang Cai
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qingfeng Fu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Leyi Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoyu Sun
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhihong Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Abstract
There are several vascular ultrasound technologies that are useful in challenging diagnostic situations. New vascular ultrasound applications include directional power Doppler ultrasound, contrast-enhanced ultrasound, B-flow imaging, microvascular imaging, 3-dimensional vascular ultrasound, intravascular ultrasound, photoacoustic imaging, and vascular elastography. All these techniques are complementary to Doppler ultrasound and provide greater ability to visualize small vessels, have higher sensitivity to detect slow flow, and better assess vascular wall and lumen while overcoming limitations color Doppler. The ultimate goal of these technologies is to make ultrasound competitive with computed tomography and magnetic resonance imaging for vascular imaging.
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Affiliation(s)
- Lori Mankowski Gettle
- University of Wisconsin - Madison, 600 Highland Avenue, E3/380, Madison, WI 53792, USA.
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale New Haven Hospital, 330 Cedar Street, TE 2-214, New Haven, CT 06520, USA. https://twitter.com/MargaritaRevzin
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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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Sun D, Lu Q, Wei C, Li Y, Zheng Y, Hu B. Differential diagnosis of <3 cm renal tumors by ultrasonography: a rapid, quantitative, elastography self-corrected contrast-enhanced ultrasound imaging mode beyond screening. Br J Radiol 2020; 93:20190974. [PMID: 32479108 DOI: 10.1259/bjr.20190974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) <3 cm in size. METHODS The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. RESULTS In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. CONCLUSIONS This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. ADVANCES IN KNOWLEDGE In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.
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Affiliation(s)
- Di Sun
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Qijie Lu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Cong Wei
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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Marschner CA, Ruebenthaler J, Schwarze V, Negrão de Figueiredo G, Zhang L, Clevert DA. Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions. ROFO-FORTSCHR RONTG 2020; 192:1053-1059. [PMID: 32294790 DOI: 10.1055/a-1127-3371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome. MATERIALS AND METHODS A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included. Patient ages ranged from 18 to 86 with (mean age 62 years; SD ± 13). CEUS (255 patients), CT (88 out of 255 patients; 34.5 %) and MRI (36 out of 255 patients; 14.1 %) were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome. RESULTS CEUS showed a sensitivity of 99.1 % (95 % confidence interval (CI): 96.7 %, 99.9 %), a specificity of 80.5 % (95 % CI: 65.1 %, 91.2 %), a positive predictive value (PPV) of 96.4 % (95 % CI: 93.0 %, 98.4 %) and a negative predictive value (NPV) of 94.3 % (95 % CI: 80.8 %, 99.3 %). CT showed a sensitivity of 97.1 % (95 % CI: 89.9 %, 99.6 %), a specificity of 47.4 % (95 % CI: 24.4 %, 71.1 %), a PPV of 87.0 % (95 % CI: 77.4 %, 93.6 %) and a NPV of 81.8 % (95 % CI: 48.2 %, 97.7 %). MRI showed a sensitivity of 96.4 % (95 % CI: 81.7 %, 99.9 %), a specificity of 75.0 % (95 % CI: 34.9 %, 96.8 %), a PPV of 93.1 % (95 % CI: 77.2 %, 99.2 %) and a NPV of 85.7 % (95 % CI: 42.1 %, 99.6 %). Out of the 212 malignant lesions a total of 130 clear cell renal carcinomas, 59 papillary renal cell carcinomas, 7 chromophobe renal cell carcinomas, 4 combined clear cell and papillary renal cell carcinomas and 12 other malignant lesions, e. g. metastases, were diagnosed. Out of the 43 benign lesions a total 10 angiomyolipomas, 3 oncocytomas, 8 benign renal cysts and 22 other benign lesions, e. g. renal adenomas were diagnosed. Using CEUS, 10 lesions were falsely identified as malignant or benign, whereas 8 lesions were false positive and 2 lesions false negative. CONCLUSION CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to CT and MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method. KEY POINTS · Wide availability. · Safe applicability in patients with known renal insufficiency or allergies to iodine or gadolinium. · Comparable sensitivity, specificity, PPV and NPV to CT and MRT. · May lead to a reduction in interventional radiological or surgical interventions. CITATION FORMAT · Marschner CA, Ruebenthaler J, Schwarze V et al. Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions. Fortschr Röntgenstr 2020; 192: 1053 - 1058.
