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Fernández T, Sebastià C, Paño B, Corominas Muñoz D, Vas D, García-Roch C, Revuelta I, Musquera M, García F, Nicolau C. Contrast-enhanced US in Renal Transplant Complications: Overview and Imaging Features. Radiographics 2024; 44:e230182. [PMID: 38781089 DOI: 10.1148/rg.230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Renal transplant is the first-line treatment of end-stage renal disease. The increasing number of transplants performed every year has led to a larger population of transplant patients. Complications may arise during the perioperative and postoperative periods, and imaging plays a key role in this scenario. Contrast-enhanced US (CEUS) is a safe tool that adds additional value to US. Contrast agents are usually administered intravenously, but urinary tract anatomy and complications such as stenosis or leak can be studied using intracavitary administration of contrast agents. Assessment of the graft and iliac vessels with CEUS is particularly helpful in identifying vascular and parenchymal complications, such as arterial or venous thrombosis and stenosis, acute tubular injury, or cortical necrosis, which can lead to graft loss. Furthermore, infectious and malignant graft involvement can be accurately studied with CEUS, which can help in detection of renal abscesses and in the differentiation between benign and malignant disease. CEUS is also useful in interventional procedures, helping to guide percutaneous aspiration of collections with better delimitation of the graft boundaries and to guide renal graft biopsies by avoiding avascular areas. Potential postprocedural vascular complications, such as pseudoaneurysm, arteriovenous fistula, or active bleeding, are identified with CEUS. In addition, newer quantification tools such as CEUS perfusion are promising, but further studies are needed to approve its use for clinical purposes. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Tomás Fernández
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carmen Sebastià
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Blanca Paño
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Daniel Corominas Muñoz
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Daniel Vas
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carmen García-Roch
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Ignacio Revuelta
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Mireia Musquera
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Fernando García
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
| | - Carlos Nicolau
- From the Departments of Radiology (T.F., C.S., B.P., D.C.M., D.V., C.N.), Nephrology (I.R.), and Urology (M.M.), Hospital Clínic de Barcelona, Villarroel 170, E3P1, 08036 Barcelona, Spain; Department of Radiology, Hospital Virgen de la Salud, Toledo, Spain (C.G.R.); and Department of Radiology, Fundación del Hospital Nacional de Parapléjicos, Toledo, Spain (F.G.)
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Como G, Da Re J, Adani GL, Zuiani C, Girometti R. Role for contrast-enhanced ultrasound in assessing complications after kidney transplant. World J Radiol 2020; 12:156-171. [PMID: 32913562 PMCID: PMC7457161 DOI: 10.4329/wjr.v12.i8.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/30/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation (KT) is an effective treatment for end-stage renal disease. Despite their rate has reduced over time, post-transplant complications still represent a major clinical problem because of the associated risk of graft failure and loss. Thus, post-KT complications should be diagnosed and treated promptly. Imaging plays a pivotal role in this setting. Grayscale ultrasound (US) with color Doppler analysis is the first-line imaging modality for assessing complications, although many findings lack specificity. When performed by experienced operators, contrast-enhanced US (CEUS) has been advocated as a safe and fast tool to improve the accuracy of US. Also, when performing CEUS there is potentially no need for further imaging, such as contrast-enhanced computed tomography or magnetic resonance imaging, which are often contraindicated in recipients with impaired renal function. This technique is also portable to patients' bedside, thus having the potential of maximizing the cost-effectiveness of the whole diagnostic process. Finally, the use of blood-pool contrast agents allows translating information on graft microvasculature into time-intensity curves, and in turn quantitative perfusion indexes. Quantitative analysis is under evaluation as a tool to diagnose rejection or other causes of graft dysfunction. In this paper, we review and illustrate the indications to CEUS in the post-KT setting, as well as the main CEUS findings that can help establishing the diagnosis and planning the most adequate treatment.
