Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions

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

Key words

incidental renal lesion - magnetic resonance tomography - sensitivity - specificity - contrast-enhanced ultrasound - computed tomography

Publikationsverlauf

Eingereicht: 21. September 2019

Angenommen: 19. Februar 2020

Artikel online veröffentlicht:
15. April 2020

• References

• 1 Chow WH, Devesa SS, Warren JL. et al. Rising incidence of renal cell cancer in the United States. JAMA 1999; 281: 1628-1631
• 2 Landis SH, Murray T, Bolden S. et al. Cancer statistics, 1999. CA Cancer J Clin 1999; 49: 8-31
• 3 Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 2002; 167: 57-60
• 4 Motzer RJ, Hutson TE, Tomczak P. et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356: 115-124
• 5 Wallen EM, Pruthi RS, Joyce GF. et al Kidney cancer. J Urol 2007; 177: 2006-2018 ; discussion 18–19
• 6 Decastro GJ, McKiernan JM. Epidemiology, clinical staging, and presentation of renal cell carcinoma. Urol Clin North Am 2008; 35: 581-592
• 7 Woldrich JM, Mallin K, Ritchey J. et al Sex differences in renal cell cancer presentation and survival: an analysis of the National Cancer Database, 1993–2004. J Urol 2008; 179: 1709-1713 ; discussion 13
• 8 Bosniak MA. The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 1991; 179: 307-317
• 9 Rubenthaler J, Bogner F, Reiser M. et al. Contrast-Enhanced Ultrasound (CEUS) of the Kidneys by Using the Bosniak Classification. Ultraschall in Med 2016; 37: 234-251
• 10 Ljungberg B, Cowan NC, Hanbury DC. et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58: 398-406
• 11 Greis C. Technology overview: SonoVue (Bracco, Milan). Eur Radiol 2004; 14 (Suppl. 08) P11-P15
• 12 Greis C. Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 2009; 43: 1-9
• 13 Greis C. Summary of technical principles of contrast sonography and future perspectives. Radiologe 2011; 51: 456-461
• 14 Piscaglia F, Bolondi L. Italian Society for Ultrasound in M. et al. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
• 15 ter Haar G. Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 2009; 47: 893-900
• 16 Clevert DA, Sterzik A, Braunagel M. et al. Modern imaging of kidney tumors. Urologe A 2013; 52: 515-526
• 17 Reimann R, Rubenthaler J, Hristova P. et al. Characterization of histological subtypes of clear cell renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2015; 63: 77-87
• 18 Rubenthaler J, Reimann R, Hristova P. et al. Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2015; 63: 89-97
• 19 Escudier B, Porta C, Schmidinger M. et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-updagger. Ann Oncol 2019; 30: 706-720
• 20 Houtzager S, Wijkstra H, de la Rosette JJ. et al. Evaluation of renal masses with contrast-enhanced ultrasound. Curr Urol Rep 2013; 14: 116-123
• 21 Barr RG, Peterson C, Hindi A. Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 2014; 271: 133-142
• 22 Rubenthaler J, Negrao de Figueiredo G, Mueller-Peltzer K. et al. Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis. Eur Radiol 2018; 28: 4542-4549
• 23 Rubenthaler J, Paprottka K, Marcon J. et al. Comparison of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear solid renal lesions. Clin Hemorheol Microcirc 2016; 64: 757-763
• 24 Mueller-Peltzer K, Negrao de Figueiredo G, Graf T. et al. Papillary renal cell carcinoma in contrast-enhanced ultrasound (CEUS) – A diagnostic performance study. Clin Hemorheol Microcirc 2019; 71: 159-164
• 25 Kazmierski B, Deurdulian C, Tchelepi H. et al. Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol (NY) 2018; 43: 880-898
• 26 Clevert DA, Minaifar N, Weckbach S. et al. Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 2008; 39: 171-178
• 27 Gerst S, Hann LE, Li D. et al. Evaluation of renal masses with contrast-enhanced ultrasound: initial experience. Am J Roentgenol 2011; 197: 897-906
• 28 Sanz E, Hevia V, Arias F. et al. Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation. Curr Urol Rep 2015; 16: 469
• 29 Forman HP, Middleton WD, Melson GL. et al. Hyperechoic renal cell carcinomas: increase in detection at US. Radiology 1993; 188: 431-434
• 30 Siegel CL, Middleton WD, Teefey SA. et al. Angiomyolipoma and renal cell carcinoma: US differentiation. Radiology 1996; 198: 789-793
• 31 Sim JS, Seo CS, Kim SH. et al. Differentiation of small hyperechoic renal cell carcinoma from angiomyolipoma: computer-aided tissue echo quantification. J Ultrasound Med 1999; 18: 261-264
• 32 Tamai H, Takiguchi Y, Oka M. et al. Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med 2005; 24: 1635-1640
• 33 Fan L, Lianfang D, Jinfang X. et al. Diagnostic efficacy of contrast-enhanced ultrasonography in solid renal parenchymal lesions with maximum diameters of 5 cm. J Ultrasound Med 2008; 27: 875-885
• 34 Haendl T, Strobel D, Legal W. et al. Renal cell cancer does not show a typical perfusion pattern in contrast-enhanced ultrasound. Ultraschall in Med 2009; 30: 58-63
• 35 Wei SP, Xu CL, Zhang Q. et al. Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses: comparison with contrast-enhanced CT. Abdom Radiol (NY) 2017; 42: 2135-2145
• 36 Klezl P, Kaspar M, Klecka J. et al. 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 2018; 57: 181-190
• 37 Thaiss WM, Bedke J, Kruck S. et al. Can contrast-enhanced ultrasound and acoustic radiation force impulse imaging characterize CT-indeterminate renal masses? A prospective evaluation with histological confirmation. World J Urol 2019; 37: 1339-1346
• 38 Rubenthaler J, Wilson S, Clevert DA. Multislice computed tomography/contrast-enhanced ultrasound image fusion as a tool for evaluating ^unclear renal cysts. Ultrasonography 2019; 38: 181-187
• 39 Cornelis F, Lasserre AS, Tourdias T. et al. Combined late gadolinium-enhanced and double-echo chemical-shift MRI help to differentiate renal oncocytomas with high central T2 signal intensity from renal cell carcinomas. Am J Roentgenol 2013; 200: 830-838
• 40 Reuter VE, Presti Jr JC. Contemporary approach to the classification of renal epithelial tumors. Semin Oncol 2000; 27: 124-137