Abdominal Radiology

, Volume 43, Issue 4, pp 880–898 | Cite as

Applications of contrast-enhanced ultrasound in the kidney

  • Brittany Kazmierski
  • Corinne Deurdulian
  • Hisham Tchelepi
  • Edward G. Grant
Pictorial essay


Incidental discovery of renal lesions on cross-sectional imaging studies performed for other indications is not uncommon. With the increased reliance on medical imaging, the number of incidentally detected renal lesions has also grown over time. While simple cysts account for the majority of these lesions, the presence of complex features within a cystic lesion, such as septations and solid components, can present a confusing picture. Solid lesions, too, can be indeterminate, and distinguishing between benign solid masses (like lipid-poor angiomyolipomas and oncocytomas) and renal cell carcinoma affects patient management and can prevent unnecessary interventions. Indeterminate renal lesions are traditionally further characterized by multiphase imaging, such as contrast-enhanced computed tomography and magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) is a new, relatively inexpensive technique that has become increasingly employed in the diagnostic workup of indeterminate 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 imaging modalities. This article provides an overview of the current clinical applications of CEUS in characterizing renal lesions, both cystic and solid. Additional applications of CEUS in the kidney, including its roles in renal transplant evaluation and guidance for percutaneous biopsy, will also be briefly discussed.


Contrast-enhanced ultrasound Renal cyst Renal mass Renal cell carcinoma Angiomyolipoma Oncocytoma 


Compliance with ethical standards



Conflict of interest

Brittany Kazmierski declares that she has no conflict of interest. Corinne Deurdulian declares that she has no conflict of interest. Hisham Tchelepi has received research Grants from General Electric and CIVCO Medical Solutions. Edward Grant has received a research Grant from General Electric.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

261_2017_1307_MOESM1_ESM.avi (10.8 mb)
Supplementary material 1 (AVI 11027 kb)
261_2017_1307_MOESM2_ESM.avi (10.8 mb)
Supplementary material 2 (AVI 11028 kb)
261_2017_1307_MOESM3_ESM.avi (22.5 mb)
Supplementary material 3 (AVI 23075 kb)
261_2017_1307_MOESM4_ESM.avi (17.1 mb)
Supplementary material 4 (AVI 17496 kb)
261_2017_1307_MOESM5_ESM.avi (16.4 mb)
Supplementary material 5 (AVI 16772 kb)
261_2017_1307_MOESM6_ESM.avi (20.2 mb)
Supplementary material 6 (AVI 20688 kb)


