Contrast-Enhanced Ultrasound as a Diagnostic Procedure in Renal Diseases: A Case Report

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Simone Sellitto

Simone Sellitto1, Luciano Tarantino2, Francesco Barone3, Nunzia Barone3, Angelica Perna4, Angela Lucariello5, Germano Guerra4, Antonio De Luca6, Amelia Filippelli7, Carmine Sellitto7

1 Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
2 Department of Surgery, Interventional Hepatology Unit, Luigi Curto Hospital, Polla, Italy
3 Emergency Unit, Dell’Immacolata Hospital, Sapri, Italy
4 Section of Human Anatomy, Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
5 Section of Human Anatomy, Department of Sport Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
6 Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
7 Section of Pharmacology, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy

Corresponding author:
Simone Sellitto
Institute of Radiology, Department of Medicine, University of Udine
via Palladio 8 33100 Udine, Italy.
E-mail: sellitto.simone@spes.uniud.it

 

Abstract

Standard ultrasound (US) finds wide use in renal diseases as a screening procedure, but it is not always able to characterize lesions, especially in differential diagnosis between benign and malignant lesions. In contrast, contrast-enhanced ultrasonography (CEUS) is appropriate in differentiating between solid and cystic lesions as well as between tumors and pseudotumors. We show the case of a nephropathic patient who showed a complex, large, growing renal mass, characterized through a CEUS. This seventy-five-year-old diabetic heart patient showed a 6 cm-complex and plurisected cyst on ultrasound of left kidney. Laboratory data showed the presence of stage IIIb chronic renal failure with GFR 30 ml/min, creatinine 2.33 mg/dl, azotemia 88 mg/dl. The patient performed abdominal CT without contrast medium, showing at the level of the left upper pole, a roundish formation with the dimensions of approximately 70x53x50 mm. At the semiannual checkup, the nephrology examination showed a slight rise in creatinine and, therefore, after six months, it was decided to perform a CT scan without contrast medium again. CT showed a slight increase in the size of the mass located at the left kidney (74x56x57 mm). Given the increased size of the left mass, albeit modest, a CEUS was performed to reach a diriment diagnosis. CEUS concluded for complex cystic formation with presence of intraluminal solid-corpuscular material, with thrombotic-hemorrhagic etiology, in progressive phase of organization, classifiable as Bosniak type II cyst. CEUS in the kidneys is a cost-effective and valuable imaging technique; it is accurate in the characterization of indeterminate lesions and complex cysts.

Keywords: Contrast-Enhanced Ultrasound, CEUS, Renal Cyst, Indeterminate Renal Mass

Introduction

Ultrasound (US) is a non-invasive technique commonly used for first level investigation in renal diseases. It is known to be an easy-to-use and relatively inexpensive approach. Computed tomography (CT) and magnetic resonance (RM) are also used for these indications, but they certainly have a higher cost and risks such as exposure to ionizing radiation in the case of CT. Standard US finds wide use as a screening procedure, but it is not always able to characterize lesions. In fact, lesions may present as isoechoic to the renal parenchyma on grey-scale imaging, and the micro-circulation can be detected with difficulty using Doppler. In addition, the standard US fails to make differential diagnosis between benign and malignant lesions [1].

In contrast, the clinical use of contrast-enhanced ultrasonography (CEUS) in the kidney has been very well defined by the guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2017. Based on these indications, CEUS is appropriate in identifying suspected vascular disorders such as infarction and cortical necrosis; in differentiating between solid and cystic lesions as well as between tumors and pseudotumors. CEUS is useful in the characterization and follow-up of complex cystic masses and in the identification of renal abscesses, as also in radiofrequency ablation of non-surgical masses [2]. 

