{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:55:19Z","timestamp":1776858919445,"version":"3.51.2"},"reference-count":79,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background\/Objectives: Cysts are the most common kidney lesions identified in patients undergoing abdominal imaging, with ultrasound (US) typically serving as the initial diagnostic tool. Contrast-enhanced ultrasound (CEUS) has emerged as a highly effective modality for the evaluation of cystic renal lesions, particularly when conventional B-mode ultrasound (US) or CE-CT are inconclusive. While simple renal cysts are readily characterised on US, cystic renal lesions require further assessment. Methods: The Bosniak classification, originally developed for CE-CT, remains the cornerstone for categorising cystic renal lesions, guiding management from surveillance to surgical intervention. Recent efforts to standardise CEUS-specific imaging parameters and adapt the Bosniak criteria aim to improve interobserver agreement, reduce subjectivity, and enhance diagnostic accuracy. Results: CEUS offers superior sensitivity for detecting slow blood flow and minimal vascularity within septa, wall or solid components, often outperforming CE-CT in real-time vascular assessment. However, the high sensitivity of CEUS can reveal additional septa or subtle enhancement, potentially leading to lesion overscoring, if the different sensitivity of CEUS and CT\/MRI for detecting enhancement is not taken into account. CEUS also plays a crucial role in the follow-up of non-surgical cystic lesions, providing a radiation-free and cost-effective alternative for long-term monitoring. Certain scenarios, such as post-interventional changes, traumatic cystic rupture, or infected cysts, fall outside the scope of the Bosniak system and require careful clinical correlation. Conclusions: By integrating CEUS into the diagnostic pathway, sonologists can achieve accurate lesion characterisation, optimise patient management, and minimise unnecessary invasive procedures, reinforcing CEUS as an essential tool in the evaluation and follow-up of complex renal cystic masses.<\/jats:p>","DOI":"10.3390\/medicina62040721","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:08:12Z","timestamp":1775812092000},"page":"721","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CEUS in Atypical Renal Cystic Masses: How, When and Why"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5583-350X","authenticated-orcid":false,"given":"Michele","family":"Bertolotto","sequence":"first","affiliation":[{"name":"Unit of Training & Research in Vascular & Multiparametric US, Clinical Department for Medical, Surgical and Health Sciences\u2014University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8008-6606","authenticated-orcid":false,"given":"Irene","family":"Campo","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Trieste, San Giovanni di Dio Hospital, Via Fatebenefratelli 34, 34170 Gorizia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8799-3564","authenticated-orcid":false,"given":"Alessandra","family":"Oliva","sequence":"additional","affiliation":[{"name":"Unit of Training & Research in Vascular & Multiparametric US, Clinical Department for Medical, Surgical and Health Sciences\u2014University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7026-3952","authenticated-orcid":false,"given":"Antonio","family":"Granata","sequence":"additional","affiliation":[{"name":"Division Nephrology and Dialysis Unit, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vito","family":"Cantisani","sequence":"additional","affiliation":[{"name":"Internal Medicine and Surgical Ultrasound Unit, Department of Radiological, Oncological, and Anatomopathological Sciences, Umberto I Hospital, Sapienza University, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/S1726-4901(08)70046-7","article-title":"Prevalence and clinical characteristics of simple renal cyst","volume":"70","author":"Chang","year":"2007","journal-title":"J. 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