Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Urology. 2021 Aug;154:320-325. doi: 10.1016/j.urology.2021.04.032. Epub 2021 May 11.
To prospectively evaluate the diagnostic accuracy of contrast enhanced ultrasound (CEUS) and MRI compared to computed tomography (CT) as the current gold standard for the characterization of cystic renal lesions using the Bosniak classification.
Between July 2014 and October 2017 we prospectively enrolled patients with cystic renal lesions. Based on the Bosniak classification of complex renal lesions (≥BII-F) we evaluated the accuracy of observed agreement by Cohen's Kappa coefficient and calculated sensitivity, specificity, positive and negative predictive values (PPV/NPV) between the three imaging modalities CT, MRI and CEUS.
We evaluated 65 cystic renal lesions in 48 patients (median age 63 years, range 36-91 years; 18 females, 30 males). According to CT 29 (47%) of the cystic renal lesions were classified as complex. The agreement between CEUS and CT in the classification of complex cystic lesions was fair (agreement 50.8%, Kappa 0.31), and was excellent between MRI and CT (agreement 93.9%, Kappa 0.88). Compared to CT, CEUS and MRI had a sensitivity of 100% and 96.6%, a specificity of 33.3% and 91.7%, a PPV of 54.7% and 90.3%, and a NPV of 100% and 97.1% with an accuracy of 63.1% and 93.8% respectively.
CEUS has an excellent sensitivity and NPV and represents a promising non-invasive screening tool for renal cystic lesions. The classification of complex renal cysts based on MRI and CT scans correlated closely.
前瞻性评估对比增强超声（CEUS）和磁共振成像（MRI）与计算机断层扫描（CT）相比作为当前用于对囊性肾脏病变进行特征分析的金标准的诊断准确性，采用 Bosniak 分类法。
我们于 2014 年 7 月至 2017 年 10 月期间前瞻性地招募了患有囊性肾脏病变的患者。基于 Bosniak 分类法（≥BII-F），我们通过 Cohen 的 Kappa 系数评估了观察一致性的准确性，并计算了三种成像方式 CT、MRI 和 CEUS 之间的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
我们评估了 48 例患者的 65 个囊性肾脏病变（中位年龄 63 岁，范围 36-91 岁；18 例女性，30 例男性）。根据 CT，29 个（47%）囊性肾脏病变被归类为复杂病变。CEUS 和 CT 在复杂囊性病变分类中的一致性为中等（一致性 50.8%，Kappa 值为 0.31），而 MRI 和 CT 之间的一致性为极好（一致性 93.9%，Kappa 值为 0.88）。与 CT 相比，CEUS 和 MRI 的敏感性分别为 100%和 96.6%，特异性分别为 33.3%和 91.7%，PPV 分别为 54.7%和 90.3%，NPV 分别为 100%和 97.1%，准确性分别为 63.1%和 93.8%。
CEUS 具有极好的敏感性和阴性预测值，是一种有前途的用于囊性肾脏病变的非侵入性筛查工具。基于 MRI 和 CT 扫描的复杂肾脏囊肿分类密切相关。