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CEUS, a world to discover. Three clinical cases and literature review

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Marina Cornacchiari

Marina Cornacchiari1, Anna Mudoni2, Bianca Visciano1, Marco Mereghetti3, Carlo Guastoni1

1 ASST Ovest Milanese, Ospedale Magenta, Nefrologia e Dialisi. Magenta (MI), Italia
2 UOC di Nefrologia e Dialisi, Azienda Ospedaliera Card. G. Panico. Tricase (LE), Italia
3 ASST Ovest Milanese, Ospedale Magenta, Reparto di Medicina. Magenta (MI), Italia
Tutti gli autori hanno partecipato nella stesura dell’articolo in ugual misura

Corrispondenza a:
Dott.ssa Anna Mudoni
U.O. Nefrologia e Dialisi A.O. Card. G. Panico
Via San Pio X, 4
73039 Tricase (Le)
Email: mudonia@libero.it

 

Abstract

Currently, CEUS (Contrast-Enhanced UltraSound) is used in the evaluation of different organs and systems. It offers valuable information about vascular disease, both on a macro- and a micro-vascular level, and has a series of well-established applications in the monitoring of adult patients; official guidelines and recommendations are also available. Its use in a nephrological setting is constantly growing thanks to the lack of nephrotoxicity of the contrast agent, the absence of ionizing radiation and the possibility of characterizing focal pathologies, for diagnosis and in clinical practice. We describe here 3 clinical cases relating to renal diseases and we review the relevant literature with a specific focus on the use of CEUS in a nephro-urological setting.

 

Keywords: Contrast-enhanced ultrasound, CEUS, contrast agents, imaging, microbubbles

Sorry, this entry is only available in Italian.

Introduzione

L’ecografia con contrasto, conosciuta anche come CEUS, acronimo di Contrast-Enhanced Ultrasound, è un tipo particolare di ecografia che consente lo studio della microcircolazione dei parenchimi o di una lesione in esame. Sebbene siano presenti alcune limitazioni intrinseche, legate alla metodica in generale (nel caso di scarsa collaborazione del paziente, obesità, localizzazione profonda di alcune lesioni, ecc.) che possono occasionalmente ostacolare una diagnosi accurata, la CEUS offre la possibilità di studiare il pattern della lesione in esame in tempo reale, pur in assenza di una valutazione simultanea dell’intero organo.

 

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Management of the incidental renal masses

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Anna Mudoni

Anna Mudoni1, Marina Cornacchiari2, Amelia Liccardo3, Pierpaolo Di Nicolo'4, Luca Di Lullo5, Carlo Guastoni2, Marco Mereghetti6

1 Unità Operativa di Nefrologia e Dialisi Ospedale Cardinale G Panico Tricase (LE)
2 Unità Operativa di Nefrologia, ASST MILANO OVEST
3 Unità Operativa di Nefrologia e Dialisi Multimedica Presidio di Castellanza (VA)
4 Unità Operativa di Nefrologia e Dialisi S. Maria della Scaletta, Imola-Bologna
5 Unità Operativa Complessa di Nefrologia e Dialisi, Ospedale “L. Parodi – Delfino”, Colleferro (RM)
6 Unità Operativa di Medicina, ASST MILANO OVEST

Autore corrispondente:
Anna Mudoni
Unità Operativa di Nefrologia e Dialisi
Ospedale Cardinale G Panico Tricase (LE)
Telefono 333 6868124; 0833 773111
E-mail mudonia@libero.it

 

Abstract

The diagnosis of renal masses has increased in the last decades owing to the widespread use of imaging (ultrasound, computed tomography and magnetic resonance).

Majority of the renal masses are detected incidentally on routine ultrasound examination.

Solid masses detected on ultrasound require further imaging evaluation with CT and/or MRI for suitable characterization. US-guided renal biopsy is a safe, effective and accurate method for evaluating the small renal masses with ambiguous radiologic findings.

Navigation technology and multimodality image fusion represent an important development in interventional radiology, especially for performing difficult percutaneous biopsies and ablations of small renal masses.

Multidisciplinary approach is required which results from experience and knowledge and in hard cases the use of serial imaging can be helpful.

 

Keywords: renal masses, imaging, ultrasound, renal biopsy, active surveillance

Sorry, this entry is only available in Italian.

Introduzione

Il riscontro di masse renali durante gli ultimi trent’anni è andato via via aumentando (1) grazie alla diffusione delle tecniche di imaging, in primo luogo l’ecografia (US), ma anche la tomografia assiale computerizzata (TC) e la risonanza magnetica nucleare (MRI).

 

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