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Assessment of Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography (CT) diagnostic accuracy in the evaluation of challenging cystic renal masses

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Abstract

Purpose

To assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) and computed tomography (CT) within Bosniak IIF/III categories.

Methods

After cystic renal mass diagnosis by contrast-enhanced CT, all patients with Bosniak score ≥ II also underwent CEUS between March 2017 and March 2019. Their exams were retrospectively analyzed. One experienced uro-radiologist performed every CEUS and reviewed the exams according to the EFSUMB 2020 Position Statement, while blinded to clinical data. CT Bosniak scores were retrospectively given blindly by two uro-radiologists (CT 1 and CT 2). We compared CEUS, CT 1 and CT 2 scores to clinical findings and histological tests. Clinical performance characteristics and area under the receiver operating characteristic (ROC) curves (AUCs) were determined separately for CEUS and CT, and then compared.

Results

101 cystic masses were analyzed. In Bosniak categories IIF and III, the AUCs were 0.854 for CT 1, 0.779 for CT 2, and 0.746 for CEUS.

Conclusion

Despite some statistical limitations, this study confirms that among cystic renal masses, those classified as Bosniak IIF and III are the most difficult to assess. The diagnostic performances of CEUS and CT are similar within this group. However, in experienced hands, CEUS could be valuable in further evaluation of ambiguous cystic masses, and in more ductile, safer, and cost-effective surveillance of those classified as Bosniak IIF and III. When challenging cystic renal masses occur, CEUS is a useful tool for clinical management and for the follow-up of non-surgical lesions.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Section of Urology, SS Antonio and Biagio and Cesare Arrigo Hospital, Via Venezia, 16, 15121, Alessandria, Italy

    Lorenzo Angelini & Armando Serao

  2. Department of Radiology, Conegliano Hospital, Conegliano, Italy

    Eugenio Gioulis, Nicoletta Civitareale, Angelica Zago & Gianluca Piccoli

  3. Nephrology and Dialysis Unit, Emergency Hospital “Cannizzaro”, Catania, Italy

    Antonio Granata

  4. Department of Emergency Medicine, Anesthesia and Critical Care, Michele and Pietro Ferrero Hospital, Verduno, Italy

    Christian Zanza

  5. Department of Anesthesia and Critical Care, SS Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy

    Yaroslava Longhitano

  6. Department of Pathology, Conegliano Hospital, Conegliano, Italy

    Piernicola Machin & Fabio Canal

  7. Department of Surgery, Section of Urology, Conegliano Hospital, Conegliano, Italy

    Salvatore Valerio

Authors
  1. Lorenzo Angelini
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  2. Eugenio Gioulis
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  3. Nicoletta Civitareale
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  4. Antonio Granata
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  6. Yaroslava Longhitano
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  7. Angelica Zago
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  8. Piernicola Machin
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  9. Fabio Canal
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  11. Gianluca Piccoli
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  12. Salvatore Valerio
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Contributions

Conceptualization and methodology: LA, EG; formal analysis and investigation: EG, NC, PM, FC; writing—original draft preparation: LA; writing—review and editing: AG, CZ, YL; resources: AZ; supervision: AS, GP, SV.

Corresponding author

Correspondence to Lorenzo Angelini.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical approval for this study was obtained from AULSS 2 Marca Trevigiana Ethics Committee (approval number 0090337).

Informed consent

The study was conducted in accordance with current legislation, in compliance with the rules of good clinical practice (GCP) and the principles of the Declaration of Helsinki. Patients in the study were provided with the information pursuant to and for the purposes of the National Regulation relating to the protection of individuals with regard to the processing of personal data. For deceased or non-contactable patients at the time of enrollment in the study, a specific authorization of the local Committee was applied.

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Angelini, L., Gioulis, E., Civitareale, N. et al. Assessment of Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography (CT) diagnostic accuracy in the evaluation of challenging cystic renal masses. J Ultrasound 25, 905–913 (2022). https://doi.org/10.1007/s40477-022-00683-2

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  • DOI: https://doi.org/10.1007/s40477-022-00683-2

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