Impact of contrast-enhanced ultrasound in patients with renal function impairment

• Published in: World journal of radiology Vol. 9; no. 1; pp. 10 - 16
• Main Authors: Girometti, Rossano, Stocca, Tiziano, Serena, Elena, Granata, Antonio, Bertolotto, Michele
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 28.01.2017
• Subjects: Retrospective Study; Renal lesions; Renal function impairment; Bosniak classification; Contrast-enhanced ultrasonography; Acute renal failure; Renal cysts; Renal infarction
• ISSN: 1949-8470; 1949-8470
• DOI: 10.4329/wjr.v9.i1.10

AIM To investigate the role of contrast enhanced ultrasound(CEUS) in evaluating patients with renal function impairment(RFI) showing:(1) acute renal failure(ARF) of suspicious vascular origin; or(2) suspicious renal lesions.METHODS We retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF(first group of 50 subjects) or assess previously found suspicious renal lesions(second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 m L of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTS In the first group, CEUS detected renal infarction orcortical ischemia in 18/50 patients(36%; 95%CI: 23.3-50.9) and 1/50 patients(2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher(P = 0.0002; Mc Nemar test) compared to color Doppler ultrasonography(10%). No vascular causes of ARF were identified in the remaining 31/50 patients(62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions(21/41; 51.2%) vs complex cysts(20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions(surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak Ⅱ, ⅡF, Ⅲ and Ⅳ in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSION CEUS showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.