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Junhong R, Wen H. Standardized evaluation methodology for renal cortical blood perfusion in elderly patients using contrast-enhanced ultrasound: A Chinese expert consensus (2024 edition). Aging Med (Milton) 2024; 7:429-437. [PMID: 39234205 PMCID: PMC11369325 DOI: 10.1002/agm2.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
As a sensitive and non-invasive method for assessing changes in renal cortical blood perfusion in the elderly, contrast-enhanced ultrasound (CEUS) can indirectly reflect changes in kidney filtration and reabsorption function, thus providing feasibility for early evaluation of renal function changes. However, significant differences exist among researchers in terms of operational methods, contrast agent selection, post-data analysis, and many other aspects, leading to substantial heterogeneity in results. This hinders horizontal comparisons and greatly limits the clinical application of contrast-enhanced ultrasound for evaluating renal cortical blood flow perfusion. Based on the latest domestic and overseas literature and discussions with clinical experts, this consensus provides recommended guidelines for the evaluation of renal cortical blood flow perfusion using contrast-enhanced ultrasound. It is hoped that this consensus will promote a better understanding of CEUS among medical practitioners at all levels and standardize the examination of renal cortical blood flow perfusion with CEUS.
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Affiliation(s)
- Ren Junhong
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - He Wen
- Department of Ultrasound, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Li HJ, Sui GQ, Teng DK, Lin YQ, Wang H. Incorporation of CEUS and SWE parameters into a multivariate logistic regression model for the differential diagnosis of benign and malignant TI-RADS 4 thyroid nodules. Endocrine 2024; 83:691-699. [PMID: 37889469 PMCID: PMC10902020 DOI: 10.1007/s12020-023-03524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/03/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) quantitative analysis parameters combined with shear wave elastography (SWE) quantitative parameters in the differentiation of benign and malignant ACR TI-RADS category 4 thyroid nodules and to provide a more effective reference for clinical work. METHODS We analyzed 187 category 4 nodules, including 132 nodules in the development cohort and 55 nodules in the validation cohort, divided the development cohort into benign and malignant groups, and analyzed the differences in all CEUS and SWE quantitative parameters between the two groups. We selected the highest AUC of the two parameters, performed binary logistic regression analysis with the ACR TI-RADS score and constructed a diagnostic model. ROC curves were applied to evaluate their diagnostic efficacy. RESULTS 1) The diagnostic model had an AUC of 0.926, sensitivity of 87.5%, specificity of 86.8%, diagnostic threshold of 3, accuracy of 87.12%, positive predictive value of 86.15%, and negative predictive value of 88.06%. 2) The diagnostic model had an AUC of 0.890 in the validation cohort, sensitivity of 81.5%, specificity of 79.6%, and accuracy of 80.00%. CONCLUSION The combined multiparameter construction of the nodule diagnostic model can effectively improve the diagnostic efficacy of 4 types of thyroid nodules and provide a new reference index for clinical diagnostic work.
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Affiliation(s)
- Hong-Jing Li
- Department of Ultrasound, China-Japan Union Hospital of Ji Lin University, Changchun, Jilin, China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Ji Lin University, Changchun, Jilin, China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Ji Lin University, Changchun, Jilin, China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Ji Lin University, Changchun, Jilin, China.
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Ji Lin University, Changchun, Jilin, China.
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Dietrich CF, Correas JM, Cui XW, Dong Y, Havre RF, Jenssen C, Jung EM, Krix M, Lim A, Lassau N, Piscaglia F. EFSUMB Technical Review - Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:36-46. [PMID: 37748503 DOI: 10.1055/a-2157-2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Jean-Michel Correas
- Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France
- Paris Cité University, Paris, France
- CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Roald Flesland Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Zhang H, Huang L, Yang Y, Qiu L, He Q, Liu J, Qian L, Luo J. Evaluation of Early Diabetic Kidney Disease Using Ultrasound Localization Microscopy: A Feasibility Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2277-2292. [PMID: 37146242 DOI: 10.1002/jum.16249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The purpose of this study is to detect the hemodynamic changes of microvessels in the early stage of diabetic kidney disease (DKD) and to test the feasibility of ultrasound localization microscopy (ULM) in early diagnosis of DKD. METHODS In this study, streptozotocin (STZ) induced DKD rat model was used. Normal rats served as the control group. Conventional ultrasound, contrast-enhanced ultrasound (CEUS), and ULM data were collected and analyzed. The kidney cortex was divided into four segments, which are 0.25-0.5 mm (Segment 1), 0.5-0.75 mm (Segment 2), 0.75-1 mm (Segment 3), and 1-1.25 mm (Segment 4) away from the renal capsule, respectively. The mean blood flow velocities of arteries and veins in each segment were separately calculated, and also the velocity gradients and overall mean velocities of arteries and veins. Mann-Whitney U test was used for comparison of the data. RESULTS Quantitative results of microvessel velocity obtained by ULM show that the arterial velocity of Segments 2, 3, and 4, and the overall mean arterial velocity of the four segments in the DKD group are significantly lower than those in the normal group. The venous velocity of Segment 3 and the overall mean venous velocity of the four segments in the DKD group are higher than those in the normal group. The arterial velocity gradient in the DKD group is lower than that in the normal group. CONCLUSION ULM can visualize and quantify the blood flow and may be used for early diagnosis of DKD.