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Affiliation(s)
| | | | - Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
| | | | - Lan Zhang
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
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Cao H, Fang L, Chen L, Zhan J, Diao X, Liu Y, Lu C, Zhang Z, Chen Y. The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound. BMC Med Imaging 2020; 20:32. [PMID: 32228606 PMCID: PMC7104488 DOI: 10.1186/s12880-020-00436-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
Background The value of contrast-enhanced ultrasound (CEUS) in differentiating between renal cell carcinoma (RCC) and angiomyolipoma (AML) was analyzed. The purpose of this study was to identify the independent indicators of CEUS for predicting RCC. Methods A total of 172 renal tumors (150 RCCs, 22 AMLs) in 165 patients underwent conventional ultrasound (CUS) and CEUS examinations before radical or partial nephrectomy, and the features on CUS and CEUS were analyzed. Results There were significant differences in echogenicity, blood flow signals in color Doppler flow imaging (CDFI), peak intensity, homogeneity of enhancement, wash in, wash out, and perilesional rim-like enhancement between RCC and AML (P < 0.05 for all). Multivariate analysis indicated that perilesional rim-like enhancement (P = 0.035, odds ratio [OR] = 9.907, 95% confidence interval [CI]: 1.169–83.971) and fast wash out (P = 0.001, OR = 9.755, 95%[CI]: 2.497–38.115) were independent indicators for predicting RCC. The area under the receiver operating characteristic (ROC) curve (AUC) for perilesional rim-like enhancement was 0.838 (95% CI: 0.774–0.890) with 76.7% sensitivity and 90.9% specificity, while the AUC of fast wash out was 0.833 (95% CI:0.768–0.885) with 74.7% sensitivity and 81.8% specificity. Conclusions This study indicated that CEUS has value in differentiating RCC and AML. Present perilesional rim-like enhancement and fast wash out may be important indicators for predicting RCC.
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Affiliation(s)
- Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China. .,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Chen Lu
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Zhengwang Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China.,Department of Urology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, 211 West Yan'an Road, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
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Affiliation(s)
- Frank Chen
- Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Lauren Alexander
- Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Melanie Caserta
- Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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An overview of non-invasive imaging modalities for diagnosis of solid and cystic renal lesions. Med Biol Eng Comput 2019; 58:1-24. [DOI: 10.1007/s11517-019-02049-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 09/17/2019] [Indexed: 12/22/2022]
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Hashimoto M, Ohkuma K, Akita H, Yamada Y, Nakatsuka S, Mizuno R, Oya M, Jinzaki M. Usefulness of contrast-enhanced ultrasonography for diagnosis of renal cell carcinoma in dialysis patients: Comparison with computed tomography. Medicine (Baltimore) 2019; 98:e18053. [PMID: 31764832 PMCID: PMC6882623 DOI: 10.1097/md.0000000000018053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To investigate the usefulness of contrast-enhanced ultrasonography for diagnosing renal cell carcinoma (RCC) in dialysis patients. MATERIAL AND METHODS Of 1301 dialysis patients who underwent abdominal computed tomography (CT) between January 2012 and March 2017, 19 were suspected to have solid renal lesions; of these patients, 18 gave consent for and underwent contrast-enhanced ultrasonography with perflubutane in addition to CT; 13 underwent dynamic contrast-enhanced CT, and 5, who could not be administered iodinated contrast media, underwent unenhanced CT. The final diagnoses were based on histopathological findings or the presence/absence of enlargement of the lesion during follow-up. RESULTS Of the 19 lesions in 18 patients, 14 were diagnosed as RCC and 5 as benign cysts. CT facilitated accurate diagnosis in 10/19 lesions (52.6%) with obvious enhancement (≥20 Hounsfield units [HU]), while definitive diagnosis by CT was difficult in 9 lesions: 2 lesions showed ambiguous enhancement (10-20 HU), 1 lesion was an inflammatory cyst with obvious enhancement, and 6 lesions were assessed by unenhanced CT. Compared with CT, contrast-enhanced ultrasonography allowed more accurate diagnosis (McNemar test, P = .02) in 17/19 lesions (89.5%, 14 RCC and 3 cysts; including all lesions assessed by unenhanced CT and 2 with ambiguous enhancement on CT), with 1 false-positive (inflammatory cyst with hyper-enhancement) and 1 false-negative result due to deep location of the lesion. CONCLUSIONS Contrast-enhanced ultrasonography was useful for the diagnosis of RCC in dialysis patients with suspected solid renal lesions especially when contrast enhancement was not obvious on CT or contrast-enhanced CT could not be performed.
