Jean-Michel Correas MD,PhD, Abstract Co-Author: Nothing to Disclose

Eric Dekeyser MD, Abstract Co-Author: Nothing to Disclose

Francois Tranquart MD, Abstract Co-Author: Nothing to Disclose

Aurore Bleuzen MD, Abstract Co-Author: Nothing to Disclose

Arnaud Mejean MD, Abstract Co-Author: Nothing to Disclose

Michel Claudon MD, Presenter: Nothing to Disclose

Olivier Helenon MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the accuracy of real time contrast-enhanced sonography (CE-US) of renal cystic masses in order to classify the lesions according to the presence of vascularity in the cystic walls using BR1 (SonoVue®, Bracco, Italy) or FSO69 (Optison®, Mallinckrodt, USA) in correlation to CT and MRI.

Fourty-four patients presenting with a complex cystic lesion at US were enrolled in this study. Fourty nine lesions were studied with conventional B mode, color Doppler US and harmonic imaging at baseline. Following a bolus of BR1 (2.4 ml) or FSO69 (2-3 ml), the renal lesions were continuously scanned at low mechanical index with imaging sequences specific to ultrasound contrast imaging (Aplio - Toshiba MS, Sequoia – Siemens, HDI 5000 – Philips US). The final diagnosis was obtained by CT, MRI, surgery and/or follow-up (30 benign lesions, 18 cystic malignant tumors, and 1 false aneurism). The sensitivity for the detection of vascularity in cystic walls and the pattern of enhancement were compared between CE-US and CT alone, MRI alone, and CT+MRI combined. The pattern of enhancement was compared to pathology when available (22 lesions).

The normal cortex strongly enhanced in all cases. CE-US detected the vascularity in cystic walls and was correlated to combined MRI and CT (sensitivity 98%). No false positive was identified at CE-US when the gold standard was the combined CT + MRI examination. All tumoral mural nodules (n = 10) were detected during CE-US. In 4 cases of non tumoral thickening of the cystic walls, the enhancement was seen at CE-US in two hemorrhagic cysts and was correlated to MRI. Diagnosis was confirmed by the follow-up. In the remaining case, the nodule did not enhance and was considered as benign with no change during follow-up. The sensitivity of CT and MRI for the detection of the enhancement in cystic walls and mural nodules was 89% and 95% respectively, when the reference imaging modality was the combined results of MRI + CT.

Real time CE-US is an efficient modality for the detection of vascularity in complex renal cystic lesions, and thus improves their characterization.

J.C.,F.T.: Dr JM Correas and Dr F Tranquart are consultant for Altana France.

Correas, J, Dekeyser, E, Tranquart, F, Bleuzen, A, Mejean, A, Claudon, M, Helenon, O, et al, , Accuracy of Contrast-enhanced Sonography in the Diagnosis of Complex Renal Cystic Masses.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4409109.html