Skip to main content
Springer Nature Link
Log in

Comparing Sonazoid contrast-enhanced ultrasound to contrast-enhanced CT and MRI for differentially diagnosing renal lesions: a prospective multicenter study

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

A Correction to this article was published on 13 June 2024

This article has been updated

Abstract

Purpose

To evaluate the diagnostic performance of contrast-enhanced (CE) ultrasound using Sonazoid (SNZ–CEUS) by comparing with contrast-enhanced computed tomography (CE–CT) and contrast-enhanced magnetic resonance imaging (CE–MRI) for differentiating benign and malignant renal masses.

Materials and methods

306 consecutive patients (from 7 centers) with renal masses (40 benign tumors, 266 malignant tumors) diagnosed by both SNZ–CEUS, CE–CT or CE–MRI were enrolled between September 2020 and February 2021. The examinations were performed within 7 days, but the sequence was not fixed. Histologic results were available for 301 of 306 (98.37%) lesions and 5 lesions were considered benign after at least 2 year follow-up without change in size and image characteristics. The diagnostic performances were evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and compared by McNemar’s test.

Results

In the head-to-head comparison, SNZ–CEUS and CE–MRI had comparable sensitivity (95.60 vs. 94.51%, P = 0.997), specificity (65.22 vs. 73.91%, P = 0.752), positive predictive value (91.58 vs. 93.48%) and negative predictive value (78.95 vs. 77.27%); SNZ–CEUS and CE–CT showed similar sensitivity (97.31 vs. 96.24%, P = 0.724); however, SNZ–CEUS had relatively lower than specificity than CE–CT (59.09 vs. 68.18%, P = 0.683). For nodules > 4 cm, CE–MRI demonstrated higher specificity than SNZ–CEUS (90.91 vs. 72.73%, P = 0.617) without compromise the sensitivity.

Conclusions

SNZ–CEUS, CE–CT, and CE–MRI demonstrate desirable and comparable sensitivity for the differentiation of renal mass. However, the specificity of all three imaging modalities is not satisfactory. SNZ–CEUS may be a suitable alternative modality for patients with renal dysfunction and those allergic to gadolinium or iodine-based agents.

Key Points

  • This prospective multicenter study demonstrated that the diagnostic performance of SNZ–CEUS was comparable to CE–CT and CE–MRI.

  • The three imaging modalities displayed desirable sensitivity, while the specificity needs to be further improved.

  • CE–MRI may have better specificity than SNZ–CEUS for differentiating renal masses bigger than 4 cm

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Data availability

The article does not contain applicable data availability statements.

Change history

Abbreviations

ALMs:

Angioleiomyomas

BMI:

Body mass index

ccRCC:

Clear-cell RCC

CE:

Contrast-enhanced

CE–CT:

Contrast-enhanced computed tomography

CE–MRI:

Contrast-enhanced magnetic resonance imaging

CEUS:

Contrast-enhanced ultrasound

EAU:

European Association of Urology

NPV:

Negative predictive value

PPV:

Positive predictive value

RCC:

Renal cell carcinoma

SNZ–CEUS:

Contrast-enhanced ultrasound using Sonazoid

TFE3:

Transcription factor e3

References

  1. Siegel RL, Miller KD, Fuchs HE et al (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7

    Article  PubMed  Google Scholar 

  2. Ferlay J, Colombet M, Soerjomataram I et al (2018) Cancer incidence and mortality patterns in Europe: estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer 103:356

    Article  CAS  PubMed  Google Scholar 

  3. Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913

    Article  PubMed  Google Scholar 

  4. Song XD, Tian YN, Li H et al (2020) Research progress on advanced renal cell carcinoma. J Int Med Res 48:300060520924265

    Article  CAS  PubMed  Google Scholar 

  5. Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271:133

    Article  PubMed  Google Scholar 

  6. Kazmierski B, Deurdulian C, Tchelepi H et al (2018) Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol 43:880

    Article  Google Scholar 

  7. Bertolotto M, Bucci S, Valentino M et al (2018) Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol 105:41

    Article  PubMed  Google Scholar 

  8. Tsuruoka K, Yasuda T, Koitabashi K et al (2010) Evaluation of renal microcirculation by contrast-enhanced ultrasound with Sonazoid as a contrast agent. Int Heart J 51:176

    Article  PubMed  Google Scholar 

  9. Miyoshi T, Okayama H, Hiasa G et al (2016) Contrast-enhanced ultrasound for the evaluation of acute renal infarction. J Med Ultrason 43(141):2016

    Google Scholar 

  10. Siedlecki AM, Benson C, Frates M et al (2019) First report of perfluorobutane microsphere-enhanced ultrasound in the transplant kidney. Transplantation 103:e283

    Article  PubMed  Google Scholar 

  11. Davenport MS, Cohan RH, Ellis JH (2015) Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction. AJR Am J Roentgenol 204:1174

    Article  PubMed  Google Scholar 

  12. Shen L, Li Y, Li N et al (2019) Clinical utility of contrast-enhanced ultrasonography in the diagnosis of benign and malignant small renal masses among Asian population. Cancer Med 8:7532