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Affiliation(s)
- Hong Zhang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijie Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yi Yang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Lanyan Qiu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiong He
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jinping Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianwen Luo
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Shin J, Hwang JH, Park SB, Kim SH. Prediction of renal recovery following sepsis-associated acute kidney injury requiring renal replacement therapy using contrast-enhanced ultrasonography. Kidney Res Clin Pract 2023; 42:473-486. [PMID: 37551127 PMCID: PMC10407630 DOI: 10.23876/j.krcp.22.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Microcirculatory dysfunction plays a critical role in sepsis-associated acute kidney injury (S-AKI) development; however, its impact on renal recovery remains uncertain. We investigated the association between cortical microcirculatory function assessed using contrast-enhanced ultrasonography (CEUS) and renal recovery after S-AKI needing renal replacement therapy (RRT). METHODS This retrospective study included 23 patients who underwent CEUS among those who underwent acute RRT for S-AKI. In addition, we acquired data from 17 healthy individuals and 18 patients with chronic kidney disease. Renal recovery was defined as sustained independence from RRT for at least 14 days. RESULTS Of the CEUS-derived parameters, rise time, time to peak, and fall time were longer in patients with S-AKI than in healthy individuals (p = 0.045, 0.01, and 0.096, respectively). Fourteen patients (60.9%) with S-AKI receiving RRT experienced renal recovery; and these patients had higher values of peak enhancement, wash-in area under the curve (AUC), wash-in perfusion index, and washout AUC than those without recovery (p = 0.03, 0.01, 0.03, and 0.046, respectively). We evaluated the receiver operating characteristic curve and found that the peak enhancement, wash-in AUC, wash-in perfusion index, and wash-out AUC of CEUS derivatives estimated the probability of renal recovery after S-AKI requiring RRT (p = 0.03, 0.01, 0.03, and 0.04, respectively). CONCLUSION CEUS-assessed cortical microvascular perfusion may predict renal recovery following S-AKI that requires RRT. Further studies are essential to validate the clinical utility of microcirculatory parameters obtained from CEUS to estimate renal outcomes in various etiologies and severities of kidney disease.
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Affiliation(s)
- Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
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Huang X, Nie F, Zhu J, Liu L, Wang N. Diagnostic Value of Contrast-Enhanced Ultrasound Features for WHO/ISUP Grading in Renal Cell Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1519-1525. [PMID: 36591798 DOI: 10.1002/jum.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/29/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES By analyzing the differences of contrast-enhanced ultrasound (CEUS) features between low- and high-grade of WHO/ISUP grading, to explore the diagnostic value of CEUS in evaluating the prognosis of renal cell carcinoma (RCC). METHODS The qualitative and quantitative features of CEUS in 69 patients with RCC confirmed by surgical pathology in the Lanzhou University Second Hospital from March to October 2021 were retrospectively analyzed. Patients were categorized into two groups: low-grade group (n = 22) and high-grade group (n = 47), with surgical pathology as reference standard. The diagnostic performance of statistically significant CEUS features was evaluated by receiver operating characteristic (ROC) curves. RESULTS There were statistically significant differences in enhancement degree (P = .032) and quantitative features such as slopelesion (P = .034), the differences between lesion and cortex in arrive time (∆AT = ATlesion - ATcortex , P = .013), peak intensity(∆PI = [PIlesion - PIcortex ]/PIcortex , P = .003), area under the curve (∆Area = Arealesion - Areacortex , P = .008) in two groups, and the sensitivity was 70.2% and specificity was 71.4% of ∆PI, which has a high diagnostic performance in the differentiation of low-grade group from high-grade group (P = .005). CONCLUSIONS CEUS features such as ∆PI, may help differentiate low-grade RCC from high-grade RCC. CEUS has a promising application prospect in preoperative evaluation of the prognosis of RCC.
