page_title: Renal ultrasonography
section_title: CEUS, image fusion and elastography
hierarchical_section_title: Renal ultrasonography / CEUS, image fusion and elastography
caption_attribution_description: English: Renal cell carcinoma successfully treated with thermal ablation, as no contrast enhancement is seen. For context, see en:Renal ultrasonography
context_page_description: Renal ultrasonography is the examination of one or both kidneys using medical ultrasound.
  Ultrasonography of the kidneys is essential in the diagnosis and management of kidney-related diseases. The kidneys are easily examined, and most pathological changes in the kidneys are distinguishable with ultrasound. US is an accessible, versatile inexpensive and fast aid for decision-making in patients with renal symptoms and for guidance in renal intervention.
  Renal ultrasound is a common examination, which has been performed for decades. Using B-mode imaging, assessment of renal anatomy is easily performed, and US is often used as image guidance for renal interventions. Furthermore, novel applications in renal US have been introduced with contrast-enhanced ultrasound, elastography and fusion imaging. However, renal US has certain limitations, and other modalities, such as CT and MRI, should always be considered as supplementary imaging modalities in the assessment of renal disease.
context_section_description: Contrast-enhanced ultrasound (CEUS) can evaluate microvasculature, which color Doppler US is unable to detect. In renal US examination, CEUS can be used to differentiate tumor and pseudotumor, such as prominent columns of Bertin. Pseudotumors enhance as adjacent renal tissue. The use of CEUS is recommended in special cases to distinguish between cystic and hypovascularized solid lesions, to characterize complex cysts, abscesses, traumatic lesions and ischemic lesions.
  Solid malignant tumors in the kidney do not exhibit specific enhancement patterns like some liver lesions, and no valid enhancement criteria between benign and malignant renal lesions have been proposed. However, CEUS is used in some patients after ablation of renal cell carcinoma to evaluate contrast uptake in the treated area (Figure 30).
  Image fusion of ultrasound with a previously recorded dataset of CT or other modalities is rarely used in renal US. Reports on image fusion using CEUS or US combined with CT or MRI in the examination of renal lesions and in difficult US-guided renal interventions have been published (Figure 31). However, no recommendations have been published so far.
  Elastography is a US method to visualize the elasticity of tissue. Preliminary reports on US elastography used on transplanted kidneys to evaluate cortical fibrosis have been published showing promising results (Figure 32).
caption: Figure 30. Renal cell carcinoma successfully treated with thermal ablation, as no contrast enhancement is seen.[1]
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