Diagnostic accuracy of contrast-enhanced ultrasound for characterization of kidney lesions in patients with and without chronic kidney disease

Emily Hueywen Chang, Wui Kheong Chong, Sandeep Kumar Kasoji, Julia Rose Fielding, Ersan Altun, Lee B. Mullin, Jung In Kim, Jason Peter Fine, Paul Alexander Dayton, Wendy Kimryn Rathmell

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Patients with chronic kidney disease are at increased risk of cystic kidney disease that requires imaging monitoring in many cases. However, these same patients often have contraindications to contrast-enhanced computed tomography and magnetic resonance imaging. This study evaluates the accuracy of contrast-enhanced ultrasound (CEUS), which is safe for patients with chronic kidney disease, for the characterization of kidney lesions in patients with and without chronic kidney disease. Methods: We performed CEUS on 44 patients, both with and without chronic kidney disease, with indeterminate or suspicious kidney lesions (both cystic and solid). Two masked radiologists categorized lesions using CEUS images according to contrast-enhanced ultrasound adapted criteria. CEUS designation was compared to histology or follow-up imaging in cases without available tissue in all patients and the subset with chronic kidney disease to determine sensitivity, specificity and overall accuracy. Results: Across all patients, CEUS had a sensitivity of 96% (95% CI: 84%, 99%) and specificity of 50% (95% CI: 32%, 68%) for detecting malignancy. Among patients with chronic kidney disease, CEUS sensitivity was 90% (95% CI: 56%, 98%), and specificity was 55% (95% CI: 36%, 73%). Conclusions: CEUS has high sensitivity for identifying malignancy of kidney lesions. However, because specificity is low, modifications to the classification scheme for contrast-enhanced ultrasound could be considered as a way to improve contrast-enhanced ultrasound specificity and thus overall performance. Due to its sensitivity, among patients with chronic kidney disease or other contrast contraindications, CEUS has potential as an imaging test to rule out malignancy. Trial registration: This trial was registered in clinicaltrials.gov, NCT01751529.

Original languageEnglish (US)
Article number266
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Aug 9 2017

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Chronic Renal Insufficiency
Kidney
Cystic Kidney Diseases
Neoplasms
Histology
Tomography
Magnetic Resonance Imaging
Sensitivity and Specificity

Keywords

  • Chronic kidney disease
  • Contrast
  • Contrast-enhanced ultrasound
  • Kidney
  • Kidney lesion
  • Ultrasound

ASJC Scopus subject areas

  • Nephrology

Cite this

Diagnostic accuracy of contrast-enhanced ultrasound for characterization of kidney lesions in patients with and without chronic kidney disease. / Chang, Emily Hueywen; Chong, Wui Kheong; Kasoji, Sandeep Kumar; Fielding, Julia Rose; Altun, Ersan; Mullin, Lee B.; Kim, Jung In; Fine, Jason Peter; Dayton, Paul Alexander; Rathmell, Wendy Kimryn.

In: BMC Nephrology, Vol. 18, No. 1, 266, 09.08.2017.

Research output: Contribution to journalArticle

Chang, Emily Hueywen ; Chong, Wui Kheong ; Kasoji, Sandeep Kumar ; Fielding, Julia Rose ; Altun, Ersan ; Mullin, Lee B. ; Kim, Jung In ; Fine, Jason Peter ; Dayton, Paul Alexander ; Rathmell, Wendy Kimryn. / Diagnostic accuracy of contrast-enhanced ultrasound for characterization of kidney lesions in patients with and without chronic kidney disease. In: BMC Nephrology. 2017 ; Vol. 18, No. 1.
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abstract = "Background: Patients with chronic kidney disease are at increased risk of cystic kidney disease that requires imaging monitoring in many cases. However, these same patients often have contraindications to contrast-enhanced computed tomography and magnetic resonance imaging. This study evaluates the accuracy of contrast-enhanced ultrasound (CEUS), which is safe for patients with chronic kidney disease, for the characterization of kidney lesions in patients with and without chronic kidney disease. Methods: We performed CEUS on 44 patients, both with and without chronic kidney disease, with indeterminate or suspicious kidney lesions (both cystic and solid). Two masked radiologists categorized lesions using CEUS images according to contrast-enhanced ultrasound adapted criteria. CEUS designation was compared to histology or follow-up imaging in cases without available tissue in all patients and the subset with chronic kidney disease to determine sensitivity, specificity and overall accuracy. Results: Across all patients, CEUS had a sensitivity of 96{\%} (95{\%} CI: 84{\%}, 99{\%}) and specificity of 50{\%} (95{\%} CI: 32{\%}, 68{\%}) for detecting malignancy. Among patients with chronic kidney disease, CEUS sensitivity was 90{\%} (95{\%} CI: 56{\%}, 98{\%}), and specificity was 55{\%} (95{\%} CI: 36{\%}, 73{\%}). Conclusions: CEUS has high sensitivity for identifying malignancy of kidney lesions. However, because specificity is low, modifications to the classification scheme for contrast-enhanced ultrasound could be considered as a way to improve contrast-enhanced ultrasound specificity and thus overall performance. Due to its sensitivity, among patients with chronic kidney disease or other contrast contraindications, CEUS has potential as an imaging test to rule out malignancy. Trial registration: This trial was registered in clinicaltrials.gov, NCT01751529.",
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AU - Chang, Emily Hueywen

