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. 2019 Jan-Feb;33(1):203-208.
doi: 10.21873/invivo.11460.

Fusion Imaging of Contrast-enhanced Ultrasound With CT or MRI for Kidney Lesions

Thomas Auer  1   2 , Isabel Heidegger  3 , Tobias DE Zordo  2   4 , Daniel Junker  1   2 , Werner Jaschke  2 , Fabian Steinkohl  2 , Friedrich Aigner  5
Affiliations

Fusion Imaging of Contrast-enhanced Ultrasound With CT or MRI for Kidney Lesions

Thomas Auer et al. In Vivo. 2019 Jan-Feb.

Abstract

Aim: To evaluate the feasibility of ultrasound (US) computed tomography (CT) or magnetic resonance imaging (MRI) fusion imaging (FI) for localization and assessment of kidney lesions.

Materials and methods: Twenty-eight patients with kidney lesions previously detected on CT or MRI were included in this retrospective study. All 28 patients with kidney lesions, which were indefinable (42.9%) or hard to localize (57.1%) on gray-scale US alone, underwent FI of US with CT/MRI datasets. In 23 (82%) patients with indeterminate kidney lesions, FI including contrast-enhanced US was conducted.

Results: FI was successfully performed in 25 out of 28 (89.3%) patients. FI with contrast-enhanced US was able to clarify the previously detected kidney lesions in 21 out of 23 patients (91.3%).

Conclusion: FI is a feasible technique for localizing kidney lesions that are hard to define by grayscale US alone and the additional application of contrast-enhanced US is useful in clarifying indeterminate CT or MRI findings.

Keywords: Fusion imaging; computed tomography; contrast-enhanced ultrasound; kidney; magnetic resonance imaging; ultrasound.

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Figures

Figure 1
Figure 1. This image shows how fusion imaging is able to localize a kidney lesion which was not visible in gray-scale ultrasound (US) alone. After localization with fusion imaging, a solid tumor with contrast enhancement (Bosniak IV) was confirmed by contrast-enhanced US. Partial nephrectomy was performed and the histopathological finding was papillary renal cell cancer. A: In grayscale US, the kidney lesion was isoechoic (arrow) relative to the renal cortex and almost indefinable. B: Synchronized monophasic contrast-enhanced computed tomography showed indeterminate high-attenuation kidney lesion (arrow).
Figure 2
Figure 2. Fusion imaging of contrast-enhanced ultrasound (CEUS) and monophasic contrast-enhanced computed tomography (CT) in a patient with multiple similar kidney lesions (only one lesion is shown). A: Cystic lesion in CEUS with absence of contrast agent uptake on CEUS (arrow). B: High-attenuation (>20 HU) kidney lesion (arrow) on a previously conducted monophasic contrast enhanced CT. After performing fusion imaging with the CT dataset, CEUS excluded contrast enhancement therefore the final diagnosis was Bosniak class II cyst.
Figure 3
Figure 3. Downgrading of a Bosniak class III cyst on magnetic resonance imaging (MRI) to class IIf on contrast-enhanced ultrasound (CEUS). Follow-up confirmed the diagnosis of Bosniak class IIf. A: Image shows fusion imaging with CEUS; note that only septal enhancement (arrow) was visible. B Synchronized previously conducted contrast-enhanced MRI: Bosniak III cyst was diagnosed in MRI because more than septal enhancement was suspected.
See this image and copyright information in PMC

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