The Performance of Flash Replenishment Contrast-Enhanced Ultrasound for the Qualitative Assessment of Kidney Lesions in Patients with Chronic Kidney Disease

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  • Walmer, Rachel W.
    • Affiliation: School of Medicine, Joint Department of Biomedical Engineering, North Carolina State University
  • Ritter, Victor S.
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics
  • Sridharan, Anush
    • Affiliation: School of Medicine, Joint Department of Biomedical Engineering, North Carolina State University
  • Kasoji, Sandeep K.
    • Affiliation: School of Medicine, Joint Department of Biomedical Engineering, North Carolina State University
  • Altun, Ersan
    • Affiliation: School of Medicine, Department of Radiology
  • Lee, Ellie
    • Affiliation: School of Medicine, Department of Radiology
  • Olinger, Kristen
    • Affiliation: School of Medicine, Department of Radiology
  • Wagner, Sean
    • Affiliation: School of Medicine, Department of Radiology
  • Radhakrishna, Roshni
    • Affiliation: School of Medicine, Department of Medicine
  • Johnson, Kennita A.
    • Affiliation: School of Medicine, Joint Department of Biomedical Engineering, North Carolina State University
  • Rathmell, W. Kimryn
    • Other Affiliation: Vanderbilt University
  • Qaqish, Bahjat
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics
  • Dayton, Paul A.
    • Affiliation: School of Medicine, Joint Department of Biomedical Engineering, North Carolina State University
  • Chang, Emily H.
    • Affiliation: School of Medicine, Department of Medicine
Abstract
  • We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe kidney disease, CT and MRI contrast agents may be contraindicated. Contrast-enhanced ultrasound (CEUS) is a safe alternative for characterizing these lesions, but data on its performance among CKD patients are limited. We performed flash replenishment CEUS in 60 CKD patients (73 lesions). Final analysis included 53 patients (63 lesions). Four readers, blinded to true diagnosis, interpreted each lesion. Reader evaluations were compared to true lesion classifications. Performance metrics were calculated to assess malignant and benign diagnoses. Reader agreement was evaluated using Bowker’s symmetry test. Combined reader sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant lesions were 71%, 75%, 45%, and 90%, respectively. Sensitivity (81%) and specificity (83%) were highest in CKD IV/V patients when grouped by CKD stage. Combined reader sensitivity, specificity, PPV, and NPV for diagnosing benign lesions were 70%, 86%, 91%, and 61%, respectively. Again, in CKD IV/V patients, sensitivity (81%), specificity (95%), and PPV (98%) were highest. Inter-reader diagnostic agreement varied from 72% to 90%. In CKD patients, CEUS is a potential low-risk option for screening kidney lesions. CEUS may be particularly beneficial for CKD IV/V patients, where kidney preservation techniques are highly relevant.
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  • Article
License
  • Attribution 4.0 International
Journal title
  • Journal of Clinical Medicine
Journal volume
  • 12
Journal issue
  • 20
Page start
  • 6494
Language
  • English
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  • Publisher
ISSN
  • 2077-0383
Publisher
  • MDPI

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