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Affiliation(s)
| | - Kiyoshi Ohkuma
- Department of Radiology, Saitama City Hospital, Saitama City, Saitama
| | - Hirotaka Akita
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Seishi Nakatsuka
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo
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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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Tedesco G, Sarno A, Rizzo G, Grecchi A, Testa I, Giannotti G, D’Onofrio M. Clinical use of contrast-enhanced ultrasound beyond the liver: a focus on renal, splenic, and pancreatic applications. Ultrasonography 2019; 38:278-288. [PMID: 31230431 PMCID: PMC6769197 DOI: 10.14366/usg.18061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 12/11/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly used, diagnostic imaging modality. In recent years, due to its safety, quickness, and repeatability, several studies have demonstrated the accuracy, specificity, and sensitivity of CEUS. The European Federation of Societies for Ultrasound in Medicine and Biology has recently updated the previous guidelines from 2012 for the use of CEUS in non-hepatic applications. This review deals with the clinical use and applications of CEUS for the evaluation of non-hepatic abdominal organs, focusing on renal, splenic, and pancreatic applications.
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Affiliation(s)
- Giorgia Tedesco
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Alessandro Sarno
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Giulio Rizzo
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Annamaria Grecchi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Ilaria Testa
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Gabriele Giannotti
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Mirko D’Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
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Kahn AE, Ostrowski AK, Caserta MP, Galler IJ, Thiel DD. Contrast enhanced ultrasound characterization of surgically resected renal masses in patients on dialysis. Scand J Urol 2019; 53:344-349. [PMID: 31549563 DOI: 10.1080/21681805.2019.1666917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Diagnostic work-up of suspicious renal masses has traditionally been conducted with contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI). However, patients who are not candidates for intravenous contrast due to allergy, renal insufficiency, or those on dialysis are discouraged from utilizing traditional contrast imaging due to risks of anaphylaxis, nephrotoxicity, or further kidney damage. We evaluated contrast-enhanced ultrasound (CEUS) in patients on dialysis who would benefit from alternative imaging options to CECT or MRI.Methods: Following IRB approval, nine renal masses from eight patients (aged 54-74 years) with chronic renal insufficiency were evaluated with CEUS and shown to be enhancing after the intravenous administration of ultrasound contrast agent. The ultrasound contrast agent Lumason (Sulfur hexafluoride lipid type-A microspheres, Bracco Diagnostics, Monroe Township, NJ, USA) was utilized. Enhancement was considered present when microbubble contrast agent was visualized within the lesion of interest.Results: Nine CEUS enhancing masses were pathologically examined following laparoscopic radical nephrectomy. Eight of the nine lesions were renal cell carcinoma (two clear cell, four papillary, two cystic). One resected mass was an unspecified benign renal lesion.Conclusions: In this sample of surgically resected tumors, CEUS was effective in characterizing renal lesions as solid neoplasms or complex cystic lesions suspicious for neoplasm-findings which merit further investigation.
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Affiliation(s)
- Amanda E Kahn
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Silverman SG, Pedrosa I, Ellis JH, Hindman NM, Schieda N, Smith AD, Remer EM, Shinagare AB, Curci NE, Raman SS, Wells SA, Kaffenberger SD, Wang ZJ, Chandarana H, Davenport MS. Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019; 292:475-488. [PMID: 31210616 DOI: 10.1148/radiol.2019182646] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cystic renal cell carcinoma (RCC) is almost certainly overdiagnosed and overtreated. Efforts to diagnose and treat RCC at a curable stage result in many benign neoplasms and indolent cancers being resected without clear benefit. This is especially true for cystic masses, which compared with solid masses are more likely to be benign and, when malignant, less aggressive. For more than 30 years, the Bosniak classification has been used to stratify the risk of malignancy in cystic renal masses. Although it is widely used and still effective, the classification does not formally incorporate masses identified at MRI or US or masses that are incompletely characterized but are highly likely to be benign, and it is affected by interreader variability and variable reported malignancy rates. The Bosniak classification system cannot fully differentiate aggressive from indolent cancers and results in many benign masses being resected. This proposed update to the Bosniak classification addresses some of these shortcomings. The primary modifications incorporate MRI, establish definitions for previously vague imaging terms, and enable a greater proportion of masses to enter lower-risk classes. Although the update will require validation, it aims to expand the number of cystic masses to which the Bosniak classification can be applied while improving its precision and accuracy for the likelihood of cancer in each class.
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Affiliation(s)
- Stuart G Silverman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Ivan Pedrosa
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - James H Ellis
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicole M Hindman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicola Schieda
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Andrew D Smith
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Erick M Remer
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Atul B Shinagare
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicole E Curci
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Steven S Raman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Shane A Wells
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Samuel D Kaffenberger
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Zhen J Wang
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Hersh Chandarana
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Matthew S Davenport
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
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47
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Wu DF, He W, Lin S, Han B, Zee CS. Using Real-Time Fusion Imaging Constructed from Contrast-Enhanced Ultrasonography and Magnetic Resonance Imaging for High-Grade Glioma in Neurosurgery. World Neurosurg 2019; 125:e98-e109. [DOI: 10.1016/j.wneu.2018.12.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/20/2023]
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Abstract
In patients with end-stage renal disease, the treatment of choice for most patients is renal transplantation. Complications that occur after kidney transplant can be broadly divided into vascular and non-vascular categories. Non-vascular complications can further be divided into surgical and medical categories. When evaluating renal transplant imaging, it is helpful to consider the occurrence of complications in a timeline from time of surgery. Ultrasound is often the first modality used for evaluation of renal transplants particularly in the early postoperative period. Contrast-enhanced ultrasound can be a helpful adjunct in evaluating certain complications such as hematoma, rejection, and infection. Computed tomography (CT) is also helpful in accurately diagnosing complications. Surgical complications include perinephric fluid collections (hematoma, urinoma from urine leak, abscess, and lymphocele), urinary obstruction, and incisional fluid collections and hernias. One major category of medical complications that affect the renal parenchyma includes rejection (hyperacute, acute, and chronic), delayed graft function, acute tubular necrosis (ATN), and nephrotoxicity. Infection, renal calculi, and neoplasms such as post-transplant lymphoproliferative disease are medical complications that occur after renal transplantation. It is important for radiologists to be aware of the ultrasound and CT findings of the surgical and medical complications after renal transplant for prompt identification and treatment.
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Affiliation(s)
- Nancy Kim
- Department of Radiology, MedStar Georgetown University Hospital, CCC Building, Ground Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
| | - Roxanna Juarez
- Department of Radiology, MedStar Georgetown University Hospital, CCC Building, Ground Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Angela D Levy
- Department of Radiology, MedStar Georgetown University Hospital, CCC Building, Ground Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA
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49
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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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50
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van Oostenbrugge TJ, Fütterer JJ, Mulders PFA. Diagnostic Imaging for Solid Renal Tumors: A Pictorial Review. KIDNEY CANCER 2018; 2:79-93. [PMID: 30740580 PMCID: PMC6364093 DOI: 10.3233/kca-180028] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prognosis of renal tumors depends on histologic subtype. The increased use of abdominal imaging has resulted in an increase in the number of small renal incidentaloma in recent decades. Of these incidentally discovered tumors, 20% are benign lesions warranting conservative management, but most are renal cell carcinomas that warrant a more aggressive therapeutic approach due to their malignant potential. Dedicated diagnostic renal imaging is important for characterization of renal tumors to facilitate treatment planning. This review discusses the ability to detect and differentiate renal cell carcinoma subtypes, angiomyolipoma and oncocytoma based on ultrasound imaging, computed tomography, multiparametric magnetic resonance, and nuclear imaging.
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Affiliation(s)
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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