Claire Cuscaden MBBS, Presenter: Nothing to Disclose

Alain M. Lavoipierre MD, Abstract Co-Author: Nothing to Disclose

Mark Frydenberg MBBS, Abstract Co-Author: Nothing to Disclose

Daniel Moon MBBS, Abstract Co-Author: Nothing to Disclose

Mark Smyth, Abstract Co-Author: Nothing to Disclose

Melissa Scott, Abstract Co-Author: Nothing to Disclose

The aim of this study was to assess further the role of contrast enhanced ultrasound (CEUS) in the characterisation of renal lesions, with an emphasis on Bosniak 2F lesions.

Over a 40 month period, a total of 90 CEUS examinations were performed at our institution, involving 65 patients with a total of 77 lesions. All patients had had prior CT, MRI or, less commonly, US examinations. All patients were examined on Philips iU22 equipment, with the administration of intravenous boluses of intravenous perflutren (Definity TM). The examinations were all performed by a single radiologis. In those patients who subsequently underwent core biopsy 18G Bard Biopty equipment was used. Sonographically, the lesions were classified as cystic or solid, and the cysts characterised according to the Bosniak classification.

In total, 77 lesions were examined after CT Bosniak grading. Of these, the CT graded Bosniak 2F lesions comprised 32% (n=25). All were reclassified according to imaging characteristics on CEUS with 28% downgraded to Bosniak 1 and 2 (confirmed stability with 2 year follow up). 40% were upgraded to Bosniak 3 and 8% remained as Bosniak 2F. 16% (n=12) were CT graded as Bosniak 3 on CT. 60% contained features consistent with Bosniak III. 20% were upgraded to Bosniak IV (confirmed with histology) and 20% were downgraded to Bosniak II. All CEUS graded Bosniak 4 lesions were confirmed to be malignant on histology. Of the solid, malignant appearing lesions examined with CEUS, 94% were confirmed as such with histology.

CEUS offers improved contrast resolution relative to CT or MRI and plays an important role in the characterisation of renal lesions by • Helping to visualise vascularity in solid lesions or in solid components of cystic lesions with borderline or difficult to assess enhancement on CT or MRI • Upgrading or downgrading lesion as a consequence of the improved contrast resolution which therefore allows better visualisation of lesion vascularity

• Virtually abolishing the Bosniak 2F category • Allowing assessment or follow up of renal lesions, particularly in patients with impaired renal function or allergy to iodinated contrast medium, and also to avoid excessive radiation in patients requiring longer term follow up.

Cuscaden, C, Lavoipierre, A, Frydenberg, M, Moon, D, Smyth, M, Scott, M, Refining the Role of Contrast Enhanced Ultrasound in the Characterisation of Renal Lesions.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017516.html