European Radiology

, Volume 28, Issue 11, pp 4542–4549 | Cite as

Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis

  • Johannes RübenthalerEmail author
  • G. Negrão de Figueiredo
  • K. Mueller-Peltzer
  • D. A. Clevert



To investigate the usefulness of contrast-enhanced ultrasound (CEUS) in the evaluation of renal masses.


This study included 255 patients with renal masses. Ages ranged from 18–86 years. CEUS was used for determining malignancy or benignancy and findings were correlated with the histopathological outcome. Out of 255 lesions, 212 lesions were malignant (83.1%) and 43 were benign (16.9%). Diagnostic accuracy was tested using the histopathological diagnosis as the gold standard.


CEUS showed a sensitivity of 99.1% [95% confidence interval (CI): 96.7%, 99.9%], a specificity of 80.5% (CI: 65.1%, 91.2%), a positive predictive value of 96.4% (CI: 93.0%, 98.4%) and a negative predictive value of 94.3% (CI: 80.8%, 99.3%). Kappa for diagnostic accuracy was κ = 0.85 (CI: 0.75, 0.94). Of 212 malignant lesions, 200 renal cell carcinomas and 12 other malignant lesions were diagnosed. Out of 43 benign lesions, 10 angiomyolipomas, 3 oncocytomas, 8 renal cysts and 22 other benign lesions were diagnosed.


CEUS is an useful method to differentiate between malignant and benignant renal lesions. To date, to our knowledge, this is the largest study in Europe for the evaluation of renal lesions using CEUS with a histopathological validation.

Key Points

• CEUS helps clinicians detect and characterise unclear solid and cystic renal lesions

• CEUS shows a high diagnostic accuracy in the characterization of these lesions

• Proper surgical treatment or follow-up can be given with better diagnostic confidence


Carcinoma, renal cell Kidney Contrast media Perfusion imaging 



Contrast-enhanced computed tomography


Contrast-enhanced ultrasound


Confidence interval


Negative predictive value


Picture archiving and communication system


Positive predictive value



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Dirk-André Clevert.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dirk-André Clevert declares that he received compensation as a speaker from the following companies: Samsung, Philips, Siemens, Bracco, and Falk.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dipl.-Stat. Regina Schinner (Department of Radiology, LMU Munich) kindly provided statistical advice for this manuscript. She is not an author of the manuscript.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• Retrospective

• diagnostic prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyLudwig-Maximilians-University of Munich-Grosshadern CampusMunichGermany
  2. 2.Department of Radiology, Interdisciplinary Ultrasound CenterUniversity of Munich-Grosshadern CampusMunichGermany

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