An evaluation of the clinical diagnostic value of contrast-enhanced ultrasound combined with contrast-enhanced computed tomography in space-occupying lesions of the kidney

Abstract

BackgroundThere are a variety of space-occupying lesions of the kidney, and the benign lesions may be difficult to differentiate from the malignant ones. Therefore, an accurate judgment of the benign and malignant nature of the space-occupying lesions of the kidney is of high importance for the treatment and prognosis of these patients.ObjectiveTo evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CECT) in space-occupying lesions of the kidney.Data and methodsThree hundred and sixty-seven patients with space-occupying lesions of the kidney (378 lesions) were examined by CEUS and CECT, respectively, then, a combined diagnosis was made after the combination of CEUS and CECT by a multidisciplinary team. The diagnoses from the three methods were compared. The pathological results were taken as the gold standard. The sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic (ROC) curve were calculated for the three methods. Thus, the diagnostic value of the three methods was assessed.ResultsOf the 378 lesions examined, there were 301 malignant lesions and 77 benign lesions. The combined examination revealed 303 malignant lesions, with 9 benign lesions mistakenly diagnosed as malignant ones; thus, the misdiagnosis rate was 11.7%. By using the combined examination, 75 benign lesions were diagnosed, with the missed diagnosis of 7 malignant lesions, so the missed diagnosis rate was 2.3%. The sensitivity, specificity, positive and negative predictive values and area under the ROC curve with the combined examination of CEUS and CECT were 97.67% (0.950–0.989), 88.31% (0.785–0.942), 97.03% (0.942–0.985), 90.67% (0.811–0.958) and 0.930 (0.887–0.973), respectively. As compared with either CEUS or CECT alone, the difference in these indicators was of statistical significance (P<0.05). The combined examination greatly improved the sensitivity, specificity and accuracy of the diagnosis of the space-occupying lesions of the kidney.ConclusionCEUS and CECT each have advantages and disadvantages in the diagnosis of the space-occupying lesions of the kidney. The two techniques can be used in combination to compensate for the respective defects. More salient benefits can be reaped from the combined examination than from either technique used alone.

Comparison of the Diagnostic Performance of Contrast-enhanced Ultrasound with That of Contrast-enhanced Computed Tomography and Contrast-enhanced Magnetic Resonance Imaging in the Evaluation of Renal Masses: A Systematic Review and Meta-analysis

“…Six of the 16 included studies were cohort studies [17][18][19][20][21][22] and 10 were descriptive studies [23][24][25][26][27][28][29][30][31][32]; none were RCTs ( Table 1).…”

“…In Tian et al's [18] study, RMs with FD by pathology were examined with consensus of both CECT and CEUS. DA, [20] reported a significant difference between CEUS and CEMR and CECT, namely, 0.98 (95% CI 0.96-1.0) versus 0.81 (95% CI 0.68-0.94) and 0.56 (95% CI 0.41-0.71; Table 2).…”

Contrast-enhanced ultrasound manifestations of renal masses undetectable on conventional ultrasound

“…Imaging examination is the main basis for clinical differentiation of renal tumor histotypes, which is of great significance ( 1 ). Most of the patients with renal masses are asymptomatic in the early stage, and 70%–80% of renal tumors can be detected by ultrasound (US) in routine physical examination ( 2 ). Although conventional ultrasound (CUS), including B mode and color Doppler, has an important role in the diagnosis of renal tumors, it also has some limitations.…”