scholarly journals Using Contrast-Enhanced Ultrasound in Addition to Cross-Sectional Imaging for Indeterminate Renal Cysts May Lead to Overclassification in Bosniak III Category: A Case-Control Study

2021 ◽  
pp. 1-6
Author(s):  
François Audenet ◽  
Jordan Sapetti ◽  
Christophe Delavaud ◽  
Virginie Verkarre ◽  
Jean-Michel Correas ◽  
...  
Keyword(s):  
Lower Risk ◽  
Renal Cyst ◽  
Renal Cysts ◽  
Contrast Enhanced Ultrasound ◽  
Pathological Findings ◽  
Cross Sectional ◽  
Contrast Enhanced ◽  
Risk Of Malignancy ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 (<i>p</i> = 0.016) and diagnosis made with CEUS was associated with a lower risk of malignancy (<i>p</i> = 0.040). <b><i>Conclusion:</i></b> 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.

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

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.

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

2017 ◽  
Vol 43 (10) ◽  
pp. 2167-2173 ◽  
Author(s):  
Marilia Henrique Destefani ◽  
Jorge Elias ◽  
Annelise Manzano Serra Negra Trazzi ◽  
Plinio Prizon Kajiwara ◽  
Aila Ferreira de Menezes ◽  
...  
Keyword(s):  
Renal Cysts ◽  
Bosniak Classification ◽  
Cross Sectional ◽  
Ultrasound Evaluation ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Value of contrast-enhanced ultrasound (CEUS) in Focal Liver Lesions (FLL) with inconclusive findings on cross-sectional imaging

2020 ◽  
Vol 74 (3) ◽  
pp. 327-339 ◽  
Author(s):  
Timo Alexander Auer ◽  
Thomas Fischer ◽  
Stephan Rodrigo Marticorena Garcia ◽  
Tobias Penzkofer ◽  
Ernst-Michael Jung ◽  
...  
Keyword(s):  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Point-of-care contrast enhanced lung ultrasound and COVID-19

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110479
Author(s):  
Alice Tee ◽  
Gibran Timothy Yusuf ◽  
Adrian Wong ◽  
Deepak Rao ◽  
Sa Tran ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Patient Demographics ◽  
Pulmonary Angiogram ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Ct Pulmonary Angiogram

Objectives Bedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease. Methods Patient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast. Results The areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r = 0.4) and inflammatory markers, and that these areas improve as patients recover. Conclusions We confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.

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

2020 ◽  
Vol 93 (1111) ◽  
pp. 20200049 ◽  
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.

scholarly journals Proteus empyema as a rare complication from an infected renal cyst, a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kranthikiran Earasi ◽  
Caitlin Welch ◽  
Adam Zelickson ◽  
Clinton Westover ◽  
Chintan Ramani ◽  
...  
Keyword(s):  
Proteus Mirabilis ◽  
Chest Tube ◽  
Renal Cyst ◽  
Primary Source ◽  
Pleural Space ◽  
Tube Placement ◽  
Upper Respiratory Tract ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Abstract Background The most commonly isolated organisms in a parapneumonic effusion include S. pneumoniae, H. influenzae, and S. aureus. If unusual organisms are isolated from the pleural space, further investigation is warranted to locate the primary source. We present a patient with an infected chronic renal cyst found to have an empyema secondary to Proteus mirabilis to highlight the importance of further diagnostic workup when encountering unusual organisms in the pleural space. Case presentation A 40-year-old African-American female, with a past medical history of asthma and sickle cell trait, presented with 5 weeks of upper respiratory tract symptoms and chest pain. A computed tomography angiogram (CTA) of the chest was negative for a pulmonary embolism but revealed a loculated left sided pleural effusion with associated left-lower lobe consolidation. She was started on empiric antibiotics, and a chest tube was inserted with drainage of frank pus. Fluid gram stain was positive for gram negative rods. Intrapleural fibrinolytics were administered for 72 h given the presence of loculations. With no improvement following fibrinolytics, she was taken to the operating room for large bore chest tube placement and left visceral pleura decortication. Pleural fluid cultures speciated to Proteus mirabilis, so further cross-sectional imaging of her abdomen/pelvis was pursued to evaluate for a primary source. A complex cystic lesion in the upper pole of the left kidney that communicated with the ipsilateral diaphragm was identified. Subsequent drainage and culture of the renal cyst was positive for Proteus mirabilis. Given clinical improvement following these interventions she was discharged with an extended course of antibiotics with plans for repeat imaging following completion of treatment. Conclusions While cases of Proteus mirabilis empyema have previously been reported as a consequence of conditions such as pyelonephritis, we present, to our knowledge, the first case of a Proteus mirabilis empyema as a consequence of an infected renal cyst communicating with the pleural space. This study highlights that further evaluation with cross-sectional imaging is warranted when unusual organisms are found in the pleural space. Anatomic abnormalities that become apparent on imaging may help elucidate the source of infection.

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

2014 ◽  
Vol 43 (2) ◽  
pp. 80-90 ◽  
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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