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Affiliation(s)
- Xiao Huang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Ju Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Luping Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Nan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Song Y, Mei J, Xu D, Ma Y. Evaluation of Contrast-Enhanced Ultrasound in Diagnosis of Acute Kidney Injury of Patients in Intensive Care Unit. Int J Gen Med 2023; 16:2229-2236. [PMID: 37293520 PMCID: PMC10246748 DOI: 10.2147/ijgm.s403730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
Background Ultrasound can assess renal perfusion, but its role in the evaluation of acute kidney injury (AKI) is still unclear. This prospective cohort study was to investigate the value of contrast-enhanced ultrasound (CEUS) in the evaluation of AKI in intensive care unit (ICU) patients. Methods Fifty-eight patients were recruited from ICU between October 2019 and October 2020, and CEUS was used to monitor the renal microcirculation perfusion within 24h after admission. Parameters included rise time (RT), time to peak intensity (TTP), amplitude of peak intensity (PI), area under the curve (AUC), time from peak to one half (TP1/2) of renal cortex and medulla. Ultrasonographical findings, demographics, laboratory, etc were collected for further analysis. Results There were 30 patients in the AKI group and 28 patients in the non-AKI group. The TTP, PI, TP1/2 of the cortex and the RT, TTP, TP1/2 of the medulla in the AKI group were significantly longer than in the non-AKI group (P < 0.05);. The TTP (OR = 1.261, 95% CI: 1.083-1.468, P = 0.003) (AUCs 0.733, Sen% 83.3, Spe%57.1), TP1/2 (OR = 1.079, 95% CI: 1.009-1.155, P = 0.027) (AUCs 0.658, Sen% 76.7, Spe%50.0) of the cortex and RT (OR = 1.453, 95% CI: 1.051-2.011, P = 0.024) (AUCs 0.686, Sen% 43.3, Spe%92.9) of the medulla were related to the AKI. Eight new-onset AKI cases occurred in the non-AKI group within 7 days, the RT, TTP, TP1/2 of the cortex and medulla were significantly longer in the new-onset AKI group than in the non-AKI group (P < 0.05), but serum creatinine and blood urea nitrogen were no differences between groups (P > 0.05). Conclusion This study indicates CEUS can assess the renal perfusion in AKI. TTP and TP1/2 of the cortex and RT of the medulla can aid the diagnosis of AKI in ICU patients.
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Affiliation(s)
- Ye Song
- Department of Ultrasonography, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People’s Republic of China
| | - Jiangjun Mei
- Department of Ultrasonography, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People’s Republic of China
| | - Dongwei Xu
- Department of Critical Care Medicine, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, People’s Republic of China
| | - Ying Ma
- Department of Ultrasonography, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People’s Republic of China
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Song J, Yao Y, He Y, Lin S, Pan S, Zhong M. Contrast-Enhanced Ultrasonography Value for Early Prediction of Delayed Graft Function in Renal Transplantation Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:201-210. [PMID: 35603734 DOI: 10.1002/jum.16010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/11/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Delayed graft function (DGF) is a common early complication after kidney transplantation. The aim of the present study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the early prediction of DGF after kidney transplantation. METHODS A total of 89 renal transplant recipients were retrospectively enrolled and divided into DGF group or normal graft function (NGF) group according to the allograft function. Conventional Doppler ultrasound and CEUS examination data on the first postoperative day were collected and analyzed. RESULTS The resistive indices of segmental and interlobar artery in the DGF group were significantly higher than those in the NGF group (0.71 ± 0.17 versus 0.63 ± 0.08, P = .006; 0.70 ± 0.16 versus 0.62 ± 0.08, P = .004, respectively). The patients experiencing DGF had significantly lower PI-c (14.7 dB ± 6.1 dB versus 18.5 dB ± 3.3 dB, P = .001) and smaller AUC-c (779.8 ± 375.8 dB·seconds versus 991.0 ± 211.7 dB·seconds, P = .003), as well as significantly lower PI-m (12.6 dB ± 5.9 dB versus 15.9 dB ± 3.9 dB, P = .006), shorter MTT-m (30.7 ± 9.4 seconds versus 36.3 ± 7.1 seconds, P = .01), and smaller AUC-m (P = .007). Multivariate analysis demonstrated that PI-c, AUC-c, and MTT-m were independent risk factors for DGF. The area under the receiver operating characteristic curve values of the combined predicted value (PI-c + MTT-m, PI-c + AUC-c + MTT-m) of DGF incidence were bigger than that of PI-c, AUC-c, or MTT-m. CONCLUSIONS CEUS parameters of the cortex and medulla have a good value for an early prediction of DGF after renal transplantation.
