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Kontrastmittelunterstützter Ultraschall in der Differenzialdiagnose komplexer renaler Zysten und kleiner renaler Raumforderungen

Contrast-enhanced ultrasonography in the differential diagnosis of complex renal cysts and small renal masses

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Nierenraumforderungen können in komplexe Zysten und solide Läsionen unterteilt werden. Die Bosniak-Klassifikation unterteilt die Nierenzysten anhand von unterschiedlichen Kriterien in 4 Kategorien. Aufgrund dieser Charakterisierung kann eine Entscheidung über das weitere Management getroffen werden. Die Sonographie bzw. die kontrastmittelunterstützte Sonographie zählt zu den diagnostischen Standardverfahren bei Nierenzysten und ist eine zielführende Methode für die Einteilung in die Bosniak-Kategorien.

Ziel

In der vorliegenden Übersichtsarbeit werden die zystischen Nierenläsionen und deren Differenzierung mithilfe der kontrastmittelunterstützten Sonographie beschrieben, die bei der weiteren Therapieentscheidung unterstützen soll.

Material und Methoden

Dazu wurden eine selektive Literaturrecherche sowie die Auswertung des eigenen Patientenkollektivs für die Erstellung des Reviews durchgeführt.

Ergebnis

Die kontrastmittelunterstützte Sonographie ist kostengünstig und einfach. Bei der Evaluation von komplexen renalen Zysten und kleinen soliden renalen Raumforderungen bietet sie v. a. durch die Zusatzinformation über die Vaskularisation der Nierenläsionen eine schnellere Festlegung des therapeutischen Vorgehens.

Abstract

Background

Renal masses can be divided into complex cysts and solid lesions. The Bosniak classification divides renal cysts into IV categories bases on different criteria. Based on this characterization, a decision about further management can be made. Sonography or contrast-enhanced sonography is one of the standard diagnostic procedures for renal cysts and is a useful method for classification into the Bosniak categories.

Objectives

This review describes cystic kidney lesions and their differentiation using contrast-enhanced sonography, which is intended to support further management.

Materials and methods

A selective literature search and evaluation of the own patient collective were carried out for the preparation of the review.

Conclusion

Contrast-enhanced sonography is a simple and inexpensive technique. In the evaluation of complex renal cysts and small solid renal masses, it allows rapid determination of the appropriate therapeutic approach, especially since additional information about the vascularization of the renal masses is obtained.

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Literatur

  1. 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):365–371

    Article  PubMed  Google Scholar 

  2. Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43(1):1–9

    Article  PubMed  Google Scholar 

  3. Greis C (2011) Summary of technical principles of contrast sonography and future perspectives. Radiologe 51(6):456–461

    Article  CAS  PubMed  Google Scholar 

  4. Horng A, Reiser M, Clevert DA (2009) Current developments in vascular ultrasound. Radiologe 49(11):998–1004

    Article  CAS  PubMed  Google Scholar 

  5. Greis C (2014) Technical aspects of contrast-enhanced ultrasound (CEUS) examinations: tips and tricks. Clin Hemorheol Microcirc 58(1):89–95

    Article  CAS  PubMed  Google Scholar 

  6. Clevert DA, D’Anastasi M, Jung EM (2013) Contrast-enhanced ultrasound and microcirculation: efficiency through dynamics—current developments. Clin Hemorheol Microcirc 53(1):171–186

    Article  CAS  PubMed  Google Scholar 

  7. Piscaglia F, Bolondi L (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32(9):1369–1375

    Article  PubMed  Google Scholar 

  8. ter Haar G (2009) Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 47(8):893–900

    Article  PubMed  Google Scholar 

  9. Nicolau C et al (2021) Imaging characterization of renal masses. Medicina (Kaunas) 57(1):51. https://doi.org/10.3390/medicina57010051

    Article  PubMed  Google Scholar 

  10. Silverman SG et al (2019) Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment. Radiology 292(2):475–488

    Article  PubMed  Google Scholar 

  11. Kay FU, Pedrosa I (2017) Imaging of solid renal masses. Radiol Clin North Am 55(2):243–258

    Article  PubMed  Google Scholar 

  12. Ravine D et al (1993) An ultrasound renal cyst prevalence survey: specificity data for inherited renal cystic diseases. Am J Kidney Dis 22(6):803–807

    Article  CAS  PubMed  Google Scholar 

  13. Radermacher J (2003) Ultrasound of the kidney and renal vessels. I: normal findings, congenital diseases, diseases of the kidney parenchyma. Internist 44(10):1283–1297 (quiz 1298–9)

    Article  CAS  PubMed  Google Scholar 

  14. Nicolau C, Bunesch L, Sebastia C (2011) Renal complex cysts in adults: contrast-enhanced ultrasound. Abdom Imaging 36(6):742–752

