Contrast-Enhanced Ultrasound (CEUS) for the Evaluation of Bosniak III Complex Renal Cystic Lesions-A 10-Year Specialized European Single-Center Experience with Histopathological Validation

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2020-12, Vol.56 (12), p.692
• Main Authors: Schwarze, Vincent, Rübenthaler, Johannes, Čečatka, Saša, Marschner, Constantin, Froelich, Matthias Frank, Sabel, Bastian Oliver, Staehler, Michael, Knösel, Thomas, Geyer, Thomas, Clevert, Dirk-André
• Format: Article
• Language: English
• Subjects: Bosniak III; CEUS; Contrast Media; contrast-enhanced ultrasound; Humans; Kidney - diagnostic imaging; Kidney - surgery; Kidney Neoplasms; RCC; renal cysts; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina56120692

: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. : 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010-2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). : CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. : CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future.