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Affiliation(s)
- Jieqiong Song
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Yao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yizhou He
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shilong Lin
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Simeng Pan
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Wang X, Chen L, Su T. Evaluating renal microcirculation in patients with acute kidney injury by contrast-enhanced ultrasonography: a protocol for an observational cohort study. BMC Nephrol 2022; 23:392. [PMID: 36482379 PMCID: PMC9733337 DOI: 10.1186/s12882-022-03021-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) in critically ill patients has poor renal outcome with high mortality. Changes in intra-renal microcirculation and tissue oxygenation are currently considered essential pathophysiological mechanisms to the development and progression of AKI. This study aims to investigate the characteristics of contrast-enhanced ultrasonography (CEUS) derived parameters in biopsy-proven AKI patients, and examine the predictive value of these markers for renal outcome. METHODS AND DESIGN This prospective observational study will enroll AKI patients who are diagnosed and staging following KDIGO (Kidney Disease: Improving Global Outcomes) criteria. All patients undergo a kidney biopsy and pathological tubulointerstitial nephropathy is confirmed. The CEUS examination will be performed at 0, 4 and 12 weeks after biopsy to monitor renal microcirculation. The percentage decrease of serum creatinine, 4-week and 12-week eGFR (estimated glomerular filtration rate) will also be reviewed as renal prognosis. The relationship of CEUS parameters with clinical and pathological markers will be analyzed. We perform a lassologit procedure to select potential affecting variables, including clinical, laboratory indexes and CEUS markers, to be included in the logistic regression model, and examine their predictive performance to AKI outcomes. DISCUSSION If we are able to show that CEUS derived parameters contribute to diagnosis and prognosis of AKI, the quality of life of patients will be improved while healthcare costs will be reduced. TRIAL REGISTRATION This study is retrospectively registered on the Chinese Medical Research Registration information System( https://61.49.19.26/login ) on December 31, 2021: MR-11-22-003,503. This study has been approved by the Ethics and Scientific Research Department of Peking University First Hospital.
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Affiliation(s)
- Xiangyu Wang
- grid.411472.50000 0004 1764 1621Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- grid.411472.50000 0004 1764 1621Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Tao Su
- grid.411472.50000 0004 1764 1621Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China ,grid.11135.370000 0001 2256 9319Institute of Nephrology, Peking University, No 8, Xishiku Street, Xicheng District, Beijing, 100034 China
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Zhang W, Yi H, Cai B, He Y, Huang S, Zhang Y. Feasibility of contrast-enhanced ultrasonography (CEUS) in evaluating renal microvascular perfusion in pediatric patients. BMC Med Imaging 2022; 22:194. [PMID: 36357841 PMCID: PMC9650893 DOI: 10.1186/s12880-022-00925-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Changes in renal microvascular perfusion are involved in several kidney diseases. Contrast-enhanced ultrasonography (CEUS) quantitative analysis can enable the estimation of renal microvascular perfusion non-invasively. However, to date, few pediatric patients with renal disease have been subjected to CEUS quantitative analysis. This study aimed to explore the feasibility of CEUS in evaluating renal microvascular perfusion in pediatric patients and paving its way to clinical practice. Methods Seventeen pediatric patients with chronic kidney disease (CKD) and five children without kidney disease were consecutively examined using CEUS. Quantitative analysis of CEUS images based on time-intensity curve (TIC) fittings was performed using specialized software. Quantitative parameters of wash-in microvascular blood flow, including A, k, B, and TtoPk, were generated from three regions of interest (ROIs) each in the cortex and medulla of each kidney. Results CEUS was performed in all children successfully and safely without the use of sedatives. All parameters (A, B, k, and TtoPk) demonstrated no statistical differences among the three sampling ROIs in the renal cortex and medulla. All parameters (A, B, k, and TtoPk) showed no statistical differences between the left and right sides of kidneys both in cortices and medullas. Comparing with patients with CKD stage 3–5, both control group and patients with CKD stage 1–2 had significantly higher values of parameter A in the renal cortex (p = 0.025 and p = 0.031, respectively). In control group and patients stage 1–2, the values of parameters k in the renal cortices were significantly higher than that in the renal medullas, while in patients with CKD stage 3–5, parameter k showed no statistically significant differences between the renal cortex and medulla (p = 0.173). Conclusion CEUS is safe and practicable in pediatric patients with chronic kidney disease. Renal microvascular perfusion estimated by CEUS could be a robust approach in the evaluation of pediatric renal diseases. Parameters A and k derived from CEUS quantitative analysis can provide great potential in non-invasive assessment of renal microvascular perfusion impairment in pediatric CKD.
