Abstract
Obesity and bowel gas are known to impair image quality in abdominal ultrasound (US). The present study aims at identifying individual factors in B-mode US that influence contrast-enhanced US (CEUS) image quality to optimize further imaging workup of incidentally detected focal renal masses. We retrospectively analyzed renal CEUS of focal renal masses ≤ 4 cm performed at our center in 143 patients between 2016 and 2020. Patient and lesion characteristics were tested for their influence on focal and overall image quality assessed by two experienced radiologists using Likert scales. Effects of significant variables were quantified by receiver operating characteristics (ROC) curve analysis with area under the curve (AUC), and combined effects were assessed by binary logistic regression. Shrunken kidney, kidney depth, lesion depth, lesion size, and exophytic lesion growth were found to influence focal renal lesion image quality, and all factors except lesion size also influenced overall image quality. Combination of all parameters except kidney depth best predicted good CEUS image quality showing an AUC of 0.91 (p < 0.001, 95%-CI 0.863–0.958). The B-mode US parameters investigated can identify patients expected to have good CEUS image quality and thus help select the most suitable contrast-enhanced imaging strategy for workup of renal lesions.
Highlights
Renal lesions are estimated to occur in 13% to 27% of the general population [1,2,3]
Since the risk of malignancy in solid renal tumors is high with incidences of 87.2% and 83.9% reported by Frank et al and Kutikov et al, respectively [7,8], the choice of a suitable imaging method for reliable differentiation of malignant from benign lesions is essential for the diagnostic process
The cases retrieved by this search were screened regarding the following inclusion criteria: (I) age ≥ 18 years, (II) contrast-enhanced ultrasound (CEUS) examination of a focal renal lesion ≤ 4 cm, and (III) sufficient image data for quality assessment
Summary
Renal lesions are estimated to occur in 13% to 27% of the general population [1,2,3]. Small renal masses (SRMs) defined as lesions ≤ 4 cm, tend to be asymptomatic and are often detected incidentally on imaging [4,5]. Since the risk of malignancy in solid renal tumors is high with incidences of 87.2% and 83.9% reported by Frank et al and Kutikov et al, respectively [7,8], the choice of a suitable imaging method for reliable differentiation of malignant from benign lesions is essential for the diagnostic process. US has many advantages including the absence of ionizing radiation as well as low costs and high availability, a systematic review by Vogel et al identified poor diagnostic performance of conventional US in renal tumors [9], making contrast-enhanced imaging necessary for a reliable characterization. CEUS turned out to have higher diagnostic accuracy than ceCT in the evaluation of complex cystic renal masses [9]
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