Abstract
ObjectiveTo prospectively evaluate the diagnostic accuracy of contrast enhanced ultrasound (CEUS) and MRI compared to computed tomography (CT) as the current gold standard for the characterization of cystic renal lesions using the Bosniak classification. MethodsBetween July 2014 and October 2017 we prospectively enrolled patients with cystic renal lesions. Based on the Bosniak classification of complex renal lesions (≥BII-F) we evaluated the accuracy of observed agreement by Cohen's Kappa coefficient and calculated sensitivity, specificity, positive and negative predictive values (PPV/NPV) between the three imaging modalities CT, MRI and CEUS. ResultsWe evaluated 65 cystic renal lesions in 48 patients (median age 63 years, range 36-91 years; 18 females, 30 males). According to CT 29 (47%) of the cystic renal lesions were classified as complex. The agreement between CEUS and CT in the classification of complex cystic lesions was fair (agreement 50.8%, Kappa 0.31), and was excellent between MRI and CT (agreement 93.9%, Kappa 0.88).Compared to CT, CEUS and MRI had a sensitivity of 100% and 96.6%, a specificity of 33.3% and 91.7%, a PPV of 54.7% and 90.3%, and a NPV of 100% and 97.1% with an accuracy of 63.1% and 93.8% respectively. ConclusionCEUS has an excellent sensitivity and NPV and represents a promising non-invasive screening tool for renal cystic lesions. The classification of complex renal cysts based on MRI and CT scans correlated closely.
Highlights
The widespread availability of abdominal diagnostic ultrasound and computed tomography (CT) has led to increased incidental detection of cystic renal lesions.[1, 2] This often leads to a diagnostic dilemma since differentiating between malignant and benign complex renal cysts remains challenging.[3, 4] The gold standa
In patients with an initial contrast enhanced ultrasound (CEUS) evaluation for study recruitment, some complex cysts (Bosniak II-F) were later downgraded to Bosniak
The Bosniak classifications of magnetic resonance imaging (MRI) and CEUS compared to the classification obtained by CT are shown in Figure 1 and Tables 2 and S2
Summary
Study Population Between July 2014 and October 2017, 52 patients were prospectively enrolled in this study. Of these patients, 48 underwent all three imaging modalities (CT, CEUS, MRI) on a total of 65 renal cystic lesions with a transverse diameter of at least 1 cm and were included in this study. In patients with an initial CEUS evaluation for study recruitment, some complex cysts (Bosniak II-F) were later downgraded to Bosniak 30mL/min (according to the CKD-EPI formula)
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