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Tufano A, Leonardo C, Di Bella C, Lucarelli G, Dolcetti V, Dipinto P, Proietti F, Flammia RS, Anceschi U, Perdonà S, Franco G, Sciarra A, Di Pierro GB, Cantisani V. Qualitative Assessment of Contrast-Enhanced Ultrasound in Differentiating Clear Cell Renal Cell Carcinoma and Oncocytoma. J Clin Med 2023; 12:jcm12093070. [PMID: 37176510 PMCID: PMC10179124 DOI: 10.3390/jcm12093070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND We aimed to assess whether clear cell renal cell carcinoma (ccRCC) can be differentiated from renal oncocytoma (RO) on a contrast-enhanced ultrasound (CEUS). METHODS Between January 2021 and October 2022, we retrospectively queried and analyzed our prospectively maintained dataset. Renal mass features were scrutinized with conventional ultrasound imaging (CUS) and CEUS. All lesions were confirmed by histopathologic diagnoses after nephron-sparing surgery (NSS). A multivariable analysis was performed to identify the potential predictors of ccRCC. The area under the curve (AUC) was depicted in order to assess the diagnostic accuracy of the multivariable model. RESULTS A total of 126 renal masses, including 103 (81.7%) ccRCC and 23 (18.3%) RO, matched our inclusion criteria. Among these two groups, we found significant differences in terms of enhancement (homogeneous vs. heterogeneous) (p < 0.001), wash-in (fast vs. synchronous/slow) (p = 0.004), wash-out (fast vs. synchronous/slow) (p = 0.001), and rim-like enhancement (p < 0.001). On the multivariate logistic regression, heterogeneous enhancement (OR: 19.37; p = <0.001) and rim-like enhancement (OR: 3.73; p = 0.049) were independent predictors of ccRCC. Finally, these two variables had an AUC of 82.5% and 75.3%, respectively. CONCLUSIONS Diagnostic imaging for presurgical planning is crucial in the choice of either conservative or radical management. CEUS, with its unique features, revealed its usefulness in differentiating ccRCC from RO.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Chiara Di Bella
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
| | - Giuseppe Lucarelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
| | - Piervito Dipinto
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Flavia Proietti
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | | | - Giorgio Franco
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
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Schwarze V, Rübenthaler J, Čečatka S, Marschner C, Froelich MF, Sabel BO, Staehler M, Knösel T, Geyer T, Clevert DA. Contrast-Enhanced Ultrasound (CEUS) for the Evaluation of Bosniak III Complex Renal Cystic Lesions-A 10-Year Specialized European Single-Center Experience with Histopathological Validation. ACTA ACUST UNITED AC 2020; 56:medicina56120692. [PMID: 33322683 PMCID: PMC7763943 DOI: 10.3390/medicina56120692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
Background and objectives: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. Materials and Methods: 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010-2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Results: CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. Conclusions: CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
| | - Saša Čečatka
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
| | - Constantin Marschner
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
| | - Matthias Frank Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Bastian Oliver Sabel
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
| | - Michael Staehler
- Department of Urology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany;
| | - Thomas Knösel
- Institute of Pathology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany;
| | - Thomas Geyer
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
- Correspondence: ; Tel.: +49-89-4400-73620
| | - Dirk-André Clevert
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (V.S.); (J.R.); (S.Č.); (C.M.); (B.O.S.); (D.-A.C.)
