Contrast-Enhanced Ultrasound (CEUS) of the Kidneys by Using the Bosniak Classification

Abstract

Ultrasound is the most used interdisciplinary non-ionizing imaging technique in clinical routine. Therefore, ultrasound has a special value in the diagnosis and monitoring of cystic renal lesions, which can be classified as non-complicated or complicated and by means of occurrence as solitary or multifocal lesions. The Bosniak classification (I-IV) classifies renal cysts in 5 different categories with the help of ultrasound and computed tomography image criteria and is used for decisions of further clinical treatment. Additionally to normal native B-mode sonography, several new methods are in clinical use to improve diagnostic accuracy of unclear cases. Contrast enhanced ultrasound and MRI/CT are able to find and characterize difficult pathologies. This review explains the most important pathologies of cystic lesions of the kidney and stresses the different imaging methods of native B-mode sonography and the new techniques of contrast enhanced ultrasound.

Zusammenfassung

Aufgrund der standardmäßigen Verwendung der Sonografie im klinischen Alltag kommt ihr eine entscheidende Bedeutung in der Diagnostik von zystischen Läsionen der Niere zu. Diese werden nach Anzahl, Morphologie und Lokalisation unterteilt. Zur Charakterisierung von zystischen Läsionen hat sich die Bosniak-Klassifikation (I–IV) etabliert, die Zysten in 5 Stufen ursprünglich anhand ihrer bildmorphologischen Eigenschaften in der Computertomografie unterteilt, die sich aber auch in der Sonografie anwenden lassen. Über das weitere therapeutische Vorgehen kann anhand dieser Einteilung entschieden werden. Zur Verfeinerung der nativen B-Bild-sonografischen Diagnose stehen inzwischen sowohl der kontrastmittelverstärkte Ultraschall als auch die MRT/CT zur definitiven Beurteilung zur Verfügung. Sowohl der kontrastmittelverstärkte Ultraschall als auch die MRT/CT ermöglichen das Auffinden und die Charakterisierung von unklaren Befunden. Wegen der Verwendung eines nahezu nebenwirkungsfreien Kontrastmittels, der fehlenden Strahlenbelastung und der Möglichkeit der direkten Durchführung eines kontrastmittelverstärkten Ultraschalls nach initialer B-Bild-Sonografie, sollte dieser primär als weiteres Schnittbildverfahren verwendet werden. Dieses Review erläutert die wichtigsten Pathologien von zystischen Läsionen der Niere und legt dabei das Hauptaugenmerk auf die native B-Bild-Sonografie und die neuen Techniken des kontrastmittelverstärkten Ultraschalls.

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