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Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy

Received: 29 November 2021    Accepted: 14 December 2021    Published: 24 December 2021
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Abstract

Contrast-enhanced ultrasound (CEUS) is an imaging modality that utilizes a non-nephrotoxic, intravascular microbubble agent to capture real-time perfusion of the target organ. CEUS has demonstrated utility for the evaluation and surveillance of indeterminate renal lesions in patients who are unable to receive conventional contrast agents, yet its potential utility in renal surgery remains poorly defined in the current literature. We present a series of 4 patients who underwent successful intraoperative CEUS during partial nephrectomy (PN) to help define renal mass contour and proximity to vascular structures in an attempt to optimize renal function after PN. All cases were endophytic with moderate-high complexity (R.E.N.A.L. scores>9). CEUS was safely performed in all cases providing excellent tumor contour definition. In one case, CEUS provided better visualization of tumor proximity within the hilum than conventional US, facilitating surgical resection and reconstruction. In another case, CEUS provided better definition of tumor contour, allowing wedge resection rather than heminephrectomy. Margins were negative in all cases. The average global renal function preserved following PN was 90%. While grey-scale US with color Doppler is usually sufficient for intraoperative tumor visualization, CEUS can be considered during PN for complex endophytic, infiltrative or hilar tumors where accurate delineation of tumor contour is critical.

Published in International Journal of Clinical Urology (Volume 5, Issue 2)
DOI 10.11648/j.ijcu.20210502.21
Page(s) 113-117
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Contrast-enhanced Ultrasound, Kidney Neoplasms, Nephron-sparing Surgery, Functional Outcomes

References
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[6] F. Gassert et al., “Comparison of Magnetic Resonance Imaging and Contrast-Enhanced Ultrasound as Diagnostic Options for Unclear Cystic Renal Lesions: A Cost-Effectiveness Analysis,” Ultraschall in der Medizin (Stuttgart, Germany : 1980), vol. 42, no. 4, pp. 411–417, Aug. 2021, doi: 10.1055/A-1110-7172.
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[12] O. Le et al., “Feasibility of Contrast-Enhanced Intraoperative Ultrasound for Detection and Characterization of Renal Mass Undergoing Open Partial Nephrectomy.,” Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, vol. 36, no. 8, pp. 1547–1553, Aug. 2017, doi: 10.7863/ultra.16.07053.
[13] A. R. Rao, R. Gray, E. Mayer, H. Motiwala, M. Laniado, and O. Karim, “Occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS): a novel technique demonstrating segmental renal blood supply to assist zero-ischaemia robot-assisted partial nephrectomy.,” European urology, vol. 63, no. 5, pp. 913–9, May 2013, doi: 10.1016/j.eururo.2012.10.034.
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Cite This Article
  • APA Style

    Brendan Thomas Frainey, Peace Ugonma Orji, Christopher Coppa, Steven Charles Campbell. (2021). Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy. International Journal of Clinical Urology, 5(2), 113-117. https://doi.org/10.11648/j.ijcu.20210502.21

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    ACS Style

    Brendan Thomas Frainey; Peace Ugonma Orji; Christopher Coppa; Steven Charles Campbell. Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy. Int. J. Clin. Urol. 2021, 5(2), 113-117. doi: 10.11648/j.ijcu.20210502.21

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    AMA Style

    Brendan Thomas Frainey, Peace Ugonma Orji, Christopher Coppa, Steven Charles Campbell. Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy. Int J Clin Urol. 2021;5(2):113-117. doi: 10.11648/j.ijcu.20210502.21

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  • @article{10.11648/j.ijcu.20210502.21,
      author = {Brendan Thomas Frainey and Peace Ugonma Orji and Christopher Coppa and Steven Charles Campbell},
      title = {Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy},
      journal = {International Journal of Clinical Urology},
      volume = {5},
      number = {2},
      pages = {113-117},
      doi = {10.11648/j.ijcu.20210502.21},
      url = {https://doi.org/10.11648/j.ijcu.20210502.21},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20210502.21},
      abstract = {Contrast-enhanced ultrasound (CEUS) is an imaging modality that utilizes a non-nephrotoxic, intravascular microbubble agent to capture real-time perfusion of the target organ. CEUS has demonstrated utility for the evaluation and surveillance of indeterminate renal lesions in patients who are unable to receive conventional contrast agents, yet its potential utility in renal surgery remains poorly defined in the current literature. We present a series of 4 patients who underwent successful intraoperative CEUS during partial nephrectomy (PN) to help define renal mass contour and proximity to vascular structures in an attempt to optimize renal function after PN. All cases were endophytic with moderate-high complexity (R.E.N.A.L. scores>9). CEUS was safely performed in all cases providing excellent tumor contour definition. In one case, CEUS provided better visualization of tumor proximity within the hilum than conventional US, facilitating surgical resection and reconstruction. In another case, CEUS provided better definition of tumor contour, allowing wedge resection rather than heminephrectomy. Margins were negative in all cases. The average global renal function preserved following PN was 90%. While grey-scale US with color Doppler is usually sufficient for intraoperative tumor visualization, CEUS can be considered during PN for complex endophytic, infiltrative or hilar tumors where accurate delineation of tumor contour is critical.},
     year = {2021}
    }
    

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    T1  - Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy
    AU  - Brendan Thomas Frainey
    AU  - Peace Ugonma Orji
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    T2  - International Journal of Clinical Urology
    JF  - International Journal of Clinical Urology
    JO  - International Journal of Clinical Urology
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    AB  - Contrast-enhanced ultrasound (CEUS) is an imaging modality that utilizes a non-nephrotoxic, intravascular microbubble agent to capture real-time perfusion of the target organ. CEUS has demonstrated utility for the evaluation and surveillance of indeterminate renal lesions in patients who are unable to receive conventional contrast agents, yet its potential utility in renal surgery remains poorly defined in the current literature. We present a series of 4 patients who underwent successful intraoperative CEUS during partial nephrectomy (PN) to help define renal mass contour and proximity to vascular structures in an attempt to optimize renal function after PN. All cases were endophytic with moderate-high complexity (R.E.N.A.L. scores>9). CEUS was safely performed in all cases providing excellent tumor contour definition. In one case, CEUS provided better visualization of tumor proximity within the hilum than conventional US, facilitating surgical resection and reconstruction. In another case, CEUS provided better definition of tumor contour, allowing wedge resection rather than heminephrectomy. Margins were negative in all cases. The average global renal function preserved following PN was 90%. While grey-scale US with color Doppler is usually sufficient for intraoperative tumor visualization, CEUS can be considered during PN for complex endophytic, infiltrative or hilar tumors where accurate delineation of tumor contour is critical.
    VL  - 5
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Author Information
  • Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, USA

  • Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, USAGlickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, USA

  • Imaging Institute, Cleveland Clinic, Cleveland, USA

  • Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, USA

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