Attempt at differentiation of solid renal lesions by CEUS

A. Lewicki; M. Jêdrzejczyk; W. Jakubowski; W. Pypno; P. Marczyñski; A. Lewicka

doi:10.1055/s-2007-988985

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Attempt at differentiation of solid renal lesions by CEUS

A Lewicki ¹, M Jêdrzejczyk ², W Jakubowski ², W Pypno ³, P Marczyñski ¹, A Lewicka ⁴

¹Memorial Lord's Transfiguration Hospital, Urology Department, Warsaw, Poland
²Medical University of Warsaw, Department of Diagnostic Imaging, Warsaw, Poland
³Postgraduate Medical Academy, Urology Department, Warsaw, Poland
⁴Medical University of Warsaw, Department and Clinic of Obstetrics, Gynecological Disease and Gynecological Oncology, Warsaw, Poland

Abstract

Objectives: Usefulness of contrast-enhanced ultrasonography (CEUS) in the differentiation of solid renal lesions.

Methods: 60 solid renal masses detected on grey scale ultrasound were evaluated. The examination was performed with Voluson730Expert, probe C2–5MHz/3DC2–5MHz, after repeated bolus injection of 1,2ml SonoVue using Coded Pulse Inversion (MI:0,16–0,22) and Coded Harmonic Angio (MI:0,9–1,3) options. Reference examinations were contrast-enhanced computed tomography (CECT) and histopathologic results.

Results: Among 60 lesions, in 45(75%) cases CEUS suggested neoplasmatic process. In 28 cases histopathologic examination was obtained (15 RCC CCT, 5 TCC, 1 oncocytoma, 1 ovarian cancer metastasis, 2 papillary renal cell cancer, 2 AML, 1 necrosis, 1 hyperthrophic columna). In the rest 17 cases proliferative process was confirmed in CECT. In some tumors with histopathologic verification we could see specific enhancement patterns with CEUS. Among 60 lesions suspected for renal tumors 15(25%) in CEUS were evaluated as benign. Differences with CECT were in two cases: 1) CEUS – suspected, CECT – benign; 2) CEUS – necrotic area, CECT – malignant, histopathologic examination – necrosis without neoplastic cells. In one case (papillary renal cancer) both imaging methods failed suggesting nonvascular lesion. Compliance in diagnosis malignant/benign lesion with CECT was 96,6% and with histopathologic examination was 96,4% (with 92,3% for CECT).

Conclusions:

-CEUS improves focal renal lesions diagnostics in comparison to grey scale US with efficacy close to CECT,

-CEUS is valuable in diagnostics of renal pseudotumors,

-it seems that in some cases connection of grey scale imaging with CEUS may suggest probably tumor's character.

The work is supported by scientific grant from the Ministry of Science and Higher Education No 2PO5B05330