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Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound

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Abstract

Objective

The aim of this study was to assess the accuracy of Ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the characterization of renal nodules indeterminate on CT by identifying benign cystic lesions not requiring further examination.

Methods

72 patients with 83 indeterminate renal nodules on CT underwent baseline US and CEUS that classified lesions as benign (Bosniak I, II or IIF cysts) or potentially malignant (Bosniak III or IV cysts, solid nodules). The accuracy of US and CEUS in the differentiation between benign cysts and potentially malignant nodules was analyzed and compared with the final diagnosis obtained by histology or follow-up of at least 23 months with CEUS ± a conclusive CT/MR study.

Results

Final diagnoses comprised 50 benign complex cysts, 1 focal nephritis, 1 multilocular cystic nephroma, 3 oncocytomas, 1 transitional cell carcinoma and 27 renal cell carcinomas. Unenhanced US correctly classified 18/50 (36%) benign cysts and 17/33 (51.5%) of the potentially malignant lesions obtaining a sensitivity of 36%, specificity of 51.5%, and overall accuracy of 42.2%. The addition of CEUS allowed a correct diagnosis of 48 /50 (96%) benign cysts and of 31/33 (93.9%) nodules as potentially malignant, with a sensitivity of 96%, specificity of 93.9%, and overall accuracy of 95.2%.

Conclusion

CEUS is very useful in the differentiation between benign complex cysts and other lesions that require further investigation in non-conclusive renal nodules detected on CT, improving the accuracy of baseline US from 42.2 to 95.2%.

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Authors and Affiliations

  1. Radiology Department, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain

    Carlos Nicolau, Laura Buñesch, Blanca Paño, Rafael Salvador & Carmen Sebastià

  2. Urology Department, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain

    Maria Jose Ribal

  3. Pathology Department, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain

    Carme Mallofré

Authors
  1. Carlos Nicolau
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  2. Laura Buñesch
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  3. Blanca Paño
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  4. Rafael Salvador
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  5. Maria Jose Ribal
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  6. Carme Mallofré
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  7. Carmen Sebastià
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Corresponding author

Correspondence to Carlos Nicolau.

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Nicolau, C., Buñesch, L., Paño, B. et al. Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound. Abdom Imaging 40, 542–551 (2015). https://doi.org/10.1007/s00261-014-0237-3

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  • DOI: https://doi.org/10.1007/s00261-014-0237-3

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