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Friedl S, Jung EM, Bergler T, Tews HC, Banas MC, Banas B, Putz FJ. Factors influencing the time-intensity curve analysis of contrast-enhanced ultrasound in kidney transplanted patients: Toward a standardized contrast-enhanced ultrasound examination. Front Med (Lausanne) 2022; 9:928567. [PMID: 36091698 PMCID: PMC9452686 DOI: 10.3389/fmed.2022.928567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022] Open
Abstract
Background Time-intensity curve analysis (TIC analysis) based on contrast-enhanced ultrasound (CEUS) provides quantifiable information about the microcirculation of different tissues. TIC analysis of kidney transplantations is still a field of research, and standardized study protocols are missing though being mandatory for the interpretation of TIC parameters in the clinical context. The aim of this study was to evaluate the impact of different sizes and forms of regions of interest (ROIs) on the variance of different TIC parameters and the level of interoperator variance between the different ROI methods in kidney transplantations. Methods In 25 renal transplanted patients, 33 CEUS of the transplanted kidney were performed, and TIC analysis with ROIs sized 5 mm2 (ROI5), 10 mm2 (ROI10), and ROIs circumscribing the outlines of anatomical regions (ROI Anat ) were analyzed based on CEUS examination. The TIC analysis was repeated by a second independent operator for ROI5 and ROI Anat . Results Statistical analysis revealed significant differences between TIC parameters of different ROI methods, and overall, the interoperator variance was low. But a greater ROI surface (ROI10) led to higher values of the intensity parameters A and AUC compared with ROI5 (p < 0.05). The difference in the ROI form led to high variation of certain TIC parameters between ROI5 and ROI Anat in the myelon [intraclass correlation coefficient (A, ICC = 0.578 (0.139-0.793); TIC parameter (TTP); and ICC = 0.679 (0.344-0.842) (p < 0.05)]. A mean variation of 1 cm of the depth of ROI5 in the cortex did not show significant differences in the TIC parameters, though there was an impact of depth of ROI Anat on the values of TIC parameters. The interoperator variance in the cortex was low and equal for ROI5 and ROI Anat , but increased in the myelon, especially for ROI Anat . Furthermore, the analysis revealed a strong correlation between the parameter AUC and the time interval applied for the TIC analysis in the cortex and myelon (r = 0.710, 0.674, p < 0.000). Conclusion Our findings suggest the application of multiple ROIs of 5 mm2 in the cortex and medulla to perform TIC analysis of kidney transplants. For clinical interpretation of AUC, a standardized time interval for TIC analysis should be developed. After the standardization of the TIC analysis, the clinical predictive value could be investigated in further studies.
