HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Quaia, E. Articles by Cova, M. A. Search for Related Content PubMed PubMed Citation Articles by Quaia, E. Articles by Cova, M. A. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Comparison of Contrast-Enhanced Sonography with Unenhanced Sonography and Contrast-Enhanced CT in the Diagnosis of Malignancy in Complex Cystic Renal Masses

¹ All authors: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.

View larger version (41K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Drawings show different vascularity profiles that may be observed in complex cystic renal masses after microbubble contrast agent injection. Profiles shown in A–C were considered diagnostic for benignancy, whereas profiles shown in D–F were considered diagnostic for malignancy. Evidence of contrast enhancement in hairline-thin septa (< 2 mm).

View larger version (56K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Drawings show different vascularity profiles that may be observed in complex cystic renal masses after microbubble contrast agent injection. Profiles shown in A–C were considered diagnostic for benignancy, whereas profiles shown in D–F were considered diagnostic for malignancy. Continuous or discontinuous enhancement of peripheral wall.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Drawings show different vascularity profiles that may be observed in complex cystic renal masses after microbubble contrast agent injection. Profiles shown in A–C were considered diagnostic for benignancy, whereas profiles shown in D–F were considered diagnostic for malignancy. Enhancement involving both peripheral wall and hairline-thin intracystic septa.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Drawings show different vascularity profiles that may be observed in complex cystic renal masses after microbubble contrast agent injection. Profiles shown in A–C were considered diagnostic for benignancy, whereas profiles shown in D–F were considered diagnostic for malignancy. Peripheral enhancing mural nodules.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Drawings show different vascularity profiles that may be observed in complex cystic renal masses after microbubble contrast agent injection. Profiles shown in A–C were considered diagnostic for benignancy, whereas profiles shown in D–F were considered diagnostic for malignancy. Peripheral enhancing wall combined with thickened enhancing septa (> 2 mm).

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Drawings show different vascularity profiles that may be observed in complex cystic renal masses after microbubble contrast agent injection. Profiles shown in A–C were considered diagnostic for benignancy, whereas profiles shown in D–F were considered diagnostic for malignancy. Peripheral thickened enhancing wall with thickened enhancing septa and enhancing mural and septal nodules.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Complex benign cystic renal mass (stable at 24-month follow-up) on right kidney in 47-year-old woman. Longitudinal baseline sonography image of right kidney shows 4-cm multiloculated cystic mass (arrow) with several thin septa.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Complex benign cystic renal mass (stable at 24-month follow-up) on right kidney in 47-year-old woman. Longitudinal contrast-enhanced sonography images obtained by contrast-specific mode Cadence Contrast Pulse Sequencing (Acuson–Siemens Medical Solutions). Software suppresses tissue background, with almost complete cancellation of intracystic septa with evidence of only slight enhancement in thin intracystic septa (arrow, B) during arterial phase (B). Cystic lesion (arrow, C) was classified as benign after review of contrast-enhanced sonography scan (C). Transverse contrast-enhanced CT image of right kidney obtained during nephrographic phase shows evident septa and intracystic septal calcification. Lesion was classified as Bosniak IIF lesion. Cystic lesion underwent imaging follow-up on CT, which revealed no increase in diameter and no change in morphology or contrast enhancement.

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Complex benign cystic renal mass (stable at 24-month follow-up) on right kidney in 47-year-old woman. Longitudinal contrast-enhanced sonography images obtained by contrast-specific mode Cadence Contrast Pulse Sequencing (Acuson–Siemens Medical Solutions). Software suppresses tissue background, with almost complete cancellation of intracystic septa with evidence of only slight enhancement in thin intracystic septa (arrow, B) during arterial phase (B). Cystic lesion (arrow, C) was classified as benign after review of contrast-enhanced sonography scan (C). Transverse contrast-enhanced CT image of right kidney obtained during nephrographic phase shows evident septa and intracystic septal calcification. Lesion was classified as Bosniak IIF lesion. Cystic lesion underwent imaging follow-up on CT, which revealed no increase in diameter and no change in morphology or contrast enhancement.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Complex renal mass on right kidney in 55-year-old man. Transverse baseline sonography image of right kidney (K) shows 5-cm solidlike renal mass (arrow) with corpuscular pattern.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Complex renal mass on right kidney in 55-year-old man. Transverse contrast-enhanced sonography image obtained by contrast-specific mode Cadence Contrast Pulse Sequencing (Acuson–Siemens Medical Solutions) shows discontinuous enhancement in peripheral thickened wall (arrow) sparing cystic portion of lesions. Lesion was classified as benign according to contrast-enhanced sonography vascularity pattern.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Complex renal mass on right kidney in 55-year-old man. Coronal reformation from contrast-enhanced CT image of right kidney obtained during nephrographic phase shows evident cystic pattern with peripheral wall thickening (> 2 mm) (arrow). Lesion was classified as Bosniak III lesion and was considered indeterminate at retrospective CT analysis. Histologic analysis of surgical specimen revealed complicated hemorrhagic cyst.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Complex renal mass on right kidney in 32-year-old woman. Transverse baseline sonography image of right kidney shows 3-cm multiloculated cystic mass (arrow) with some thin septa.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Complex renal mass on right kidney in 32-year-old woman. Transverse contrast-enhanced sonography images obtained by contrast-specific mode Contrast Tuned Imaging (Esaote) show contrast enhancement in both peripheral wall (arrows, B; large arrow, C) and hairline-thin intracystic septa (small arrow, C) during arterial phase. Lesion was classified as benign according to contrast-enhanced sonography vascularity pattern.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Complex renal mass on right kidney in 32-year-old woman. Transverse contrast-enhanced sonography images obtained by contrast-specific mode Contrast Tuned Imaging (Esaote) show contrast enhancement in both peripheral wall (arrows, B; large arrow, C) and hairline-thin intracystic septa (small arrow, C) during arterial phase. Lesion was classified as benign according to contrast-enhanced sonography vascularity pattern.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Complex renal mass on right kidney in 32-year-old woman. Transverse contrast-enhanced CT image of right kidney obtained during nephrographic phase shows thickened enhancing wall (arrow). Lesion was classified as Bosniak category III lesion and was considered indeterminate at retrospective CT analysis. Histologic analysis of surgical specimen revealed multilocular cystic nephroma. (Reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25])