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3
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Schwarze V, Marschner C, Negrão de Figueiredo G, Knösel T, Rübenthaler J, Clevert DA. Single-center study: the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing renal oncocytoma. Scand J Urol 2020; 54:135-140. [PMID: 32162575 DOI: 10.1080/21681805.2020.1736621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the evaluation of renal oncocytoma.Method: Thirteen patients with histopathologically confirmed renal oncocytoma and 26 patients with histopathologically confirmed renal cell carcinoma were included in this retrospective single-center study on whom CEUS was performed between 2005 and 2015. The applied contrast agent was a second-generation blood pool agent. CEUS examinations were performed and interpreted by a single radiologist with more than 15 years of experience (EFSUMB Level 3).Results: CEUS examinations were successfully performed in all included patients without any adverse effects. Renal oncocytomas showed varying echogenicity (46% hypoechoic, 23% hyperechoic, 8% iso-/hyperechoic, 8% isoechoic). In two cases renal oncocytoma only demarcated upon i.v. application of contrast medium. In bilateral oncocytosis, lesions presented as hyperechoic. Only 23% of renal oncocytomas showed slight vascularization using Color Doppler. No oncocytoma-specific pattern of microperfusion could be elucidated: 85% of the oncocytomas presented hyperenhancing, of whom 50% also showed delayed venous wash-out; 8% of renal oncocytomas showed venous wash-out without early arterial hyperenhancement.Conclusions: Within the frame of the present study and in line with the recent state of knowledge, no specific sonomorphological feature - including CEUS - could be detected allowing for adequate discrimination between oncocytoma and renal cell carcinoma.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | | | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
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Klezl P, Kaspar M, Klecka J, Richterova R, Stanc O, Burgetova A, Fischerova D, Dusek L, Popken G, Zatura F. [The role of contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT) in the preoperative diagnosis of renal lesions]. Urologe A 2019; 57:181-190. [PMID: 29387906 DOI: 10.1007/s00120-018-0572-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The preoperative assessment of structural and functional changes in renal tumors using contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT). MATERIALS AND METHODS All consecutive patients referred to two tertiary hospitals for surgery on suspicion of a malignant renal lesion, who had been examined under the predefined study protocol using CEUS and CECT, were prospectively included in the study. All renal lesions suspected of being malignant were subjected to histopathological examination. Lesions expected to be benign were followed up according to the study protocol. The accuracy of CEUS and CECT with the final histology or follow-up results and the statistically significant difference between the two imaging techniques was calculated. RESULTS Over a period of 3 years (2008-2011), 68 of 93 patients examined met the study criteria. The prevalence of malignant tumors in the study was 72%. Fifty four (79%) patients underwent surgery and had a histologically confirmed renal tumor (clear cell carcinoma 45, urothelial papillocarcinoma 4, angiomyolipoma 1, oncytoma 3, xanthogranulomatous pyelonephritis 1) and 14 (21%) patients underwent regular follow-up. Specificity, sensitivity and area under the curve (AUC) reached 57.9%, 98% and 0.779 for CEUS and 52.6%, 98% and 0.753 for CECT. CONCLUSION The results show that both imaging methods can reliably rule out malignant disease due to absence of enhancement. Taking into consideration that CEUS can be carried out without severe risk or discomfort, it is time to reconsider CEUS as the method of choice for diagnosis, while CECT should be reserved for staging.
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Affiliation(s)
- P Klezl
- Department of Urology Faculty teaching Hospital, University Hospital Kralovske Vinohrady, Srobarova 50, Prag, Tschechien
| | - M Kaspar
- Department of Radiology, Hospital Na Bulovce, Prag, Tschechien
| | - J Klecka
- Department of Urology Faculty teaching Hospital, University Hospital Kralovske Vinohrady, Srobarova 50, Prag, Tschechien.
| | - R Richterova
- Department of Urology, Hospital Na Bulovce, Prag, Tschechien
| | - O Stanc
- Department of Urology, Hospital Na Bulovce, Prag, Tschechien
| | - A Burgetova
- Department of Radiology, First Faculty of Medicine and General University Hospital, Charles University, Prag, Tschechien
| | - D Fischerova
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University, Prag, Tschechien
| | - L Dusek
- Institute of Biostatistics and Analysis, Masaryk University, Brno, Tschechien
| | - G Popken
- Department of Urology, Hospital Ernst von Bergmann, Potsdam, Deutschland
| | - F Zatura
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Oloumoc, Oloumoc, Tschechien
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Bertolotto M, Bucci S, Valentino M, Currò F, Sachs C, Cova MA. Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol 2018; 105:41-48. [PMID: 30017297 DOI: 10.1016/j.ejrad.2018.05.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy.