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Affiliation(s)
- Giuseppe Como
- Institute of Radiology, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Jacopo Da Re
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Gian Luigi Adani
- Department of Medicine, General Surgery and Transplantation, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
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Mueller-Peltzer K, Rübenthaler J, Fischereder M, Habicht A, Reiser M, Clevert DA. The diagnostic value of contrast-enhanced ultrasound (CEUS) as a new technique for imaging of vascular complications in renal transplants compared to standard imaging modalities. Clin Hemorheol Microcirc 2018; 67:407-413. [PMID: 28885208 DOI: 10.3233/ch-179221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vascular complications in renal transplant patients are a well-known issue in post transplant patient care. If malfunctioning of the renal transplant is suspected to be caused by vascular complications an early diagnosis and therapy is required to maintain the renal transplant. Computed tomography (CT), digital substraction angiography (DSA) and radioisotope renography are the gold standard imaging modalities to diagnose vascular complications. OBJECTIVE To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) in comparison to the standard imaging modalities CT, DSA and radioisotope renography in the diagnosis of vascular complications in renal transplant patients. METHODS A total of 33 renal transplant recipients with elevated kidney function parameters with initial diagnostic imaging between 2006 and 2017 were included in the study. The imaging studies and clinical data were analysed retrospectively. The diagnostic accuracy of CEUS was compared to CT, DSA and renal scintigraphy respectively which are classified as gold standard for diagnosis of vascular complications in renal transplant patients. Out of 23 patients 15 patients showed vascular complications in CT, DSA or radioisotope renography and in 15 out of 15 patients CEUS detected the vascular complication. RESULTS CEUS showed a sensitivity of 100%, a specificity of 66.7%, a positive predictive value (PPV) of 71.4%, and a negative predictive value (NPV) of 100%. CONCLUSIONS CEUS is a non-nephrotoxic and safe method for the initial imaging of vascular complications in renal transplant recipients. Compared to the gold standard imaging modalities CT, DSA and radioisotope renography CEUS shows a high sensitivity and NPV in detecting vascular complications. In cases with suspected stenosis of the transplant renal artery additional DSA might be needed.
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Affiliation(s)
- K Mueller-Peltzer
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - M Fischereder
- Department of Internal Medicine IV, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - A Habicht
- Department of Internal Medicine IV, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - M Reiser
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - D-A Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
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Putz FJ, Erlmeier A, Wiesinger I, Verloh N, Stroszczynski C, Banas B, Jung EM. Contrast-enhanced ultrasound (CEUS) in renal imaging at an interdisciplinary ultrasound centre: Possibilities of dynamic microvascularisation and perfusion. Clin Hemorheol Microcirc 2017; 66:293-302. [DOI: 10.3233/ch-179103] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Franz Josef Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Anna Erlmeier
- Department of Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Isabel Wiesinger
- Department of Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Niklas Verloh
- Department of Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Kolofousi C, Stefanidis K, Cokkinos DD, Karakitsos D, Antypa E, Piperopoulos P. Ultrasonographic features of kidney transplants and their complications: an imaging review. ISRN RADIOLOGY 2012; 2013:480862. [PMID: 24967275 PMCID: PMC4045518 DOI: 10.5402/2013/480862] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
Renal transplantation is the treatment of choice for managing patients with end-stage kidney disease. Being submitted to a very serious surgical procedure, renal transplant recipients can only benefit from follow-up imaging and monitoring strategies. Ultrasound is considered as the principal imaging test in the evaluation of renal transplants. It is an easily applied bedside examination that can detect possible complications and guide further imaging or intervention. In this imaging review, we present essential information regarding the sonographic features of healthy renal transplants, detailing the surgical technique and how it affects the sonoanatomy. We focus on various complications that occur following renal transplantation and their sonographic features by reviewing pertinent literature sources and our own extensive imaging archives.
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Affiliation(s)
| | | | | | | | - Eleni Antypa
- Radiology Department, Evangelismos Hospital, 10676 Athens, Greece
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