Minimally Complex Renal Cysts: Outcomes and Ultrasound Evaluation Compared with Contrast-Enhanced Cross-Sectional Imaging Bosniak Classification

Introduction: Indeterminate renal cysts may require several imaging modalities before clinical decision. The aim of this study was to investigate the effect of the imaging modality used to characterize indeterminate renal cysts on the pathological findings after surgical resection. Methods: From our institutional database, we identified all patients surgically treated for Bosniak III renal masses between January 2008 and January 2018. All complex renal cysts were characterized with a combination of computed tomography (CT) and/or magnetic resonance imaging (MRI), and/or contrast-enhanced ultrasound (CEUS) and discussed during a multidisciplinary tumor board. Potential association between clinical/radiological characteristics and the pathological findings were investigated, using univariate and multivariate analyses. Results: Of the 52 renal cystic lesions surgically removed, with a preoperative diagnosis of Bosniak III renal cyst, 19 (37%) were malignant and 33 (63%) were benign. The proportion of malignant lesions decreased from 47% when the renal cyst was characterized with cross-sectional imaging (CT and/or MRI) to 17% when the diagnosis required CEUS in addition to cross-sectional imaging. In multivariate analysis, prior history of renal cell carcinoma was associated with a higher risk of malignancy (p = 0.016) and diagnosis made with CEUS was associated with a lower risk of malignancy (p = 0.040). Conclusion: We found that using CEUS in addition to cross-sectional imaging to characterize indeterminate renal cysts tends to redefine Bosniak III as lesions with a lower risk of malignancy and can lead to overclassification.

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Evaluation of genitourinary fistulas in pelvic malignancies with etiopathologic correlation: role of cross sectional imaging in detection and management

British Journal of Radiology ◽

10.1259/bjr.20200049 ◽

2020 ◽

Vol 93 (1111) ◽

pp. 20200049 ◽

Cited By ~ 1

Author(s):

Anitha Mandava ◽

Veeraiah Koppula ◽

Gaurav Sharma ◽

Meghana Kandati ◽

K.V.V.N. Raju ◽

...

Keyword(s):

Imaging Findings ◽

Cross Sectional ◽

Pelvic Malignancies ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Ct And Mri

Objective: Genitourinary fistulas in pelvic malignancies are abnormal communications occurring due to either locally advanced tumours invading the surrounding organs or post-therapeutic complications of malignancies. In this article we review and describe the role of cross-sectional imaging findings in the management of genitourinary fistulas in pelvic malignancies. Methods: A retrospective study, for the period January 2012 to December 2018, was undertaken in patients with pelvic malignancies having genitourinary fistulas. The cross-sectional (CT and MRI) imaging findings in various types of fistulas were reviewed and correlated with the primary malignancy and the underlying etiopathology. Results: Genitourinary fistulas were observed in 71 patients (6 males, 65 females). 11 types of fistulas were identified in carcinomas of cervix, rectum, ovary, urinary bladder, sigmoid colon, vault, endometrium and prostate. The commonest were rectovaginal and vesicovaginal fistulas. 13 patients had multiple fistulas. The sensitivity, specificity, positive and negative predictive values of CT and MRI are 98%, 100%, 66%, 98% and 95%, 25%, 88% and 50% respectively. Contrast-enhanced CT with oral and rectal contrast is more sensitive and specific than MRI in the evaluation of genitourinary fistulas. Conclusion: Imaging findings significantly influence the management and outcome of genitourinary fistulas in pelvic malignancies. Contrast-enhanced CT is the imaging modality of choice in the evaluation of pelvic fistulas associated with malignancies and MRI is complimentary to it. Advances in knowledge: To our knowledge, this study is the first of its kind wherein the mean duration of occurrence of fistulas in pelvic malignancies is correlated with the underlying etiopathology.

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Complications of Sporadic, Hereditary, and Acquired Renal Cysts: Cross-Sectional Imaging Findings

Current Problems in Diagnostic Radiology ◽

10.1067/j.cpradiol.2013.12.002 ◽

2014 ◽

Vol 43 (2) ◽

pp. 80-90 ◽

Cited By ~ 6

Author(s):

Massimo Tonolini ◽

Francesca Rigiroli ◽

Federica Villa ◽

Roberto Bianco

Keyword(s):

Renal Cysts ◽

Imaging Findings ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Arterial Portography during Transarterial Chemoembolization: Still a Necessity in the Age of Contrast-enhanced Cross-sectional Imaging?

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.10.014 ◽

2014 ◽

Vol 25 (1) ◽

pp. 41-46 ◽

Cited By ~ 3

Author(s):

Terrence C.H. Hui ◽

Uei Pua

Keyword(s):

Transarterial Chemoembolization ◽

Cross Sectional ◽

Arterial Portography ◽

Contrast Enhanced ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor

Acta Radiologica ◽

10.1177/0284185120939291 ◽

2020 ◽

pp. 028418512093929

Author(s):

Paul Spiesecke ◽

Thomas Fischer ◽

Andreas Maxeiner ◽

Bernd Hamm ◽

Markus H Lerchbaumer

Keyword(s):

Predictive Value ◽

Fast Method ◽

Contrast Enhanced Ultrasound ◽

Cross Sectional ◽

Contrast Enhanced ◽

Cross Sectional Imaging ◽

Renal Pseudotumor ◽

Sectional Imaging ◽

Rule Out

Background Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. Purpose To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. Material and Methods Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. Results CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57–98), 96% specificity (95% CI 80–99), a positive predictive value of 89% (95% CI 57–98), and a negative predictive value of 96% (95% CI 79–99) for ruling out renal malignancy in developmental pseudotumors. Conclusion CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.

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Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis

Scientific Reports ◽

10.1038/s41598-021-81690-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paul Spiesecke ◽

Frédéric Münch ◽

Thomas Fischer ◽

Bernd Hamm ◽

Markus H. Lerchbaumer

Keyword(s):

Contrast Agent ◽

Kidney Failure ◽

Resistance Index ◽

Imaging Features ◽

Cross Sectional ◽

Cortical Necrosis ◽

Renal Cortical Necrosis ◽

Contrast Enhanced ◽

Cross Sectional Imaging ◽

Sectional Imaging

AbstractRenal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (> 20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI > 1 or not measurable due to hypoperfusion as differentiator, p = 0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent.

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