    Article  PubMed  Google Scholar 

  15. Clevert DA et al (2008) Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 39(1):171–178

    Article  PubMed  Google Scholar 

  16. Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158(1):1–10

    Article  CAS  PubMed  Google Scholar 

  17. Park BK et al (2007) Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 61(2):310–314

    Article  PubMed  Google Scholar 

  18. Israel GM, Silverman SG (2011) The incidental renal mass. Radiol Clin North Am 49(2):369–383

    Article  PubMed  Google Scholar 

  19. Clevert DA et al (2010) Diagnostic algorithm in cystic renal masses. Urologe A 49(3):421–431 (quiz 432)

    Article  PubMed  Google Scholar 

  20. Graser A et al (2009) Imaging renal cell carcinoma. Urologe A 48(4):427–436 (quiz 437–8)

    Article  CAS  PubMed  Google Scholar 

  21. Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226(1):47–52

    Article  PubMed  Google Scholar 

  22. Smith AD et al (2012) Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology 262(1):152–160

    Article  PubMed  Google Scholar 

  23. Hindman NM (2016) Cystic renal masses. Abdom Radiol (NY) 41(6):1020–1034

    Article  PubMed  Google Scholar 

  24. Miskin N et al (2021) Stratification of cystic renal masses into benign and potentially malignant: applying machine learning to the bosniak classification. Abdom Radiol (NY) 46(1):311–318

    Article  PubMed  Google Scholar 

  25. Decastro GJ, McKiernan JM (2008) Epidemiology, clinical staging, and presentation of renal cell carcinoma. Urol Clin North Am 35(4):581–592

    Article  PubMed  Google Scholar 

  26. Chow WH et al (1999) Rising incidence of renal cell cancer in the United States. JAMA 281(17):1628–1631

    Article  CAS  PubMed  Google Scholar 

  27. Escudier B et al (2014) Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 25(3):iii49–56

    Article  PubMed  Google Scholar 

  28. Rübenthaler J et al (2015) Parametric imaging of clear cell and papillary renal cell carcinoma using contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 63(2):89–97

    Article  PubMed  Google Scholar 

  29. Gassert F et al (2021) Comparison of magnetic resonance imaging and contrast-enhanced ultrasound as diagnostic options for unclear cystic renal lesions: a cost-effectiveness analysis. Ultraschall Med 42(4):411–417

    Article  PubMed  Google Scholar 

  30. Hindman NM, Hecht EM, Bosniak MA (2014) Follow-up for Bosniak category 2F cystic renal lesions. Radiology 272(3):757–766

    Article  PubMed  Google Scholar 

  31. Silverman SG et al (2006) Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 240(1):6–22

    Article  PubMed  Google Scholar 

  32. Moch H et al (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours. Eur Urol 70(1):93–105

    Article  PubMed  Google Scholar 

  33. Xu ZF et al (2010) Renal cell carcinoma and renal angiomyolipoma: differential diagnosis with real-time contrast-enhanced ultrasonography. J Ultrasound Med 29(5):709–717

    Article  PubMed  Google Scholar 

  34. Siegel CL et al (1996) Angiomyolipoma and renal cell carcinoma: US differentiation. Radiology 198(3):789–793

    Article  CAS  PubMed  Google Scholar 

  35. Lu Q et al (2012) Minimal fat renal angiomyolipoma: the initial study with contrast-enhanced ultrasonography. Ultrasound Med Biol 38(11):1896–1901

    Article  PubMed  Google Scholar 

  36. Davidson AJ et al (1993) Renal oncocytoma and carcinoma: failure of differentiation with CT. Radiology 186(3):693–696

    Article  CAS  PubMed  Google Scholar 

  37. Rosenkrantz AB et al (2010) MRI features of renal oncocytoma and chromophobe renal cell carcinoma. AJR Am J Roentgenol 195(6):W421–7

    Article  PubMed  Google Scholar 

  38. Schwarze V et al (2020) Single-center study: the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing renal oncocytoma. Scand J Urol 54(2):135–140

    Article  PubMed  Google Scholar 

  39. Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271(1):133–142

    Article  PubMed  Google Scholar 

  40. Wu Y et al (2013) Renal oncocytoma: contrast-enhanced sonographic features. J Ultrasound Med 32(3):441–448

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschallzentrum, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland

    Janine Thiemann & Dirk-André Clevert

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  1. Janine Thiemann
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  2. Dirk-André Clevert
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Correspondence to Janine Thiemann.

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Interessenkonflikt

J. Thiemann und D.-A. Clevert geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Thiemann, J., Clevert, DA. Kontrastmittelunterstützter Ultraschall in der Differenzialdiagnose komplexer renaler Zysten und kleiner renaler Raumforderungen. Onkologie 29, 571–580 (2023). https://doi.org/10.1007/s00761-023-01309-w

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  • DOI: https://doi.org/10.1007/s00761-023-01309-w

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