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Advanced Ultrasound in Diagnosis and Therapy ›› 2022, Vol. 6 ›› Issue (4): 165-173.doi: 10.37015/AUDT.2022.210037

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  • 收稿日期:2021-11-19 修回日期:2021-12-06 接受日期:2021-12-10 出版日期:2022-12-30 发布日期:2022-10-25

Diagnostic Values of CEUS, CECT and CEMRI for Renal Cystic Lesions on the Current Bosniak Criterion-A Meta-analysis

Xiaojuan Yang, MDa,c,1, Huihui Yang, MDb,1, Yu He,MD, PhDb,c,*()   

  1. a Department of Ultrasound, Xi’An NO.3 Hospital, Xi’An, Shanxi, China
    b Department of Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
    c Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
  • Received:2021-11-19 Revised:2021-12-06 Accepted:2021-12-10 Online:2022-12-30 Published:2022-10-25
  • Contact: Yu He,MD, PhD E-mail:2022683036@gzhmu.edu.cn
  • About author:First author contact:1 Xiaojuan Yang and Huihui Yang contributed equally to this study.

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Abstract:

Objective: CT-based Bosniak classification system has been routinely used to assess complex renal cystic lesions and also been applied to contrast-enhanced magnetic resonance imaging (CEMRI) and contrast-enhanced ultrasound (CEUS). Besides, the 2019 new version incorporated MRI into the Bosniak system. However, the role of US in the Bosniak system has not been clearly established. The aim of this study was to compare the diagnostic ability of CEUS, CECT and CEMRI for renal cystic lesions based on the current Bosniak classification.

Methods: Related studies were searched in PubMed, EMBASE, and the Cochrane Library databases from January 1, 2010 to December 14, 2020. QUADAS-2 was used to assess the study quality. Meta-analysis was performed by “midas modules” of Stata SE 15.0 software. The bivariate mixed-effect model was used. The pooled sensitivity and specificity of these three modalities were calculated and compared. Meta-regression and subgroup analyses were conducted to reveal the source of heterogeneity.

Results: CEUS showed highest pooled sensitivity and specificity, which were 98% (95% CI: 91%, 100%) and 80% (95% CI: 64%, 90%) respectively. Pooled estimates of CEMRI were slightly lower than those of CECT with the sensitivity 85% (95% CI: 77%, 91%) versus 88% (95% CI: 77%, 94%) and specificity 71% (95% CI: 52%, 85%) versus 79% (95% CI: 70%, 86%), respectively.

Conclusions: Based on the current Bosniak classification, CEUS seemed superior to CECT and CEMRI for the diagnosis of complex renal cystic masses, and could serve as a valuable alternative for CECT and CEMRI.

Key words: Renal cystic lesions, Contrast-enhanced ultrasonography (CEUS), Contrast-enhanced computed tomographic (CECT), Contrast-enhanced magnetic resonance imaging (CEMRI), Bosniak classification

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Study ID Year Country Imaging technique Study type Patients select Patients age (years) No. of lesions Reference standard
Sanz et al. [10] 2016 Spain1 CEUS vs CECT PRO NA median 67.8 67 P+F
Edenberg et al. [15] 2016 Norway1 CEUS REP consecutive mean 63.8 (33-86) 132 P+F
Chen et al. [11] 2015 China2 CEUS vs CEMRI REP NA mean 49.6 (21-78) 71 P+F
Nicolau et al. [16] 2015 Spain1 CEUS PRO consecutive mean 64.2 (34-85) 83 P+F
Xu et al. [17] 2014 China2 CEUS REP NA mean 45.3 (23-75) 87 P
Defortescu et al. [14] 2017 France1 CECT vs CEMRI PRO consecutive median 64.7 (37-76) 47 P+F
Oh et al. [19] 2016 Korea2 CECT REP NA mean 59.88 324 P
Reese et al. [20] 2014 America1 CECT REP NA median 57 113 P
Keseroglu et al. [21] 2019 Turkey1 CECT REP NA mean 57 191 P
Ferreira et al. [12] 2016 Brazil1 CECT vs CEMRI REP NA mean 51.4 (11-82) 42 P+F
Zhong et al. [13] 2017 China2 CECT vs CEMRI REP NA mean 49 (22-69) 35 P+F
Kim MH et al. [23] 2014 Korea2 CECT REP NA mean 56 (21-90 ) 164 P+F
Kim DY et al. [22] 2010 Korea2 CECT REP NA mean 54 (22-75) 125 P
Qiu et al. [18] 2020 China2 CEUS REP consecutive median 55.5 (21~86) 102 P+F
Tse et al. [24] 2020 America1 CEMRI REP consecutive mean 55 (18~83) 59 P
Bai et al. [25] 2020 China2 CEMRI REP consecutive mean 49 (16-75) 207 P

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Imaging technique No. of studies Pooled sensitivity (%) Pooled specificity (%) Pooled AUC-value Pooled positive likelihood ratio Pooled negative likelihood ratio I2/P value
CEUS 6 0.98 (0.91, 1.0) 0.80 (0.64, 0.90) 0.97 (0.95 - 0.98) 4.9 (2.6, 9.3) 0.02 (0.00, 0.11) 75%/0.010
CECT 9 0.88 (0.77, 0.94) 0.79 (0.70, 0.86) 0.89 (0.86 - 0.92) 3.9 (2.7, 5.5) 0.14 (0.07, 0.27) 88%/0.000
CEMR 6 0.85 (0.77, 0.91) 0.71 (0.52, 0.85) 0.87 (0.84 - 0.90) 3.0 (1.7, 5.0) 0.21 (0.15, 0.29) 83%/0.001

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Imaging technique Subgroups No. of studies Pooled sensitivity (%) Pooled specificity (%) Pooled AUC-value I²/P value
CECT Study design PRO (n = 2) - - - -
REP (n = 7) 0.91 (0.88, 0.94) 0.76 (0.73, 0.79) 0.92 (0.90 - 0.94) 86%/0.000
Reference standard P (n = 4) 0.90 (0.86,0.93) 0.76 (0.63, 0.85) 0.91 (0.89 - 0.94) 79%/0.004
P + F (n = 4) 0.93 (0.29,1.00) 0.84 (0.74, 0.91) 0.88 (0.85 - 0.91) 78%/0.005
CEUS Region European or American (n = 4) 0.97 (0.86, 0.99) 0.86 (0.78, 0.92) 0.96 (0.93 - 0.97) 0%/0.353
Asian (n = 2) - - -
Reference standard P (n = 1) - - -
P + F (n = 5) 0.96 (0.92, 0.99) 0.83 (0.78, 0.87) 0.96 (0.94 - 0.97) 0%/0.473

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