  1. 1.
    Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK (2006) Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 98(18):1331–1334CrossRefPubMedGoogle Scholar
  2. 2.
    Jinzaki M, Tanimoto A, Mukai M, et al. (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr 24(6):835–842CrossRefPubMedGoogle Scholar
  3. 3.
    Li X, Liang P, Guo M, et al. (2013) Real-time contrast-enhanced ultrasound in diagnosis of solid renal lesions. Discov Med 16(86):15–25PubMedGoogle Scholar
  4. 4.
    Xu ZF, Xu HX, Xie XY, et al. (2010) Renal cell carcinoma: real-time contrast-enhanced ultrasound findings. Abdom Imaging 35(6):750–756CrossRefPubMedGoogle Scholar
  5. 5.
    Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271(1):133–142CrossRefPubMedGoogle Scholar
  6. 6.
    King KG, Gulati M, Malhi H, et al. (2015) Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time–intensity curves: how we do it. Abdom Imaging 40(7):2461–2471CrossRefPubMedGoogle Scholar
  7. 7.
    McGuire BB, Fitzpatrick JM (2010) The diagnosis and management of complex renal cysts. Curr Opin Urol 20(5):349–354CrossRefPubMedGoogle Scholar
  8. 8.
    Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158(1):1–10CrossRefPubMedGoogle Scholar
  9. 9.
    Hartman DS, Choyke PL, Hartman MS (2004) From the RSNA refresher courses: a practical approach to the cystic renal mass. Radiographics 24(Suppl 1):S101–S115CrossRefPubMedGoogle Scholar
  10. 10.
    Israel GM, Hindman N, Bosniak MA (2004) Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 231(2):365–371CrossRefPubMedGoogle Scholar
  11. 11.
    Park BK, Kim B, Kim SH, et al. (2007) Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 61(2):310–314CrossRefPubMedGoogle Scholar
  12. 12.
    Quaia E, Bertolotto M, Cioffi V, et al. (2008) Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. Am J Roentgenol 191(4):1239–1249CrossRefGoogle Scholar
  13. 13.
    Ascenti G, Mazziotti S, Zimbaro G, et al. (2007) Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 243(1):158–165CrossRefPubMedGoogle Scholar
  14. 14.
    Harvey C, Alsafi A, Kuzmich S, et al. (2015) Role of US contrast agents in the assessment of indeterminate solid and cystic lesions in native and transplant kidneys. Radiographics 35(5):1419–1430CrossRefPubMedGoogle Scholar
  15. 15.
    Forman HP, Middleton WD, Melson GL, McClennan BL (1993) Hyperechoic renal cell carcinomas: increase in detection at US. Radiology 188(2):431–434CrossRefPubMedGoogle Scholar
  16. 16.
    Jinzaki M, Tanimoto A, Narimatsu Y, et al. (1997) Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology 205(2):497–502CrossRefPubMedGoogle Scholar
  17. 17.
    Xu ZF, Xu HX, Xie XY, et al. (2010) Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast-enhanced ultrasonography. J Ultrasound Med 29(5):709–717CrossRefPubMedGoogle Scholar
  18. 18.
    Dechet CB, Bostwick DG, Blute ML, et al. (1999) Renal oncocytoma: multifocality, bilateralism, metachronous tumor development and coexistent renal cell carcinoma. J Urol 162(1):40–42CrossRefPubMedGoogle Scholar
  19. 19.
    Goiney RC, Goldenberg L, Cooperberg PL, et al. (1984) Renal oncocytoma: sonographic analysis of 14 cases. Am J Roentgenol 143(5):1001–1004CrossRefGoogle Scholar
  20. 20.
    Quinn MJ, Hartman DS, Friedman AC, et al. (1984) Renal oncocytoma: new observations. Radiology 153(1):49–53CrossRefPubMedGoogle Scholar
  21. 21.
    Davidson AJ, Hayes WS, Hartman DS, McCarthy WF, Davis CJ Jr (1993) Renal oncocytoma and carcinoma: failure of differentiation with CT. Radiology 186(3):693–696CrossRefPubMedGoogle Scholar
  22. 22.
    Choudhary S, Rajesh A, Mayer NJ, Mulcahy KA, Haroon A (2009) Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms. Clin Radiol 64(5):517–522CrossRefPubMedGoogle Scholar
  23. 23.
    Young JR, et al. (2013) Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology 267(2):444–453CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenkrantz AB, Hindman N, Fitzgerald EF, et al. (2010) MRI features of renal oncocytoma and chromophobe renal cell carcinoma. Am J Roentgenol 195(6):W421–W427CrossRefGoogle Scholar
  25. 25.
    Kang SK, Huang WC, Pandharipande PV, et al. (2014) Solid renal masses: what the numbers tell us. Am J Roentgenol 202(6):1196–1206CrossRefGoogle Scholar
  26. 26.
    Gerst S, Hann LE, Li D, et al. (2011) Evaluation of renal masses with contrast-enhanced ultrasound: initial experience. Am J Roentgenol 197(4):897–906CrossRefGoogle Scholar
  27. 27.
    Wu Y, Du L, Li F, et al. (2013) Renal oncocytoma: contrast-enhanced sonographic features. J Ultrasound Med 32(3):441–448CrossRefPubMedGoogle Scholar
  28. 28.
    Tamai H, Takiguchi Y, Oka M, et al. (2005) Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med 24(12):1635–1640CrossRefPubMedGoogle Scholar
  29. 29.
    Bhatt S, MacLennan G, Dogra V (2007) Renal pseudotumors. Am J Roentgenol 188(5):1380–1387CrossRefGoogle Scholar
  30. 30.
    Ascenti G, Zimbaro G, Mazziotti S, et al. (2001) Contrast-enhanced power Doppler US in the diagnosis of renal pseudotumors. Eur Radiol 11(12):2496–2499CrossRefPubMedGoogle Scholar
  31. 31.
    Mazziotti S, Zimbaro F, Pandolfo A, et al. (2010) Usefulness of contrast-enhanced ultrasonography in the diagnosis of renal pseudotumors. Abdom Imaging 35(2):241–245CrossRefPubMedGoogle Scholar
  32. 32.
    Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 113(Suppl 1):5–13CrossRefGoogle Scholar
  33. 33.
    Demertzis J, Menias CO (2007) State of the art: imaging of renal infections. Emerg Radiol 14:13–22CrossRefPubMedGoogle Scholar
  34. 34.
    Mitterberger M, Pinggera GM, Colleselli D, et al. (2007) Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast enhanced ultrasonography. BJU Int 101(3):341–344CrossRefPubMedGoogle Scholar
  35. 35.
    Fontanilla T, Minaya J, Cortés C, et al. (2012) Acute complicated pyelonephritis: contrast-enhanced ultrasound. Abdom Imaging 37(4):639–646CrossRefPubMedGoogle Scholar
  36. 36.
    Morichetti D, Mazzucchelli R, Lopez-Beltran A, et al. (2009) Secondary neoplasms of the urinary system and male genital organs. BJU Int 104(6):770–776CrossRefPubMedGoogle Scholar
  37. 37.
    Honda H, Coffman CE, Berbaum KS, Barloon TJ, Masuda K (1992) CT analysis of metastatic neoplasms of the kidney. Comparison with primary renal cell carcinoma. Acta Radiol 33(1):39–44CrossRefPubMedGoogle Scholar
  38. 38.
    Ignee A, Straub B, Schuessler G, Dietrich CF (2010) Contrast enhanced ultrasound of renal masses. World J Radiol 2(1):15–31CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Penn I, Brunson ME (1988) Cancers after cyclosporine therapy. Transplant Proc 20(suppl 3):885–892PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of RadiologyKeck USC School of MedicineLos AngelesUSA

Personalised recommendations