Abstract
Background: The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses. Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent. Results: Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%). Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.
Highlights
Ninety-six patients (84%) with histopathologically confirmed renal cell carcinoma were included in this study: 47 patients (41%) with clear cell renal cell carcinoma (CCRCC), 42 patients (37%) with papillary renal cell carcinoma (PRCC), and 7 patients (6%) with chromophobe renal cell carcinoma (ChRCC)
The PRCC lesions were hypoechoic in 27/42 cases (64%), hyperechoic in 8/42 cases (19%), and isoechoic in 5/42 cases (12%)
Our findings are consistent with the current state of knowledge
Summary
The number of unclear renal lesions incidentally detected on cross-sectional imaging or ultrasound has grown along with the more widespread use of medical imaging [1,2,3].Conventional B-mode ultrasound is the most frequently used imaging modality for the initial classification of kidney lesions and allows for discriminating between cystic and solid renal lesions.Complicated renal cysts require dedicated contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging (MRI) for definitive characterization and the diagnosis of renal cell carcinoma (RCC) [4,5].Recently, the use of contrast-enhanced ultrasound (CEUS) has established itself as a well-tolerated, highly accurate, and cost-effective imaging modality for diagnosing RCC [6,7,8]. Conventional B-mode ultrasound is the most frequently used imaging modality for the initial classification of kidney lesions and allows for discriminating between cystic and solid renal lesions. The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses. Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study
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