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Objective: The aim of this study was to assess the accuracy of Ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the characterization of renal nodules indeterminate on CT by identifying benign cystic lesions not requiring further examination., Methods: 72 patients with 83 indeterminate renal nodules on CT underwent baseline US and CEUS that classified lesions as benign (Bosniak I, II or IIF cysts) or potentially malignant (Bosniak III or IV cysts, solid nodules). The accuracy of US and CEUS in the differentiation between benign cysts and potentially malignant nodules was analyzed and compared with the final diagnosis obtained by histology or follow-up of at least 23 months with CEUS ± a conclusive CT/MR study., Results: Final diagnoses comprised 50 benign complex cysts, 1 focal nephritis, 1 multilocular cystic nephroma, 3 oncocytomas, 1 transitional cell carcinoma and 27 renal cell carcinomas. Unenhanced US correctly classified 18/50 (36%) benign cysts and 17/33 (51.5%) of the potentially malignant lesions obtaining a sensitivity of 36%, specificity of 51.5%, and overall accuracy of 42.2%. The addition of CEUS allowed a correct diagnosis of 48 /50 (96%) benign cysts and of 31/33 (93.9%) nodules as potentially malignant, with a sensitivity of 96%, specificity of 93.9%, and overall accuracy of 95.2%., Conclusion: CEUS is very useful in the differentiation between benign complex cysts and other lesions that require further investigation in non-conclusive renal nodules detected on CT, improving the accuracy of baseline US from 42.2 to 95.2%.

Purpose: To evaluate the diagnostic value of computed tomography (CT) performed immediately after excretory urography (EU) in patients with delayed renal opacification or dilated upper urinary system with nonconclusive diagnosis after EU., Materials and Methods: CT was performed immediately after EU in 39 patients with delayed opacification or dilated upper urinary system of unknown cause, without additional intravenous contrast administration for the CT study. We classified EU + CT findings as benign or malignant causes and we compared our results with the final diagnosis., Results: The combination of EU + CT correctly diagnosed 38 out of the 39 cases with a sensitivity of 97%. Correct diagnosis was established in all malignant cases (n = 17) but one benign case consistent with blood clots in the upper urinary tract was incorrectly diagnosed as a multicentric urothelial carcinoma. Sensitivity, specificity, and accuracy for the diagnosis of the underlying cause with EU + CT was 100%, 95%, and 97%, respectively. The final diagnoses were: urothelial carcinoma (n = 10), stone disease (n = 10), bladder tumor (n = 4), benign post-treatment ureteral stenosis (n = 4), ureteral invasion (n = 3), benign bladder disease (n = 2), urinary tract infections (n = 2), crossing vessels (n = 1), ureteropelvic junction obstruction (n = 1), retrocaval ureter (n = 1), and blood clots in the upper urinary tract due to bleeding renal metastasis from lung cancer (n = 1)., Conclusion: Combined EU and CT study allowed correct diagnosis of the underlying cause of delayed excretion or upper urinary tract dilatation in 97% of cases. The combination of EU and CT provides diagnosis reducing time and radiation.

The administration of a contrast agent is considered an essential tool to evaluate abdominal diseases using Ultrasound. The most targeted organ is the liver, especially to characterize focal liver lesions and to assess the response to percutaneous treatment. However, the expanding abdominal indications of contrast-enhanced ultrasound make this technique an important tool in the assessment of organ perfusion including the evaluation of ischemic, traumatic, and inflammatory diseases.

Contrast-enhanced ultrasound (CEUS) has been proved to be a useful imaging modality to characterize complex renal cysts using the Bosniak classification in a similar way as Computed Tomography (CT). CEUS helps not only in the characterization of complex cysts detected on baseline US but also in the characterization of indeterminate cystic lesions on CT or Magnetic Resonance (MR).

Contrast-enhanced ultrasound imaging represents a new approach to imaging tumoral neovascularity. This review describes the application of contrast-enhanced ultrasound in the detection, differential diagnosis, and staging of bladder cancer.