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Affiliation(s)
- Sarah Friedl
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology, Interdisciplinary Ultrasound, University of Regensburg, Regensburg, Germany
| | - Tobias Bergler
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Hauke C. Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital, Regensburg, Germany
| | - Miriam C. Banas
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University of Regensburg, Regensburg, Germany
| | - Franz Josef Putz
- Department of Nephrology, University of Regensburg, Regensburg, Germany
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Ma N, Li Y, Wang S, Li M, Li Y, Ai H, Zhu H, Wang Y, Guo F, Ren J. Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis. Chin Med J (Engl) 2022; 135:00029330-990000000-00073. [PMID: 35864596 PMCID: PMC9532041 DOI: 10.1097/cm9.0000000000002162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aims to observe the dynamic changes of renal artery (RA) disease and cortical blood perfusion (CBP) evaluated by contrast-enhanced ultrasound (CEUS) after percutaneous transluminal renal artery stenting (PTRAS) in patients with severe atherosclerotic renal artery stenosis (ARAS) and to analyze the relationship between CBP and prognosis. METHODS This was a single-center retrospective cohort study. A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included. According to renal glomerular filtration rate (GFR) detected by radionuclide imaging at 12 months after PTRAS, all patients were divided into the poor prognosis group (n = 21, GFR decreased by ≥20% compared with baseline) and the control group (n = 77, GFR decreased by < 20% or improved compared with baseline). Renal artery stenosis was diagnosed by digital subtraction angiography, and renal CBP was evaluated by CEUS using TomTec Imaging Systems (Germany) before PTRAS, at 6 months and 12 months after discharge. The receiver operating characteristic (ROC) curve with area under the curve (AUC) was used to analyze the predictive value of CBP parameters, including area under ascending curve (AUC1), area under the descending curve (AUC2), rising time (RT), time to peak intensity (TTP), maximum intensity (IMAX), and mean transit time (MTT) for poor prognosis. RESULTS Among the 98 patients, there were 52 males (53.1%), aged 55-74 years old, with an average age of 62.1 ± 8.7 years, and an average artery stenosis of 82.3 ± 12.9%. The poor prognosis group was associated with significantly increased incidence of diabetes (76.2% vs. 41.6%), and lower levels of GFR of the stenotic kidney (21.8 mL/min vs. 25.0 mL/min) and total GFR (57.6 mL/min vs. 63.7 mL/min) (all P < 0.05), compared with the control group (P < 0.05). In addition, the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group (9.5% vs. 0, χ2 = 9.462, P = 0.002). Compared with the control group, the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2, and extended duration of TTP and MTT (P < 0.05). At 6 months and 12 months of follow-up, patients in the control group were associated with markedly increased AUC1, AUC2, and IMAX, and shorter duration of RT and MTT (P < 0.05). The ROC curve showed that the predictive values of AUC1, AUC2, RT, TTP, IMAX, and MTT for poor prognosis were 0.812 (95% CI: 0.698-0.945), 0.752 (95% CI: 0.591-0.957), 0.724 (95% CI: 0.569-0.961), 0.720 (95% CI: 0.522-0.993), 0.693 (95% CI: 0.507-0.947), and 0.786 (95% CI: 0.631-0.979), respectively. CONCLUSIONS Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced, and does not show significant improvement after stent treatment over the first year of follow-up. The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients. Trial Registration: ChiCTR.org.cn, ChiCTR1800016252.
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Affiliation(s)
- Na Ma
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Yan Li
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Siyu Wang
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Mengpu Li
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Yongjun Li
- Department of Vascular Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Hu Ai
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Hui Zhu
- Department of Nuclear Medicine, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Yang Wang
- Department of Medical Research & Biometrics Center, National Center for Cardiovascular Diseases and Fuwai Hospital, CAMS and PUMC, Beijing 100037, China
| | - Fajin Guo
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
| | - Junhong Ren
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China
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Chen J, Jin P, Song Y, Feng L, Lu J, Chen H, Xin L, Qiu F, Cong Z, Shen J, Zhao Y, Xu W, Cai C, Zhou Y, Yang J, Zhang C, Chen Q, Jing X, Huang P. Auto-Segmentation Ultrasound-Based Radiomics Technology to Stratify Patient With Diabetic Kidney Disease: A Multi-Center Retrospective Study. Front Oncol 2022; 12:876967. [PMID: 35860551 PMCID: PMC9290767 DOI: 10.3389/fonc.2022.876967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022] Open
Abstract
Background An increasing proportion of patients with diabetic kidney disease (DKD) has been observed among incident hemodialysis patients in large cities, which is consistent with the continuous growth of diabetes in the past 20 years. Purpose In this multicenter retrospective study, we developed a deep learning (DL)-based automatic segmentation and radiomics technology to stratify patients with DKD and evaluate the possibility of clinical application across centers. Materials and Methods The research participants were enrolled retrospectively and separated into three parts: training, validation, and independent test datasets for further analysis. DeepLabV3+ network, PyRadiomics package, and least absolute shrinkage and selection operator were used for segmentation, extraction of radiomics variables, and regression, respectively. Results A total of 499 patients from three centers were enrolled in this study including 246 patients with type II diabetes mellitus (T2DM) and 253 patients with DKD. The mean intersection-over-union (Miou) and mean pixel accuracy (mPA) of automatic segmentation of the data from the three medical centers were 0.812 ± 0.003, 0.781 ± 0.009, 0.805 ± 0.020 and 0.890 ± 0.004, 0.870 ± 0.002, 0.893 ± 0.007, respectively. The variables from the renal parenchyma and sinus provided different information for the diagnosis and follow-up of DKD. The area under the curve (AUC) of the radiomics model for differentiating between DKD and T2DM patients was 0.674 ± 0.074 and for differentiating between the high and low stages of DKD was 0.803 ± 0.037. Conclusion In this study, we developed a DL-based automatic segmentation, radiomics technology to stratify patients with DKD. The DL technology was proposed to achieve fast and accurate anatomical-level segmentation in the kidney, and an ultrasound-based radiomics model can achieve high diagnostic performance in the diagnosis and follow-up of patients with DKD.
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Affiliation(s)
- Jifan Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Peile Jin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Song
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Liting Feng
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiayue Lu
- Department of Clinical Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjian Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Post-Doctoral Research Center, Hangzhou Supor South Ocean Pharmaceutical Co., Ltd, Hangzhou, China
| | - Lei Xin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Fuqiang Qiu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhang Cong
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaxin Shen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanan Zhao
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen Xu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenxi Cai
- Department of Ultrasound, The People’s Hospital of Yinshang, Anhui, China
| | - Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Jinfeng Yang
- Department of Ultrasound, The People’s Hospital of Yinshang, Anhui, China
| | - Chao Zhang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Qin Chen
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Pintong Huang, ; Xiang Jing, ; Qin Chen,
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- *Correspondence: Pintong Huang, ; Xiang Jing, ; Qin Chen,
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Ultrasound in Medicine and Biomedical Engineering Research Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
- Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China
- *Correspondence: Pintong Huang, ; Xiang Jing, ; Qin Chen,
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Almushayt SJ, Pham A, Phillips BE, Williams JP, Taal MW, Selby NM. Repeatability of Contrast-Enhanced Ultrasound to Determine Renal Cortical Perfusion. Diagnostics (Basel) 2022; 12:diagnostics12051293. [PMID: 35626449 PMCID: PMC9141960 DOI: 10.3390/diagnostics12051293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Alterations in renal perfusion play a major role in the pathogenesis of renal diseases. Renal contrast-enhanced ultrasound (CEUS) is increasingly applied to quantify renal cortical perfusion and to assess its change over time, but comprehensive assessment of the technique’s repeatability is lacking. Ten adults attended two renal CEUS scans within 14 days. In each session, five destruction/reperfusion sequences were captured. One-phase association was performed to derive the following parameters: acoustic index (AI), mean transit time (mTT), perfusion index (PI), and wash-in rate (WiR). Intra-individual and inter-operator (image analysis) repeatability for the perfusion variables were assessed using intra-class correlation (ICC), with the agreement assessed using a Bland–Altman analysis. The 10 adults had a median (IQR) age of 39 years (30–46). Good intra-individual repeatability was found for mTT (ICC: 0.71) and PI (ICC: 0.65). Lower repeatability was found for AI (ICC: 0.50) and WiR (ICC: 0.56). The correlation between the two operators was excellent for all variables: the ICCs were 0.99 for PI, 0.98 for AI, 0.87 for mTT, and 0.83 for WiR. The Bland–Altman analysis showed that the mean biases (± SD) between the two operators were 0.03 ± 0.16 for mTT, 0.005 ± 0.09 for PI, 0.04 ± 0.19 for AI, and −0.02 ± 0.11 for WiR.
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Affiliation(s)
- Shatha J. Almushayt
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
- Correspondence:
| | - Alisa Pham
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
| | - Bethan E. Phillips
- MRC/Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham DE22 3DT, UK; (B.E.P.); (J.P.W.)
