Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions

Abstract

Purpose To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome. Materials and methods A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included. Patient ages ranged from 18 to 86 with (mean age 62 years; SD ± 13). CEUS (255 patients), CT (88 out of 255 patients; 34.5 %) and MRI (36 out of 255 patients; 14.1 %) were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome. Results CEUS showed a sensitivity of 99.1 % (95 % confidence interval (CI): 96.7 %, 99.9 %), a specificity of 80.5 % (95 % CI: 65.1 %, 91.2 %), a positive predictive value (PPV) of 96.4 % (95 % CI: 93.0 %, 98.4 %) and a negative predictive value (NPV) of 94.3 % (95 % CI: 80.8 %, 99.3 %). CT showed a sensitivity of 97.1 % (95 % CI: 89.9 %, 99.6 %), a specificity of 47.4 % (95 % CI: 24.4 %, 71.1 %), a PPV of 87.0 % (95 % CI: 77.4 %, 93.6 %) and a NPV of 81.8 % (95 % CI: 48.2 %, 97.7 %). MRI showed a sensitivity of 96.4 % (95 % CI: 81.7 %, 99.9 %), a specificity of 75.0 % (95 % CI: 34.9 %, 96.8 %), a PPV of 93.1 % (95 % CI: 77.2 %, 99.2 %) and a NPV of 85.7 % (95 % CI: 42.1 %, 99.6 %). Out of the 212 malignant lesions a total of 130 clear cell renal carcinomas, 59 papillary renal cell carcinomas, 7 chromophobe renal cell carcinomas, 4 combined clear cell and papillary renal cell carcinomas and 12 other malignant lesions, e. g. metastases, were diagnosed. Out of the 43 benign lesions a total 10 angiomyolipomas, 3 oncocytomas, 8 benign renal cysts and 22 other benign lesions, e. g. renal adenomas were diagnosed. Using CEUS, 10 lesions were falsely identified as malignant or benign, whereas 8 lesions were false positive and 2 lesions false negative. Conclusion CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to CT and MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method. Key Points: Citation Format

Contrast-Enhanced Ultrasound (CEUS) for the Evaluation of Bosniak III Complex Renal Cystic Lesions—A 10-Year Specialized European Single-Center Experience with Histopathological Validation

“…CEUS showed equivalent diagnostic validity compared to more elaborate CT and MRI [24] in terms of assessing indeterminate renal lesions. Nevertheless, several studies described that CEUS like any other imaging modality is unfeasible to safely distinguish between RCC subtypes solely relying on qualitative imaging features.…”

Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI–CEUS) in Oncology

“…Hence, it is plausible that assessing renal lesions by MRI may result in different Bosniak stratification compared when doing so by means of CT. Computed tomography is most suitable for detecting calcification of renal lesions. Comparable diagnostic performances of CEUS compared to CT and MRI for analyzing renal lesions were previously demonstrated [ 56 ]. A meta-analysis revealed an even higher diagnostic sensitivity of CEUS compared to MRI for analyzing complex renal lesions [ 54 ].…”

A comparative study of contrast-enhanced ultrasound and contrast-enhanced CT for the detection and characterization of renal masses

“…In addition, CECT is contraindicated for patients with an allergy to iodine contrast agent, renal insufficiency, and severe hyperthyroidism. Moreover, CECT is expensive and radioactive (4). Therefore, it is particularly important to seek a complementary diagnostic imaging method for CECT.…”