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Complicated malignant cystic renal mass on right kidney in 58-year-old man. (B and C reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25]) Longitudinal baseline sonography image shows solidlike mass (arrow) in lower pole of right kidney.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Complicated malignant cystic renal mass on right kidney in 58-year-old man. (B and C reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25]) Contrast-enhanced sonography image of right kidney obtained by contrast-specific mode Contrast Tuned Imaging (Esaote)shows 6-cm uniloculate cystic mass with several enhancing mural nodules (arrows). Lesion was classified as malignant according to contrast-enhanced sonography vascularity pattern.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Complicated malignant cystic renal mass on right kidney in 58-year-old man. (B and C reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25]) Transverse contrast-enhanced CT image of right kidney obtained during nephrographic phase shows complex renal mass with peripheral enhancing mural nodules (arrow). Lesion was classified as malignant according to Bosniak classification. Histologic analysis of surgical specimen revealed cystic clear cell renal cell carcinoma.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Complicated malignant cystic renal mass on left kidney in 78-year-old man. (A and C reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25]) Oblique contrast-enhanced sonography images of left kidney obtained by contrast-specific mode Contrast Tuned Imaging (Esaote) show 8-cm multiloculated cystic mass with several enhancing thickened septa, mural nodules (arrows, A), and septal nodules. Lesion was classified as malignant according to contrast-enhanced sonography vascularity pattern.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Complicated malignant cystic renal mass on left kidney in 78-year-old man. (A and C reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25]) Oblique contrast-enhanced sonography images of left kidney obtained by contrast-specific mode Contrast Tuned Imaging (Esaote) show 8-cm multiloculated cystic mass with several enhancing thickened septa, mural nodules (arrows, A), and septal nodules. Lesion was classified as malignant according to contrast-enhanced sonography vascularity pattern.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Complicated malignant cystic renal mass on left kidney in 78-year-old man. (A and C reprinted with permission from Quaia E, ed. Contrast media in ultrasonography: basic principles and clinical applications. Heidelberg, Germany: Springer-Verlag, 2005 [25]) Transverse contrast-enhanced CT image of left kidney obtained during nephrographic phase shows complex renal mass (arrow) with thickened enhancing septa. Lesion was classified as malignant according to Bosniak classification. Histologic analysis of surgical specimen revealed cystic clear cell renal cell carcinoma.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Graphs show receiver operating characteristic (ROC) curve analyses for individual readers for CT (dotted line), contrast-enhanced sonography (solid line), and baseline sonography (dashed line). Diagonal gray line represents hypothetical technique that is unable to distinguish malignant from benign cystic renal masses. Graphs show ROC curves for readers 1 (A), 2 (B), and 3 (C). Area under each ROC curve expresses each reader's diagnostic confidence in diagnosis of malignancy. Difference in diagnostic confidence between contrast-enhanced sonography and CT was not statistically significant.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Graphs show receiver operating characteristic (ROC) curve analyses for individual readers for CT (dotted line), contrast-enhanced sonography (solid line), and baseline sonography (dashed line). Diagonal gray line represents hypothetical technique that is unable to distinguish malignant from benign cystic renal masses. Graphs show ROC curves for readers 1 (A), 2 (B), and 3 (C). Area under each ROC curve expresses each reader's diagnostic confidence in diagnosis of malignancy. Difference in diagnostic confidence between contrast-enhanced sonography and CT was not statistically significant.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Graphs show receiver operating characteristic (ROC) curve analyses for individual readers for CT (dotted line), contrast-enhanced sonography (solid line), and baseline sonography (dashed line). Diagonal gray line represents hypothetical technique that is unable to distinguish malignant from benign cystic renal masses. Graphs show ROC curves for readers 1 (A), 2 (B), and 3 (C). Area under each ROC curve expresses each reader's diagnostic confidence in diagnosis of malignancy. Difference in diagnostic confidence between contrast-enhanced sonography and CT was not statistically significant.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati