Clinical Value Of Contrast-enhanced Ultrasonography Bosniak Classification In Renal Cystic Lesions

Objective:To conduct Bosniak classification of the renal cystic lesions with pathological results as the gold standard through contrast-enhanced ultrasonography,and to evaluate the benign and malignant lesions by classification results.To explore the clinical value of contrast-enhanced ultrasonography Bosniak classification in renal cystic lesions.Method:The Bosniak^[3]classification system is an imaging standard for assessing the degree of benign and malignant renal cystic lesions.It is derived from the imaging findings of enhanced CT.By observing the number of lesions separation,the cyst wall or separation thickness,whether there is calcification,any solid nodules and whether cyst wall,separation or solid nodules of the lesions are strengthened after enhanced lesions,and the degree of benign and malignant lesions is classified.This study selected 60 patients diagnosed as renal occupied lesion in our hospital from October 2016 to October 2018.Double-blind contrast-enhanced ultrasonography?CEUS?was used to make Bosniak classification of the degree of benign and malignant lesions.60 cases of contrast-enhanced ultrasonography Bosniak classification results and final surgical pathological results were tested for Kappa consistency,to understand whether the contrast-enhanced ultrasonography Bosniak classification has clinical value in the diagnosis of renal cystic lesions.In addition,all patients underwent contrast-enhanced computed tomography?CECT?examination before surgery.The Bosniak classification of CEUS and CECT was compared and the?2 test was performed to see if the results of the two examinations were statistically significant.Results:The total number of patients diagnosed with Bostonk I-IV by CEUS and CECT in all 60 patients was 3,4,6,10,37,and 1,5,7,26,21,respectively.All cases were confirmed by surgical pathology,including 33 malignant lesions and 27 benign lesions.Among the 27 benign lesions,the number of lesions diagnosed with Bosniak I-IV by CEUS and CECT was 3,4,6,6,8 and1,5,7,11,and 3,respectively.Among the 33 malignant lesions,the number of lesions diagnosed with Bosniak?F-?by CEUS and CECT was 1,3,29and 0,15,18.The Kappa consistency test was performed on the CEUS diagnosis and pathological results.The Kappa value was about 0.621,which was in good agreement with the pathological results,P=0.000<0.05,which was statistically significant.The results of CEUS and CECT the two types of paired examinations in all 60 patients were analyzed by?2 test,P=0.274>0.05.The difference between the two was not statistically significant.27 patients with benign lesions underwent?2 test,and Fisher's exact probability method obtained,P=0.766>0.05,the difference between the two was also not statistically significant.The results of two types of paired examinations of 33 patients with malignant lesions were analyzed by?2 test,Fisher's exact probability method was used.P=0.044<0.05,and the difference was statistically significant.By comparison with pathological results,the specificity,accuracy,positive predictive value and negative predictive value of CEUS and CECT in the diagnosis of benign and malignant renal occupied lesion were 66.67%,81.67%,77.50%,90.00%and 74.07%,73.33%,77.42%,and 68.97%,respectively.The difference was not statistically significant?P>0.05?.The sensitivity was 93.94%and 72.73%,respectively,and the difference was statistically significant?P<0.05?.Conclusion:The Bosniak classification standard for renal cystic lesions is based on the imaging features of enhanced CT,but it is also suitable for contrast-enhanced ultrasonography.Contrast-enhanced ultrasonography agent is a pure blood pool contrast agent that exists only in blood vessels that doesn't penetrate into the extravascular space and allows for a clearer display of tiny blood vessels within the lesion,especially for the internal structure of the lesions that are poorly supplied.Moreover,the sensitivity and accuracy of contrast-enhanced ultrasonography in the diagnosis of renal cystic lesions is much higher than that of enhanced CT,and the rate of missed diagnosis is lower,which has higher diagnostic value in clinical work.