Contrast-Enhanced Ultrasound as a Next-Step Tool After Indeterminate CT in ESRD

Area of Science:

• Nephrology
• Radiology
• Medical Imaging

Background:

• Patients with end-stage renal disease (ESRD) often present with indeterminate renal lesions on computed tomography (CT).
• Further imaging is crucial for characterizing these lesions and guiding management decisions.

Purpose of the Study:

• To evaluate contrast-enhanced ultrasound (CEUS) as a subsequent imaging modality for indeterminate renal lesions in ESRD patients.
• To assess CEUS diagnostic performance and its impact on surgical decision-making compared to CT.

Main Methods:

• Retrospective chart review of 76 ESRD patients who underwent both CEUS and CT.
• Analysis of radiology reports, histopathology, and clinical follow-up for lesion characterization.
• Comparison of CEUS and CT accuracy for lesion characterization, diameter, and location.

Main Results:

• CEUS showed comparable accuracy to CT in characterizing renal lesions (P=0.51).
• No significant differences were found in lesion diameter (P=0.70) or location (P=0.87) between CEUS and CT.
• CEUS findings led to surgery referrals for 11 of 12 patients (91.7%), with 100% confirmed malignancy.

Conclusions:

• CEUS is a reliable tool for characterizing indeterminate renal lesions in ESRD patients, with performance comparable to CT.
• CEUS can effectively guide surgical decisions, minimizing contrast and radiation exposure.
• Integrating CEUS into clinical pathways can streamline evaluation and support timely management for ESRD patients.