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale Sant'Antonio Abate, Via Giobatta Morgagni 18, 33028 Tolmezzo, UD, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Camilla Sachs
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
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Sanz E, Hevia V, Gómez V, Álvarez S, Fabuel JJ, Martínez L, Rodriguez-Patrón R, González-Gordaliza C, Burgos FJ. Renal Complex Cystic Masses: Usefulness of Contrast-Enhanced Ultrasound (CEUS) in Their Assessment and Its Agreement with Computed Tomography. Curr Urol Rep 2016; 17:89. [DOI: 10.1007/s11934-016-0646-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Histotype differentiation of hypo-echoic renal tumors on CEUS: usefulness of enhancement homogeneity and intensity. ACTA ACUST UNITED AC 2016; 40:1675-83. [PMID: 25549784 DOI: 10.1007/s00261-014-0340-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study is to evaluate qualitative and quantitative analysis of contrast-enhanced ultrasound (CEUS) in differential diagnoses of hypo-echoic renal tumor histotypes. METHODS Our study cohort comprised 103 clear cell renal cell carcinomas (ccRCCs), 24 papillary renal cell carcinomas (pRCCs), 28 chromophobe renal cell carcinomas (cRCCs), and 34 angiomyolipomas (AMLs), hypo-echoic on ultrasound, and imaged between January 2011 and December 2013. Enhancement homogeneity and tumor-to-cortex intensity ratio (TOC ratio) were retrospectively analyzed. RESULTS Overall, heterogeneous enhancement was more common in ccRCCs than AMLs, pRCCs, and cRCCs. TOC ratio showed the trend ccRCC > AML > pRCC = cRCC. Similar trends were seen in tumors <4 cm. Using heterogeneous enhancement or TOC ratio >107.5% to differentiate ccRCC from other histotypes, the sensitivity, specificity, positive and negative predictive values were 93.1%, 74.5%, 84.8%, and 87.5%, respectively. Tumors >4 cm exhibited considerable overlap in enhancement homogeneity among different histotypes. TOC ratios were similar between homo- and heterogeneously enhancing tumors for ccRCCs and for pRCCs and cRCCs, but higher in homogeneously enhancing than heterogeneously enhancing AMLs. In homo- and heterogeneously enhancing tumors, TOC ratios followed the trends ccRCCs > AMLs > pRCCs = cRCCs and ccRCCs > AMLs = pRCCs = cRCCs, respectively. With TOC ratio >105.81% and >72.37% to differentiate homo- and heterogeneously enhancing ccRCCs from other histotypes in tumors >4 cm with same enhancement homogeneity, the sensitivity, specificity, positive and negative predictive values were 70.0%, 85.7%, 70.0%, 85.7%, and 91.7%, 94.4%, 95.7%, 89.5%, respectively. CONCLUSION CEUS homogeneity and TOC ratio are helpful in differential diagnosis of hypo-echoic renal tumor histotypes. Diameter and enhancement homogeneity should be considered when deciding the diagnostic TOC ratio cutoff.
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Chang EH, Chong WK, Kasoji SK, Dayton PA, Rathmell WK. Management of Indeterminate Cystic Kidney Lesions: Review of Contrast-enhanced Ultrasound as a Diagnostic Tool. Urology 2015; 87:1-10. [PMID: 26483268 DOI: 10.1016/j.urology.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 01/29/2023]
Abstract
Indeterminate cystic kidney lesions found incidentally are an increasingly prevalent diagnostic challenge. Standard workup includes Bosniak classification with contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). However, these tests are costly and not without risks. Contrast-enhanced ultrasound (CEUS) is a relatively new technique with lower risk of adverse events than iodine-containing contrast or gadolinium. In our review of the evidence for characterization of cystic kidney lesions with CEUS, CEUS displayed sensitivity (89%-100%) and negative predictive value (86%-100%) comparable to contrast-enhanced CT or MRI, with no decrease in specificity compared with CT and only a slight decrease compared with MRI.
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Affiliation(s)
- Emily H Chang
- Department of Medicine, Division of Nephrology and Hypertension, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Wui K Chong
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sandeep K Kasoji
- Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State at Raleigh, Raleigh, NC
| | - Paul A Dayton
- Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State at Raleigh, Raleigh, NC
| | - W Kimryn Rathmell
- Department of Medicine, Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Differentiation of Renal Tumor Histotypes: Usefulness of Quantitative Analysis of Contrast-Enhanced Ultrasound. AJR Am J Roentgenol 2015; 205:W335-42. [PMID: 26295670 DOI: 10.2214/ajr.14.14204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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10
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Sanz E, Hevia V, Arias F, Fabuel JJ, Álvarez S, Rodríguez-Patrón R, Gómez V, Díez-Nicolás V, González-Gordaliza C, Burgos FJ. Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation. Curr Urol Rep 2015; 16:469. [PMID: 25404183 DOI: 10.1007/s11934-014-0469-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8%) and CT in two patients (2/16, 12.5%). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75% (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.
