Walmer Rachel W, Ritter Victor S, Sridharan Anush, Kasoji Sandeep K, Altun Ersan, Lee Ellie, Olinger Kristen, Wagner Sean, Radhakrishna Roshni, Johnson Kennita A, Rathmell W Kimryn, Qaqish Bahjat, Dayton Paul A, Chang Emily H
Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA.
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
J Clin Med. 2023 Oct 12;12(20):6494. doi: 10.3390/jcm12206494.
We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe kidney disease, CT and MRI contrast agents may be contraindicated. Contrast-enhanced ultrasound (CEUS) is a safe alternative for characterizing these lesions, but data on its performance among CKD patients are limited. We performed flash replenishment CEUS in 60 CKD patients (73 lesions). Final analysis included 53 patients (63 lesions). Four readers, blinded to true diagnosis, interpreted each lesion. Reader evaluations were compared to true lesion classifications. Performance metrics were calculated to assess malignant and benign diagnoses. Reader agreement was evaluated using Bowker's symmetry test. Combined reader sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant lesions were 71%, 75%, 45%, and 90%, respectively. Sensitivity (81%) and specificity (83%) were highest in CKD IV/V patients when grouped by CKD stage. Combined reader sensitivity, specificity, PPV, and NPV for diagnosing benign lesions were 70%, 86%, 91%, and 61%, respectively. Again, in CKD IV/V patients, sensitivity (81%), specificity (95%), and PPV (98%) were highest. Inter-reader diagnostic agreement varied from 72% to 90%. In CKD patients, CEUS is a potential low-risk option for screening kidney lesions. CEUS may be particularly beneficial for CKD IV/V patients, where kidney preservation techniques are highly relevant.
我们研究了超声造影（CEUS）对慢性肾脏病（CKD）患者肾囊性和实性病变特征的诊断准确性。囊性病变采用用于计算机断层扫描（CT）和磁共振成像（MRI）的博斯尼亚克标准进行评估；然而，对于中重度肾脏病患者，CT和MRI造影剂可能是禁忌的。超声造影（CEUS）是一种用于明确这些病变特征的安全替代方法，但关于其在CKD患者中的表现的数据有限。我们对60例CKD患者（73个病变）进行了快速补充CEUS检查。最终分析纳入53例患者（63个病变）。四位对真实诊断不知情的阅片者对每个病变进行解读。将阅片者的评估结果与病变的真实分类进行比较。计算性能指标以评估恶性和良性诊断。使用鲍克对称性检验评估阅片者间的一致性。联合阅片者诊断恶性病变的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为71%、75%、45%和90%。按CKD分期分组时，CKD Ⅳ/Ⅴ期患者的敏感性（81%）和特异性（83%）最高。联合阅片者诊断良性病变的敏感性、特异性、PPV和NPV分别为70%、86%、91%和61%。同样，在CKD Ⅳ/Ⅴ期患者中，敏感性（81%）、特异性（95%）和PPV（98%）最高。阅片者间的诊断一致性在72%至90%之间。在CKD患者中，CEUS是筛查肾病变的一种潜在低风险选择。CEUS可能对CKD Ⅳ/Ⅴ期患者特别有益，因为肾脏保留技术在该期高度相关。
