Chang Emily Hueywen, Chong Wui Kheong, Kasoji Sandeep Kumar, Fielding Julia Rose, Altun Ersan, Mullin Lee B, Kim Jung In, Fine Jason Peter, Dayton Paul Alexander, Rathmell Wendy Kimryn
University of North Carolina, 7024 Burnett Womack, CB 7155, Chapel Hill, NC, 27599, USA.
Diagnostic Radiology, Abdominal Imaging Section, The University of Texas MD Anderson Cancer Center, Unit 1473 FCT15.5092, 1400 Pressler Street, Houston, TX, 77030, USA.
BMC Nephrol. 2017 Aug 9;18(1):266. doi: 10.1186/s12882-017-0681-8.
Patients with chronic kidney disease are at increased risk of cystic kidney disease that requires imaging monitoring in many cases. However, these same patients often have contraindications to contrast-enhanced computed tomography and magnetic resonance imaging. This study evaluates the accuracy of contrast-enhanced ultrasound (CEUS), which is safe for patients with chronic kidney disease, for the characterization of kidney lesions in patients with and without chronic kidney disease.
We performed CEUS on 44 patients, both with and without chronic kidney disease, with indeterminate or suspicious kidney lesions (both cystic and solid). Two masked radiologists categorized lesions using CEUS images according to contrast-enhanced ultrasound adapted criteria. CEUS designation was compared to histology or follow-up imaging in cases without available tissue in all patients and the subset with chronic kidney disease to determine sensitivity, specificity and overall accuracy.
Across all patients, CEUS had a sensitivity of 96% (95% CI: 84%, 99%) and specificity of 50% (95% CI: 32%, 68%) for detecting malignancy. Among patients with chronic kidney disease, CEUS sensitivity was 90% (95% CI: 56%, 98%), and specificity was 55% (95% CI: 36%, 73%).
CEUS has high sensitivity for identifying malignancy of kidney lesions. However, because specificity is low, modifications to the classification scheme for contrast-enhanced ultrasound could be considered as a way to improve contrast-enhanced ultrasound specificity and thus overall performance. Due to its sensitivity, among patients with chronic kidney disease or other contrast contraindications, CEUS has potential as an imaging test to rule out malignancy.
This trial was registered in clinicaltrials.gov, NCT01751529 .
慢性肾病患者患囊性肾病的风险增加，在许多情况下需要进行影像监测。然而，这些患者往往存在对比增强计算机断层扫描和磁共振成像的禁忌证。本研究评估了对慢性肾病患者安全的对比增强超声（CEUS）在有或无慢性肾病患者中对肾脏病变特征的识别准确性。
我们对44例有或无慢性肾病、存在不确定或可疑肾脏病变（包括囊性和实性）的患者进行了CEUS检查。两名放射科医生根据对比增强超声适用标准，使用CEUS图像对病变进行分类。在所有患者以及慢性肾病亚组中，将CEUS诊断结果与无可用组织病例的组织学检查或随访影像进行比较，以确定敏感性、特异性和总体准确性。
在所有患者中，CEUS检测恶性肿瘤的敏感性为96%（95%置信区间：84%，99%），特异性为50%（95%置信区间：32%，68%）。在慢性肾病患者中，CEUS敏感性为90%（95%置信区间：56%，98%），特异性为55%（95%置信区间：36%，73%）。
CEUS在识别肾脏病变恶性肿瘤方面具有高敏感性。然而，由于特异性较低，可考虑对对比增强超声分类方案进行修改，以提高对比增强超声的特异性，从而改善整体性能。由于其敏感性，在慢性肾病患者或其他对比禁忌证患者中，CEUS有作为排除恶性肿瘤的影像检查的潜力。
本试验在clinicaltrials.gov注册，注册号为NCT01751529。