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Affiliation(s)
- Enrique Sanz
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
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Jun HY, Ryu JH, Byun SJ, Jeong CW, Kim TH, Lee YH, Yoon KH. Combined Radiofrequency Ablation and Double Anti-Angiogenic Protein Therapy to Increase Coagulation Efficacy: An Experimental Study in a Murine Renal Carcinoma Model. Korean J Radiol 2015; 16:776-82. [PMID: 26175576 PMCID: PMC4499541 DOI: 10.3348/kjr.2015.16.4.776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 03/18/2015] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate whether suppression of tumor microvasculature by double anti-angiogenic protein (DAAP) treatment could increase the extent of radiofrequency ablation (RFA)-induced coagulation in a murine renal cell carcinoma model. Materials and Methods Renal cell carcinoma cell lines were implanted subcutaneously into 10 nude mice. Four mice received adenoviral DAAP treatment and 6 mice received sterile 0.9% saline solution as DAAP-untreated group. The effect of DAAP was evaluated according to the vascularity by contrast-enhanced ultrasound (CEUS) using microbubbles. Four DAAP-treated mice and 4 DAAP-untreated mice were then treated with RFA, resulting in 3 groups: no-therapy (n = 2), RFA only (n = 4), and RFA combined with DAAP treatment (n = 4). Immediately after RFA, the size of coagulation necrosis and mitochondrial enzyme activity were compared between the groups using analysis of variance (ANOVA) and post hoc test. Results The contrast enhancement ratio for tumor vascularization on CEUS was significantly lower in the DAAP treated group than in DAAP-untreated group (30.2 ± 9.9% vs. 77.4 ± 17.3%; p = 0.021). After RFA, the mean coagulation diameter was 0 mm for no-therapy group, 6.7 ± 0.7 mm for the RFA only group and 8.5 ± 0.4 mm for the RFA with DAAP group (ANOVA, p < 0.001). The area of viable mitochondria within the tumor was 27.9 ± 3.9% in no-therapy group, 10.3 ± 4.5% in the RFA only group, and 2.1 ± 0.7% in the RFA with DAAP group (ANOVA, p < 0.001). Conclusion Our results suggest the potential value of combining RFA with anti-angiogenic therapy.
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Affiliation(s)
- Hong Young Jun
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Jong-Hyun Ryu
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Seung Jae Byun
- Department of Surgery, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Chang Won Jeong
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Tae-Hoon Kim
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Young Hwan Lee
- Department of Radiology, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Kwon-Ha Yoon
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea. ; Department of Radiology, Wonkwang University School of Medicine, Iksan 570-711, Korea
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Lu Q, Huang BJ, Wang WP, Li CX, Xue LY. Qualitative and quantitative analysis with contrast-enhanced ultrasonography: diagnosis value in hypoechoic renal angiomyolipoma. Korean J Radiol 2015; 16:334-41. [PMID: 25741195 PMCID: PMC4347269 DOI: 10.3348/kjr.2015.16.2.334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022] Open
Abstract
Objective To evaluate the value of enhancement features and quantitative parameters of contrast-enhanced ultrasonography (CEUS) in differentiating solid hypoechoic renal angiomyolipomas (AMLs) from clear cell renal cell carcinomas (ccRCCs). Materials and Methods We analyzed the enhancement features and quantitative parameters of CEUS in 174 hypoechoic renal masses (32 AMLs and 142 ccRCCs) included in the study. Results Centripetal enhancement pattern was more common in AMLs than in ccRCCs on CEUS (71.9% vs. 23.2%, p < 0.001). At peak enhancement, all AMLs showed homogeneous enhancement (100% in AML, 27.5% in ccRCCs; p < 0.001). Quantitative analysis showed no significant difference between rise time and time to peak. Tumor-to-cortex (TOC) enhancement ratio in AMLs was significantly lower than that in ccRCCs (p < 0.001). The criteria of centripetal enhancement and homogeneous peak enhancement together with TOC ratio < 91.0% used to differentiate hypoechoic AMLs from ccRCCs resulted in a sensitivity and specificity of 68.9% and 95.8%, respectively. Conclusion Both qualitative and quantitative analysis with CEUS are valuable in the differential diagnosis of hypoechoic renal AMLs from ccRCCs.
