European Radiology

, Volume 18, Issue 2, pp 376–383

Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT. A feasibility study

  • Michele Bertolotto
  • Alberto Martegani
  • Luca Aiani
  • Roberta Zappetti
  • Stefano Cernic
  • Maria Assunta Cova
Urogenital

Abstract

The effectiveness of contrast-enhanced ultrasonography (CEUS) in the evaluation of patients with acute renal infarcts was investigated, using contrast-enhanced helical computed tomography (CT) as the reference imaging procedure. Twenty-seven consecutive patients with acute renal infarcts detected with contrast-enhanced helical CT underwent CEUS. Digital cine-clips of CEUS were evaluated by two independent readers blinded to CT findings. Image quality was rated subjectively on a four-point scale. Then, readers were asked to assign a confidence level in diagnosis of renal infarct at the upper pole, medium portion, and lower pole of each kidney according to a five-degree scale, ranging from definitely absent to definitely present. ROC curve analysis was employed to assess the overall confidence of diagnosis of infarct, and weighted kappa values were calculated to assess inter-reader agreement. The subjective image quality of CEUS was lower than the image quality of CT at the upper poles. However, the diagnostic performance of CEUS was excellent (area under receiver-operator characteristic curve 0.992 ± 0.006 for reader 1; 0.991 ± 0.007 for reader 2), with very good inter-reader agreement (weighted kappa value = 0.83). CEUS is a reproducible tool to detect acute renal infarcts in men, with a diagnostic performance approaching that of CT.

Keywords

Microbubble contrast agents Ultrasound Kidney Renal infarction Contrast-enhanced ultrasonography 

References

  1. 1.
    Korzets Z, Plotkin E, Bernheim J et al (2002) The clinical spectrum of acute renal infarction. Isr Med Assoc J 4:781–784PubMedGoogle Scholar
  2. 2.
    Yudd M, Llach F (2002) Vascular complications involving the renal vessels. In: Brenner B (ed) Brenner & Rector’s The Kidney. W.B. Saunders, Philadelphia, pp 1537–1562Google Scholar
  3. 3.
    Domanovits H, Paulis M, Nikfardjam M et al (1999) Acute renal infarction. Clinical characteristics of 17 patients. Medicine (Baltimore) 78:386–394CrossRefGoogle Scholar
  4. 4.
    Kawashima A, Sandler CM, Ernst RD et al (2000) CT evaluation of renovascular disease. Radiographics 20:1321–1340PubMedGoogle Scholar
  5. 5.
    Murphy SW, Barrett BJ, Parfrey PS (2000) Contrast nephropathy. J Am Soc Nephrol 11:177–182PubMedGoogle Scholar
  6. 6.
    Bolderman R, Oyen R, Verrijcken A et al (2006) Idiopatic Renal Infarction. Am J Med 119:356.e9–356.e12CrossRefGoogle Scholar
  7. 7.
    Quaia E, Siracusano S, Palumbo A et al (2006) Detection of focal renal perfusion defects in rabbits after sulphur hexafluoride-filled microbubble injection at low transmission power ultrasound insonation. Eur Radiol 16:166–172PubMedCrossRefGoogle Scholar
  8. 8.
    Correas JM, Claudon M, Tranquart F et al (2003) [Contrast-enhanced ultrasonography: renal applications]. J Radiol 84:2041–2054PubMedGoogle Scholar
  9. 9.
    Martinoli C, Bertolotto M, Pretolesi F et al (1999) Kidney: normal anatomy. Eur Radiol 9(Suppl 3):S389–S393PubMedCrossRefGoogle Scholar
  10. 10.
    Martinoli C, Crespi G, Bertolotto M et al (1996) Interlobular vasculature in renal transplants: a power Doppler US study with MR correlation. Radiology 200:111–117PubMedGoogle Scholar
  11. 11.
    Quaia E, Bertolotto M (2002) Renal parenchymal diseases: is characterization feasible with ultrasound? Eur Radiol 12:2006–2020PubMedGoogle Scholar
  12. 12.
    Nilsson A, Olofsson PA, Loren I et al (1997) Color Doppler energy: computer analysis of color to assess angle dependency and detection of volume flow differences. J Ultrasound Med 16:275–279PubMedGoogle Scholar
  13. 13.
    Thomsen HS (2006) Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide. Eur Radiol 16:2619–2621PubMedCrossRefGoogle Scholar
  14. 14.
    Broome DR, Girguis MS, Baron PW et al (2007) Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. AJR Am J Roentgenol 188:586–592PubMedCrossRefGoogle Scholar
  15. 15.
    Piscaglia F, Bolondi L (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32:1369–1375PubMedCrossRefGoogle Scholar
  16. 16.
    Taylor GA, Ecklund K, Dunning PS (1996) Renal cortical perfusion in rabbits: visualization with color amplitude imaging and an experimental microbubble-based US contrast agent. Radiology 201:125–129PubMedGoogle Scholar
  17. 17.
    Taylor GA, Barnewolt CE, Adler BH et al (1998) Renal cortical ischemia in rabbits revealed by contrast-enhanced power Doppler sonography. AJR Am J Roentgenol 170:417–422PubMedGoogle Scholar
  18. 18.
    Taylor GA, Barnewolt CE, Claudon M et al (1999) Depiction of renal perfusion defects with contrast-enhanced harmonic sonography in a porcine model. AJR Am J Roentgenol 173:757–760PubMedGoogle Scholar
  19. 19.
    Robbin ML, Lockhart ME, Barr RG (2003) Renal imaging with ultrasound contrast: current status. Radiol Clin North Am 41:963–978PubMedCrossRefGoogle Scholar
  20. 20.
    Nilsson A (2004) Contrast-enhanced ultrasound of the kidneys. Eur Radiol 14(Suppl 8):P104–P109PubMedGoogle Scholar
  21. 21.
    Beer AJ, Dobritz M, Zantl N et al (2006) Comparison of 16-MDCT and MRI for characterization of kidney lesions. AJR Am J Roentgenol 186:1639–1650PubMedCrossRefGoogle Scholar
  22. 22.
    Wong WS, Moss AA, Federle MP et al (1984) Renal infarction: CT diagnosis and correlation between CT findings and etiologies. Radiology 150:201–205PubMedGoogle Scholar
  23. 23.
    Obuchowski NA (2003) Receiver operating characteristic curves and their use in radiology. Radiology 229:3–8PubMedCrossRefGoogle Scholar
  24. 24.
    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Michele Bertolotto
    • 1
  • Alberto Martegani
    • 2
  • Luca Aiani
    • 2
  • Roberta Zappetti
    • 1
  • Stefano Cernic
    • 1
  • Maria Assunta Cova
    • 1
  1. 1.UCO di RadiologiaUniversità di Trieste, Ospedale di CattinaraTriesteItaly
  2. 2.Servizio di Diagnostica per ImmaginiOspedale ValduceComoItaly

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