title: Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation.
abstract: Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8%) and CT in two patients (2/16, 12.5%). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75% (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.
authors.affiliation: Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Sanz
authors.forename: Vital
authors.initials: V
authors.lastname: Hevia
authors.forename: Fernando
authors.initials: F
authors.lastname: Arias
authors.forename: José Javier
authors.initials: JJ
authors.lastname: Fabuel
authors.forename: Sara
authors.initials: S
authors.lastname: Álvarez
authors.forename: Rafael
authors.initials: R
authors.lastname: Rodríguez-Patrón
authors.forename: Victoria
authors.initials: V
authors.lastname: Gómez
authors.forename: Víctor
authors.initials: V
authors.lastname: Díez-Nicolás
authors.forename: Cristina
authors.initials: C
authors.lastname: González-Gordaliza
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Burgos
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000601:surgery; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media