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Affiliation(s)
- Qing Lu
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bei-jian Huang
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wen-ping Wang
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cui-xian Li
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li-yun Xue
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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13
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Bertolotto M, Derchi LE, Cicero C, Iannelli M. Renal Masses as Characterized by Ultrasound Contrast. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.cult.2013.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Haers H, Daminet S, Smets PMY, Duchateau L, Aresu L, Saunders JH. Use of quantitative contrast-enhanced ultrasonography to detect diffuse renal changes in Beagles with iatrogenic hypercortisolism. Am J Vet Res 2013; 74:70-7. [PMID: 23270348 DOI: 10.2460/ajvr.74.1.70] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the feasibility of quantitative contrast-enhanced ultrasonography (CEUS) for detection of changes in renal blood flow in dogs before and after hydrocortisone administration. ANIMALS 11 Beagles. PROCEDURE Dogs were randomly assigned to 2 treatment groups: oral administration of hydrocortisone (9.6 mg/kg; n = 6) or a placebo (5; control group) twice a day for 4 months, after which the dose was tapered until treatment cessation at 6 months. Before treatment began and at 1, 4, and 6 months after, CEUS of the left kidney was performed by IV injection of ultrasonography microbubbles. Images were digitized, and time-intensity curves were generated from regions of interest in the renal cortex and medulla. Changes in blood flow were determined as measured via contrast agent (baseline [background] intensity, peak intensity, area under the curve, arrival time of contrast agent, time-to-peak intensity, and speed of contrast agent transport). RESULTS Significant increases in peak intensity, compared with that in control dogs, were observed in the renal cortex and medulla of hydrocortisone-treated dogs 1 and 4 months after treatment began. Baseline intensity changed similarly. A significant increase from control values was also apparent in area under the curve for the renal cortex 4 months after hydrocortisone treatment began and in the renal medulla 1 and 4 months after treatment began. A significant time effect with typical time course was observed, corresponding with the period during which hydrocortisone was administered. No difference was evident in the other variables between treated and control dogs. CONCLUSIONS AND CLINICAL RELEVANCE Quantitative CEUS allowed detection of differences in certain markers of renal blood flow between dogs treated orally with and without hydrocortisone. Additional studies are needed to investigate the usefulness of quantitative CEUS in the diagnosis of diffuse renal lesions.
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Affiliation(s)
- Hendrik Haers
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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Corcoran AT, Russo P, Lowrance WT, Asnis-Alibozek A, Libertino JA, Pryma DA, Divgi CR, Uzzo RG. A review of contemporary data on surgically resected renal masses--benign or malignant? Urology 2013; 81:707-13. [PMID: 23453080 DOI: 10.1016/j.urology.2013.01.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/31/2012] [Accepted: 01/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To clearly define the proportions of benign vs malignant histologic findings in resected renal masses through an in-depth review of the contemporary medical data to assist in preoperative risk assessment. MATERIALS AND METHODS PubMed and select oncology congresses were searched for publications that identify the histologic classification of resected renal masses in a representative sample from the contemporary data: [search] incidence AND (renal cell carcinoma AND benign); incidence AND (renal tumor AND benign); percentage AND (renal cell carcinoma AND benign); limit 2003-2011. RESULTS We identified 26 representative studies meeting the inclusion criteria and incorporating 27,272 patients. The frequency of benign tumors ranged from 7% to 33%, with most studies within a few percentage points of the mean (14.5% ± 5.2%, median 13.9%). Clear cell renal cell carcinoma occurred in 46% to 83% of patients, with a mean of 68.3% (median 61.3; SD = 11.9%). An inverse relationship between tumor size and benign pathologic features was identified in 14 of 19 (74%) studies that examined an association between tumor size and pathologic characteristics. A statistically significant correlation between clear cell renal cell carcinoma and tumor size was identified in 13 of 19 studies (63%). The accuracy of preoperative cross-sectional imaging was low in the 2 studies examining computed tomography (17%). CONCLUSION Benign renal tumors represent ∼15% of detected surgically resected renal masses and are more prevalent among small clinical T1a lesions. Noninvasive preoperative differentiation between more and less aggressive renal masses would be an important clinical advance that could allow clinicians greater diagnostic confidence and guide patient management through improved risk stratification.
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Affiliation(s)
- Anthony T Corcoran
- Division of Urology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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16
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Evaluation of renal masses with contrast-enhanced ultrasound: initial experience. AJR Am J Roentgenol 2011; 197:897-906. [PMID: 21940577 DOI: 10.2214/ajr.10.6330] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Nearly 25% of solid renal tumors are indolent cancer or benign and can be managed conservatively in selected patients. This prospective study was performed to determine whether preoperative IV microbubble contrast-enhanced ultrasound can be used to differentiate indolent and benign renal tumors from more aggressive clear cell carcinoma. SUBJECTS AND METHODS Thirty-four patients with renal tumors underwent preoperative gray-scale, color, power Doppler, and octafluoropropane microbubble IV contrast-enhanced ultrasound. Three blinded radiologists reading in consensus compared rate of contrast wash-in, grade and pattern of enhancement, and contrast washout compared with adjacent parenchyma. Contrast ultrasound findings were compared with surgical histopathologic findings for all patients. RESULTS The 34 patients had 23 clear cell carcinomas, three type 1 papillary carcinomas, one chromophobe carcinoma, one clear rare multilocular low-grade malignant tumor, two unclassified lesions, three oncocytomas, and one benign angiomyolipoma. The combination of heterogeneous lesion echotexture and delayed lesion washout had 85% positive predictive value, 43% negative predictive value, 48% sensitivity, and 82% specificity for predicting whether a lesion was conventional clear cell carcinoma or another tumor. Diminished lesion enhancement grade had 75% positive predictive value, 81% negative predictive value, 55% sensitivity, and 91% specificity for non-clear cell histologic features, either benign or low-grade malignant. Combining delayed washout with quantitative lesion peak intensity of at least 20% of kidney peak intensity had 91% positive predictive value, 40% negative predictive value, 63% sensitivity, and 80% specificity in the prediction of clear cell histologic features. CONCLUSION Ultrasound features of gray-scale heterogeneity, lesion washout, grade of contrast enhancement, and quantitative measure of peak intensity may be useful for differentiating clear cell carcinoma and non-clear cell renal tumors.
