Affiliations: [a] Charité – Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| [b] Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| [c] Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| [d] Charité – Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Berlin, Germany
| [e] Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
Correspondence:
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Corresponding author: Markus H. Lerchbaumer, MD, Department of Radiology, Interdisciplinary Ultrasound Center
Charité - Universitätsmedizin Berlin Campus CharitéMitte, Charitéplatz 1, 10117 Berlin, Germany.
Tel.: +49(0)30 450 657084; Fax: +49(0)30 450 7557901; E-mail: markus.lerchbaumer@charite.de.
Abstract: PURPOSE:Contrast-enhanced-ultrasound (CEUS) has been frequently used in assessment of cystic renal lesions. OBJECTIVE:The aim of this study was to investigate the Bosniak classification in CEUS compared to CT and MRI in a multi-center setting. METHODS:Bosniak classification in CEUS examinations of cystic renal lesions were compared to imaging findings in computed-tomography (ceCT) and magnetic-resonance-imaging (ceMRI). Imaging results were correlated to histopathological reports. All examinations were performed by experts (EFSUMB level 3) using up-to-date CEUS examination-protocols. RESULTS:Overall, 173 cystic renal lesions were compared to subgroups CT (n = 87) and MRI (n = 86). Using Bosniak-classification 64/87 renal cysts (73.6%) were rated equal compared to CT with upgrade of four lesions (4.6%) and downgrade of 19 lesions (21.8%) by CT (Intra-class-correlation [ICC] coefficient of 0.824 [p < 0.001]). CEUS compared to MRI, presenting different scoring especially in classes Bosniak IIF (n = 16/31) and Bosniak III (n = 16/28) with an ICC coefficient of 0.651 (p < 0.001). CONCLUSION:CEUS can visualize even finest septal and small nodular wall enhancement, which may result in an upgrade of cystic lesions into a higher Bosniak class compared to CT or MRI. Thus, a modification of the Bosniak classification on CEUS may reduce unnecessary biopsies and surgery.