    Article  PubMed  PubMed Central  Google Scholar 

  13. Furrer MA, Spycher SCJ, Büttiker SM et al (2020) Comparison of the diagnostic performance of contrast-enhanced ultrasound with that of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging in the evaluation of renal masses: a systematic review and meta-analysis. Eur Urol Oncol 3:464

    Article  PubMed  Google Scholar 

  14. Cai Y, Du L, Li F et al (2014) Quantification of enhancement of renal parenchymal masses with contrast-enhanced ultrasound. Ultrasound Med Biol 40:1387

    Article  PubMed  Google Scholar 

  15. Ascenti G, Zimbaro G, Mazziotti S et al (2001) Usefulness of power doppler and contrast-enhanced sonography in the differentiation of hyperechoic renal masses. Abdom Imaging 26:654

    Article  CAS  PubMed  Google Scholar 

  16. Lu Q, Huang BJ, Wang WP et al (2015) Qualitative and quantitative analysis with contrast-enhanced ultrasonography: diagnosis value in hypoechoic renal angiomyolipoma. Korean J Radiol 16:334

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ignee A, Straub B, Schuessler G et al (2010) Contrast enhanced ultrasound of renal masses. World J Radiol 2:15

    Article  PubMed  PubMed Central  Google Scholar 

  18. Aoki S, Hattori R, Yamamoto T et al (2011) Contrast-enhanced ultrasound using a time-intensity curve for the diagnosis of renal cell carcinoma. BJU Int 108:349

    Article  PubMed  Google Scholar 

  19. Gassert F, Schnitzer M, Kim SH et al (2021) Comparison of magnetic resonance imaging and contrast-enhanced ultrasound as diagnostic options for unclear cystic renal lesions: a cost-effectiveness analysis. Ultraschall Med 42:411

    Article  PubMed  Google Scholar 

  20. Zhao P, Zhu J, Wang L et al (2023) Comparative diagnostic performance of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for differentiating clear cell and non-clear cell renal cell carcinoma. Eur Radiol 33:3766

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by Grants 81871374 and 82171941, 91859201 and 82030047 from the National Scientific Foundation Committee of China. The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Author notes

  1. Qin-xian Zhao and Chong Wu are Co-first author.

Authors and Affiliations

  1. Fifth Medical Center of Chinese PLA General Hospital, Beijing, China

    Qin-xian Zhao, Chong Wu, Shuilian Tan, Yongfeng Yang, Run-ze Ling-hu, Xiao-ling Yu, Jie Yu, Zhi-gang Cheng & Ping Liang

  2. Tongji Medical College, Wuhan, China

    Xin-Wu Cui

  3. Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland

    Christoph F. Dietrich

  4. Central hospital of eastern theater command, Nanjing, China

    Bin Yang & Chao-li Xu

  5. The Third Medical Centre of Chinese PLA General Hospital, Beijing, China

    Yong-yan Gao

  6. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Ming-xing Xie

  7. The First Affiliated Hospital of Harbin Medical University, Harbin, China

    Chang-jun Wu

  8. First Hospital of Shanxi Medical University, Taiyuan, China

    Li-ping Liu

  9. The Second Hospital of Shanxi Medical University, Taiyuan, China

    Xing-hua Wang

  10. MianYang Central Hospital, MianYang, China

    Ning Wang

  11. XU Chang Central Hospital, Xuchang, China

    Fei Wang

  12. The 940th Hospital of Joint Logistics Support force of Chinese people’s Liberation Army, Lanzhou, China

    Xiu-li Wang

  13. The First Affiliated Hospital of USTC, Hefei, China

    Guo-yan Liu

Authors
  1. Qin-xian Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuilian Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yongfeng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xin-Wu Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph F. Dietrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chao-li Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yong-yan Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ming-xing Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chang-jun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Li-ping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Xing-hua Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Run-ze Ling-hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ning Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Fei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Xiu-li Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Guo-yan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Xiao-ling Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Jie Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Zhi-gang Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Ping Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: Ping Liang, Zhi-gang Cheng. Experiments and procedures: All authors. Writing of article: Qin-xian Zhao, Yang Bai. Statistical analysis: Qin-xian Zhao, Yang Bai, Ming-jing Mei; Case collection: Qin-xian Zhao, Chong Wu, Hai-xiang Zhang, Mei-mei Zhu, Xiang-ru Dong, Hua Liang, Si-jie Yuan, Yue Song. Thanks for support of GE healthcare pharmaceutical diagnostics medical affairs for contributing to the data analysis.

Corresponding authors

Correspondence to Zhi-gang Cheng or Ping Liang.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.

Ethical approval

The study was approved and supervised by the institutional review boards of the seven participating institutions.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised due to incorrect first author name. Now, it has been corrected from Qin-xin Zhao to Qin-xian Zhao.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 30 KB)

Supplementary file2 (DOCX 2279 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, Qx., Wu, C., Tan, S. et al. Comparing Sonazoid contrast-enhanced ultrasound to contrast-enhanced CT and MRI for differentially diagnosing renal lesions: a prospective multicenter study. World J Urol 42, 302 (2024). https://doi.org/10.1007/s00345-024-04885-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00345-024-04885-7

Keywords