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HAERS HENDRIK, SMETS PASCALE, PEY PASCALINE, PIRON KOEN, DAMINET SYLVIE, SAUNDERS JIMMYH. CONTRAST HARMONIC ULTRASOUND APPEARANCE OF CONSECUTIVE PERCUTANEOUS RENAL BIOPSIES IN DOGS. Vet Radiol Ultrasound 2011; 52:640-7. [DOI: 10.1111/j.1740-8261.2011.01843.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- HENDRIK HAERS
- Department of Veterinary Medical Imaging and Small Animal Orthopedics; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - PASCALE SMETS
- Department of Small Animal Medicine and Clinical Biology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - PASCALINE PEY
- Department of Veterinary Medical Imaging and Small Animal Orthopedics; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - KOEN PIRON
- Department of Small Animal Medicine and Clinical Biology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - SYLVIE DAMINET
- Department of Small Animal Medicine and Clinical Biology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
| | - JIMMY H. SAUNDERS
- Department of Veterinary Medical Imaging and Small Animal Orthopedics; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133; 9820; Merelbeke; Belgium
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18
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The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology. World J Urol 2011; 29:633-8. [PMID: 21604017 DOI: 10.1007/s00345-011-0699-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/05/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND By using a microbubble contrast agent and contrast-specific imaging software, the contrast-enhanced ultrasound (CEUS) is able to depict the micro and macrocirculation of the target organ. METHODS A review of the peer reviewed literature was done regarding the current role of ultrasound CEUS imaging in the evaluation of renal pathology with reference to the diagnosis of renal ischaemia, in the characterization of complex cystic lesions and in those with equivocal enhancement at CT. RESULTS CEUS provides information on tissue perfusion and may play a role in kidney mass characterization similar to the role of contrast-enhanced CT and MRI. In this context, the characterization of cystic lesions is probably the most consolidated field of application of contrast agents on kidney ultrasound imaging. Finally, CEUS provides a good alternative to CT, especially in patients with contraindications to iodinated contrast agents. CONCLUSIONS The usefulness of CEUS in these applications is confirmed by extensive literature production and this article focuses on the potential clinical applications of recent advances in CEUS technology in urology.
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Haers H, Vignoli M, Paes G, Rossi F, Taeymans O, Daminet S, Saunders JH. Contrast harmonic ultrasonographic appearance of focal space-occupying renal lesions. Vet Radiol Ultrasound 2010; 51:516-22. [PMID: 20973385 DOI: 10.1111/j.1740-8261.2010.01690.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
To describe the contrast-enhanced ultrasonographic appearance of various focal, space-occupying renal lesions and determine its value in their detection and characterization. Following baseline B-mode sonography of 15 dogs and one cat with renal space-occupying lesion(s), contrast-enhanced sonography was performed. The resulting images were evaluated qualitatively using conspicuity and number of lesions, and enhancement patterns were assessed during early arterial and late corticomedullary phases. Renal lesions were malignant in the cat (renal cell carcinoma) and 10 dogs (four renal cell carcinoma, two histiocytic sarcoma, one B-cell lymphoma, two hemangiosarcoma metastasis, one ch emodectoma metastasis) and benign in five dogs (two abscesses, one traumatic hematoma, one idiopathic hematoma, one hemorrhagic/necrotic nodule). Substantial overlap was present regarding the baseline sonographic features of benign vs. malignant lesions. With contrast-enhanced sonography, all renal cell carcinomas were characterized by large tortuous arteries, sometimes enhancing slightly earlier than vessels in the surrounding normal kidney. During the late corticomedullary phase, renal cell carcinomas had intense homo- or heterogeneous, iso- or slightly hypoechoic enhancement, which decreased progressively. Compared with renal cell carcinoma, histiocytic sarcoma and lymphoma had smaller and less obvious arteries, and an earlier loss of enhancement during the late phase. All hemangiosarcoma metastases appeared as nonenhancing nodules during the early arterial and late corticomedullary phases of enhancement, and additional lesions were detected. Histiocytic sarcoma and benign lesions had increased conspicuity with baseline sonography. The descriptions provided herein will be valuable as more work is done to establish the role of contrast-enhanced sonography in the assessment of renal lesions.
