Department of Radiology, Ludwig-Maximilians-University Munich, Germany.
Rofo. 2020 Nov;192(11):1053-1059. doi: 10.1055/a-1127-3371. Epub 2020 Apr 15.
To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome.
A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included. Patient ages ranged from 18 to 86 with (mean age 62 years; SD ± 13). CEUS (255 patients), CT (88 out of 255 patients; 34.5 %) and MRI (36 out of 255 patients; 14.1 %) were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome.
CEUS showed a sensitivity of 99.1 % (95 % confidence interval (CI): 96.7 %, 99.9 %), a specificity of 80.5 % (95 % CI: 65.1 %, 91.2 %), a positive predictive value (PPV) of 96.4 % (95 % CI: 93.0 %, 98.4 %) and a negative predictive value (NPV) of 94.3 % (95 % CI: 80.8 %, 99.3 %). CT showed a sensitivity of 97.1 % (95 % CI: 89.9 %, 99.6 %), a specificity of 47.4 % (95 % CI: 24.4 %, 71.1 %), a PPV of 87.0 % (95 % CI: 77.4 %, 93.6 %) and a NPV of 81.8 % (95 % CI: 48.2 %, 97.7 %). MRI showed a sensitivity of 96.4 % (95 % CI: 81.7 %, 99.9 %), a specificity of 75.0 % (95 % CI: 34.9 %, 96.8 %), a PPV of 93.1 % (95 % CI: 77.2 %, 99.2 %) and a NPV of 85.7 % (95 % CI: 42.1 %, 99.6 %). Out of the 212 malignant lesions a total of 130 clear cell renal carcinomas, 59 papillary renal cell carcinomas, 7 chromophobe renal cell carcinomas, 4 combined clear cell and papillary renal cell carcinomas and 12 other malignant lesions, e. g. metastases, were diagnosed. Out of the 43 benign lesions a total 10 angiomyolipomas, 3 oncocytomas, 8 benign renal cysts and 22 other benign lesions, e. g. renal adenomas were diagnosed. Using CEUS, 10 lesions were falsely identified as malignant or benign, whereas 8 lesions were false positive and 2 lesions false negative.
CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to CT and MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method.
· Wide availability. · Safe applicability in patients with known renal insufficiency or allergies to iodine or gadolinium. · Comparable sensitivity, specificity, PPV and NPV to CT and MRT. · May lead to a reduction in interventional radiological or surgical interventions.
· Marschner CA, Ruebenthaler J, Schwarze V et al. Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions. Fortschr Röntgenstr 2020; 192: 1053 - 1058.
比较对比增强超声（CEUS）、计算机断层扫描（CT）和磁共振成像（MRI）在评估不明确的肾脏病变方面的敏感性和特异性与组织病理学结果的关系。
共纳入 2005 年至 2015 年间 255 例单发性不明确肾脏肿块的患者。患者年龄 18-86 岁，平均年龄 62 岁±13 岁。CEUS（255 例患者）、CT（255 例患者中的 88 例；34.5%）和 MRI（255 例患者中的 36 例；14.1%）用于确定良恶性，初始发现与组织病理学结果相关。
CEUS 的敏感性为 99.1%（95%置信区间：96.7%，99.9%），特异性为 80.5%（95%置信区间：65.1%，91.2%），阳性预测值（PPV）为 96.4%（95%置信区间：93.0%，98.4%），阴性预测值（NPV）为 94.3%（95%置信区间：80.8%，99.3%）。CT 的敏感性为 97.1%（95%置信区间：89.9%，99.6%），特异性为 47.4%（95%置信区间：24.4%，71.1%），PPV 为 87.0%（95%置信区间：77.4%，93.6%），NPV 为 81.8%（95%置信区间：48.2%，97.7%）。MRI 的敏感性为 96.4%（95%置信区间：81.7%，99.9%），特异性为 75.0%（95%置信区间：34.9%，96.8%），PPV 为 93.1%（95%置信区间：77.2%，99.2%），NPV 为 85.7%（95%置信区间：42.1%，99.6%）。212 例恶性病变中，共诊断出 130 例透明细胞肾细胞癌、59 例乳头状肾细胞癌、7 例嫌色细胞肾细胞癌、4 例透明细胞和乳头状肾细胞癌混合癌和 12 例其他恶性病变，例如转移瘤。43 例良性病变中，共诊断出 10 例血管平滑肌脂肪瘤、3 例嗜酸细胞瘤、8 例良性肾囊肿和 22 例其他良性病变，例如肾腺瘤。CEUS 错误地将 10 个病变识别为恶性或良性，而 8 个病变为假阳性，2 个病变为假阴性。
CEUS 是一种有用的方法，可以额外用于临床区分恶性和良性肾脏病变。CEUS 与 CT 和 MRI 具有相似的敏感性、特异性、PPV 和 NPV。在日常临床实践中，患有其他成像方式禁忌症的患者尤其可以受益于该方法。
广泛应用。
安全适用于已知肾功能不全或对碘或钆过敏的患者。
与 CT 和 MRI 具有相似的敏感性、特异性、PPV 和 NPV。
可能导致减少介入放射学或手术干预。