AU - Chong, Wui Kheong

AU - Kasoji, Sandeep Kumar

AU - Fielding, Julia Rose

AU - Altun, Ersan

AU - Mullin, Lee B.

AU - Kim, Jung In

AU - Fine, Jason Peter

AU - Dayton, Paul Alexander

AU - Rathmell, Wendy Kimryn

PY - 2017/8/9

Y1 - 2017/8/9

N2 - Background: Patients with chronic kidney disease are at increased risk of cystic kidney disease that requires imaging monitoring in many cases. However, these same patients often have contraindications to contrast-enhanced computed tomography and magnetic resonance imaging. This study evaluates the accuracy of contrast-enhanced ultrasound (CEUS), which is safe for patients with chronic kidney disease, for the characterization of kidney lesions in patients with and without chronic kidney disease. Methods: We performed CEUS on 44 patients, both with and without chronic kidney disease, with indeterminate or suspicious kidney lesions (both cystic and solid). Two masked radiologists categorized lesions using CEUS images according to contrast-enhanced ultrasound adapted criteria. CEUS designation was compared to histology or follow-up imaging in cases without available tissue in all patients and the subset with chronic kidney disease to determine sensitivity, specificity and overall accuracy. Results: Across all patients, CEUS had a sensitivity of 96% (95% CI: 84%, 99%) and specificity of 50% (95% CI: 32%, 68%) for detecting malignancy. Among patients with chronic kidney disease, CEUS sensitivity was 90% (95% CI: 56%, 98%), and specificity was 55% (95% CI: 36%, 73%). Conclusions: CEUS has high sensitivity for identifying malignancy of kidney lesions. However, because specificity is low, modifications to the classification scheme for contrast-enhanced ultrasound could be considered as a way to improve contrast-enhanced ultrasound specificity and thus overall performance. Due to its sensitivity, among patients with chronic kidney disease or other contrast contraindications, CEUS has potential as an imaging test to rule out malignancy. Trial registration: This trial was registered in clinicaltrials.gov, NCT01751529.

AB - Background: Patients with chronic kidney disease are at increased risk of cystic kidney disease that requires imaging monitoring in many cases. However, these same patients often have contraindications to contrast-enhanced computed tomography and magnetic resonance imaging. This study evaluates the accuracy of contrast-enhanced ultrasound (CEUS), which is safe for patients with chronic kidney disease, for the characterization of kidney lesions in patients with and without chronic kidney disease. Methods: We performed CEUS on 44 patients, both with and without chronic kidney disease, with indeterminate or suspicious kidney lesions (both cystic and solid). Two masked radiologists categorized lesions using CEUS images according to contrast-enhanced ultrasound adapted criteria. CEUS designation was compared to histology or follow-up imaging in cases without available tissue in all patients and the subset with chronic kidney disease to determine sensitivity, specificity and overall accuracy. Results: Across all patients, CEUS had a sensitivity of 96% (95% CI: 84%, 99%) and specificity of 50% (95% CI: 32%, 68%) for detecting malignancy. Among patients with chronic kidney disease, CEUS sensitivity was 90% (95% CI: 56%, 98%), and specificity was 55% (95% CI: 36%, 73%). Conclusions: CEUS has high sensitivity for identifying malignancy of kidney lesions. However, because specificity is low, modifications to the classification scheme for contrast-enhanced ultrasound could be considered as a way to improve contrast-enhanced ultrasound specificity and thus overall performance. Due to its sensitivity, among patients with chronic kidney disease or other contrast contraindications, CEUS has potential as an imaging test to rule out malignancy. Trial registration: This trial was registered in clinicaltrials.gov, NCT01751529.

KW - Chronic kidney disease

KW - Contrast

KW - Contrast-enhanced ultrasound

KW - Kidney

KW - Kidney lesion

KW - Ultrasound

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