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Affiliation(s)
- Hendrik Haers
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
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20
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Ignee A, Straub B, Schuessler G, Dietrich CF. Contrast enhanced ultrasound of renal masses. World J Radiol 2010; 2:15-31. [PMID: 21160736 PMCID: PMC2998906 DOI: 10.4329/wjr.v2.i1.15] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 01/20/2010] [Accepted: 01/22/2010] [Indexed: 02/06/2023] Open
Abstract
Contrast enhanced ultrasound (CEUS) has gained clinical importance over the last years for the characterization of hepatic masses. Its role in extrahepatic indications has been investigated repeatedly but has been less comprehensively studied. Currently more than 50% of renal masses are incidentally diagnosed, mostly by B-mode ultrasound. The method of choice for characterization of renal lesions is contrast enhanced computed tomography (CECT). In the case of cystic lesions CECT refers to the Bosniak classification for cystic lesions to assess the risk of malignant behavior. The majority of masses are renal cell carcinoma, but the exact proportion is controversial. Disadvantages of CECT are a significant risk for patients with impaired renal function, allergic reactions and hyperthyroidism due to iodinated contrast agents. Several studies concerning CEUS for the characterization of both solid and cystic renal lesions have been published, but prospective multicenter studies are missing, the presented data being mainly descriptive. The aim of the this manuscript is to review the current literature for CEUS in renal masses, to summarize the available data and focus on possible concepts for studies in the future.
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21
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Jiang J, Chen Y, Zhou Y, Zhang H. Clear cell renal cell carcinoma: contrast-enhanced ultrasound features relation to tumor size. Eur J Radiol 2008; 73:162-7. [PMID: 18996660 DOI: 10.1016/j.ejrad.2008.09.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/26/2008] [Accepted: 09/24/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To analyze the contrast-enhanced ultrasound (CEUS) features of clear cell renal cell carcinoma (CCRCC) in relation to tumor size. MATERIALS AND METHODS The CEUS appearance of 92 CCRCCs confirmed pathologically were retrospectively analyzed. Tumor size was stratified into six groups with a 1cm interval. For each lesion, the degree of enhancement, the homogeneity of enhancement and the presence of pseudocapsule sign were evaluated and compared with the pathologic findings. RESULTS The tumors of groups I-VI were counted for 13, 26, 21, 11, 10 and 11, respectively. All the CCRCCs mainly showed a marked enhancement, and there was no statistically significance between the degree of enhancement and tumor size (P>0.05). However, both homogeneity of enhancement and frequency of pseudocapsule correlated well with the tumor size (P<0.01). Homogeneous enhancement was shown in 85%, 65%, 19%, 9%, 0% and 0% of the tumors in the six groups, respectively. In tumors < or =3cm the frequency (72%) of homogeneity was significantly higher than in tumors >3cm (9%; P<0.01). The detection rate of pseudocapsule sign in the six group was 23%, 62%, 71%, 64%, 50% and 0%, respectively. The frequency of pseudocapsule sign was significantly higher in tumors 2.1-5cm than <2cm and >5cm (66%, 23%, 24%, respectively; P<0.01). On the pathologic examinations, the mean MVD was significantly higher in marked enhancement tumors than slight enhancement tumors (46.0+/-15.9, 27.5+/-8.3, respectively; P<0.01). Any tumors with a heterogeneous enhancement pattern were accompanied by intratumoral necrosis or cysts on histologic specimen. A pseudocapsule was seen at pathology in all the 46 cases with perilesional enhancement and 4 of 46 tumors without perilesional enhancement at CEUS. CONCLUSION CEUS features of CCRCCs vary with the size of the tumor, especially in the homogeneity of enhancement and the presence of pseudocapsule sign. CEUS is effective in demonstrating the sonographic visualization of tumoral characteristics.
