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DOI: 10.1148/radiol.2431051924
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(Radiology 2007;243:158-165.)
© RSNA, 2007

Genitourinary Imaging

Complex Cystic Renal Masses: Characterization with Contrast-enhanced US1

Giorgio Ascenti, MD, Silvio Mazziotti, MD, Giovanni Zimbaro, MD, Nicola Settineri, MD, Carlo Magno, MD, Darwin Melloni, MD, Rosario Caruso, MD and Emanuele Scribano, MD

1 From the Department of Radiological Sciences (G.A., S.M., G.Z., N.S., E.S.), Clinic of Urology (C.M., D.M.), and Department of Pathology (R.C.), University of Messina, via Consolare Valeria-Gazzi, 98100 Messina, Italy. Received November 26, 2005; revision requested January 19, 2006; revision received February 22; accepted March 10; final version accepted August 23. Address correspondence to S.M. (e-mail: smazziotti{at}unime.it).

Purpose: To prospectively compare contrast material–enhanced ultrasonography (US) with computed tomography (CT) in the classification of complex cystic renal masses with the Bosniak system.

Materials and Methods: Ethics committee approval and written informed consent were obtained. Forty patients (17 women, 23 men; age range, 31–77 years) with 44 complex cystic renal masses detected with conventional US were prospectively examined by using second-harmonic US with a second-generation contrast agent and multiphasic helical CT. Thirty-six patients had one lesion, and four patients had two lesions. Surgical resection in nine patients and imaging follow-up in 31 patients were used to determine the outcome.

Results: On contrast-enhanced US images, masses were classified as Bosniak category II (n = 18), IIF (ie, lesions were classified as category II and follow-up was needed) (n = 16), III (n = 7), or IV (n = 3) lesions. On CT images, masses were classified as Bosniak category II (n = 24), IIF (n = 10), III (n = 7), or IV (n = 3) lesions. Interobserver agreement was high ({kappa} = 0.86, P < .001) for classification with US. Complete concordance between the readers was found for classification with CT. Complete concordance between contrast-enhanced US and CT was observed in the differentiation of surgical and nonsurgical complex cysts. Complete concordance among the three readers in the assessment of vascularity with contrast-enhanced US was found. Interobserver agreement in the evaluation of enhancement on CT images was high ({kappa} = 0.88, P < .001). Concordance between contrast-enhanced US and CT in the evaluation of vascularization was high ({kappa} = 0.77, P < .001).

Conclusion: The study data suggest that contrast-enhanced second-harmonic US is appropriate for renal cyst classification with the Bosniak system.

© RSNA, 2007




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