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Affiliation(s)
- Jun Jiang
- Department of ultrasound, Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
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23
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Wink MH, de la Rosette JJMCH, Laguna P, Lagerveld BW, Wijkstra H. Ultrasonography of Renal Masses Using Contrast Pulse Sequence Imaging: A Pilot Study. J Endourol 2007; 21:466-72. [PMID: 17523897 DOI: 10.1089/end.2006.0255] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND PURPOSE The use of contrast-enhanced ultrasonography for imaging of renal masses was first described in 1994. Since then, many new techniques for visualization of the effect of microbubble contrast agents have been developed. In this pilot study, a small number of patients was investigated with contrast pulse sequence imaging (CPS), and the characteristics of this perfusion imaging technique were evaluated subjectively and judged against the clinical diagnosis and histology findings when available. The purpose of this pilot study was to describe CPS imaging in several cases. PATIENTS AND METHODS Eighteen patients with 20 previously identified renal masses were examined with CPS. Perfusion imaging was compared with clinical diagnosis and with histologic findings when available. RESULTS Nineteen masses were visible. Various enhancement patterns could be observed, and interpretations of CPS characteristics are described. In carcinomas, inhomogeneous enhancement patterns were observed, and areas without enhancement inside the inhomogeneous lesions corresponded to necrotic areas in histologic specimens. All simple cysts and complex benign cysts showed absence of enhancement inside or in the wall of the lesion and a regular shape. CONCLUSION To our knowledge, this is the first study in which the characteristics of CPS imaging of renal masses have been related to clinical diagnoses and histologic features. From the results of this pilot project, we conclude that CPS is a promising technique to determine perfusion patterns in the kidney.
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Affiliation(s)
- Margot H Wink
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Kawata N, Igarashi T, Ichinose T, Hirakata H, Hachiya T, Takimoto Y, Ogawa M. Usefulness of contrast-enhanced ultrasound for the diagnosis of recurrent renal cell carcinoma in contralateral kidney. Int J Urol 2006; 13:325-8. [PMID: 16643641 DOI: 10.1111/j.1442-2042.2006.01295.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We studied contrast-enhanced ultrasound (CEU) for recurrence of renal cell carcinoma (RCC) at the contralateral kidney during postoperative follow up of localized renal cell carcinoma. CEU successfully detected all recurring cases, despite the fact that 5/6 cases were observed using conventional ultrasound; the remaining one case was not detected using conventional ultrasound. CEU using Levovisto successfully revealed renal tumors as RCC. Lesions were diagnosed as cystic renal tumors by Bosniac classification, and pathological findings demonstrated RCC, in accordance with the prior tumor.
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Affiliation(s)
- Nozomu Kawata
- Department of Urology, Nihon University School of Medicine, Nihon, Japan.
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D'Onofrio M, Martone E, Faccioli N, Zamboni G, Malagò R, Mucelli RP. Focal liver lesions: sinusoidal phase of CEUS. ACTA ACUST UNITED AC 2006; 31:529-36. [PMID: 16802201 DOI: 10.1007/s00261-005-0066-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 06/29/2005] [Indexed: 12/27/2022]
Abstract
Ultrasound examination is the first imaging modality for hepatic study in neoplastic and chronic liver diseases. Focal liver lesions frequently cause diagnostic problems in terms of characterization, especially when small and hypoechoic to the rest of the parenchyma. Contrast--enhanced ultrasonography (CEUS) has shown its value in the characterization of focal liver lesions. This study assessed the value of the sinusoidal phase of CEUS with a second-generation contrast agent in the characterization of focal liver lesions to distinguish benign from malignant. Two hundred hepatic lesions with suspicious features at baseline ultrasound were prospectively studied with CEUS. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the sinusoidal phase in the characterization of benign versus malignant liver lesions were evaluated. Hypoechogenicity of the focal liver lesion, during the sinusoidal phase of CEUS, allowed the diagnosis of malignancy with a sensitivity of 85%, specificity of 88%, positive predictive value of 92%, negative predictive value of 77%, and diagnostic accuracy of 86%. The diagnostic confidence in the diagnosis of malignancy significantly increased, with receiver operating characteristic curve areas from 0.536 for baseline ultrasound to 0.902 for the sinusoidal phase of CEUS.
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Affiliation(s)
- M D'Onofrio
- Department of Radiology, Policlinico G. B. Rossi, University of Verona, Verona, Italy.
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Liu JB, Wansaicheong G, Merton DA, Forsberg F, Goldberg BB. Contrast-enhanced Ultrasound Imaging: State of the Art. J Med Ultrasound 2005. [DOI: 10.1016/s0929-6441(09)60100-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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