| | - John P. Williams
- MRC/Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham DE22 3DT, UK; (B.E.P.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Maarten W. Taal
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
| | - Nicholas M. Selby
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
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15
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Liu PQ, Ding CW, Zhang YC, Ma Q, Liu LJ. Diagnostic value of ultrasound and contrast-enhanced ultrasound in septic acute kidney injury. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:505-514. [PMID: 34965309 DOI: 10.1002/jcu.23118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE This study aimed to explore the clinical value of ultrasonic Doppler examination and contrast-enhanced ultrasound (US) in the circulation of septic acute kidney injury (AKI). METHODS Patients with intensive care unit-related infection were divided into AKI group and control groups. The AKI group was divided into three subgroups according to the serum creatinine value: stage 1, stage 2, and stage 3. Relevant parameters and blood flow of the renal artery were measured, and further contrast-enhanced US was performed and time-intensity curve was analyzed. RESULTS The renal blood flow (RBF) and time-averaged velocity decreased significantly in the AKI group compared with the control group (p = .021 and p = .001). The peak value decreased and time to peak (TTP) prolonged in the AKI group (p < .001). With the aggravation of the disease, the RBF decreased slightly among subgroups (p = 0.124). However, the peak value gradually decreased and the TTP prolonged (all p < .05). The multiple linear regression model showed that only PI, RI, and TTP were independently and linearly correlated with the serum creatinine value. CONCLUSIONS Doppler US and contrast-enhanced US are of great help in the detection of condition changes and prognosis of patients with sepsis-induced AKI.
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Affiliation(s)
- Pei Qing Liu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Wei Ding
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Chun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Ma
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Jun Liu
- Department of critical medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
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16
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Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors. J Clin Med 2022; 11:jcm11030791. [PMID: 35160243 PMCID: PMC8836871 DOI: 10.3390/jcm11030791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/22/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations.
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Contrast-enhanced ultrasonography for assessing histopathology in pediatric immunoglobulin A nephropathy and Henoch-Schönlein purpura nephritis. Pediatr Radiol 2022; 52:2575-2583. [PMID: 35695915 PMCID: PMC9701653 DOI: 10.1007/s00247-022-05399-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Glomerular disease, including immunoglobulin A nephropathy (IgAN) and Henoch-Schönlein purpura nephritis, is one of the most common kidney diseases in children. The diagnosis of these diseases depends on pathological biopsy, although this procedure is seriously limited by its invasive and high-risk nature. OBJECTIVE To investigate the potential of contrast-enhanced ultrasonography (CEUS) for evaluating the histopathological severity of IgAN and Henoch-Schönlein purpura nephritis (HSPN). MATERIALS AND METHODS We investigated a total of 13 children with IgAN and 12 children with HSPN confirmed by renal histopathology. We reevaluated the pathological lesions of the children according to the Oxford classification and the Lee grading system and then all the children underwent CEUS. Using SonoLiver software, we constructed time-intensity curves of CEUS for regions of interest in the renal cortex. We analyzed CEUS quantitative parameters for IgAN and HSPN and used Spearman correlation analysis to examine the correlation between CEUS parameters and clinicopathological indexes in the study cohort. RESULTS The CEUS parameters rise time (RT) and time to peak (TTP) were significantly higher in children with Lee grade IV than in those with Lee grades II or III. Spearman correlation analysis revealed a positive correlation between rise time and time to peak with Lee grade in the overall cohort of children, and a positive correlation between rise time and time to peak and severity of crescents in the Oxford classification scoring system. CONCLUSION Contrast-enhanced US may be used as a noninvasive imaging technique to evaluate the severity of renal pathology and formation of crescents in children with IgAN and HSPN.
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18
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Wang Y, Li N, Tian X, Lin L, Liang S, Zhao P, Dong Z, Wang Q, Li Q, Tang J, Luo Y. Evaluation of Renal Microperfusion in Diabetic Patients With Kidney Injury by Contrast-Enhanced Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1361-1368. [PMID: 33035374 DOI: 10.1002/jum.15516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/13/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To conduct a quantitative analysis of renal microvascular perfusion in diabetic patients with kidney injury using contrast-enhanced ultrasound (CEUS). METHODS A total of 172 patients with type 2 diabetes mellitus and kidney injury were recruited from May 2017 to November 2019. After collection of clinical characteristics, a CEUS examination was performed after injection of the contrast agent SonoVue (Bracco SpA, Milan, Italy). Time-intensity curves and renal perfusion parameters were analyzed. Ultrasound-guided renal biopsy was performed. The patients were divided into a diabetic nephropathy (DN) group and a nondiabetic renal disease (NDRD) group according to renal pathologic results. The discrimination of perfusion parameters between the groups was analyzed statistically with SPSS version 19.0 software (IBM Corporation, Armonk, NY). Receiver operating characteristic curves were used to illustrate the diagnostic performance of indicators. RESULTS Ninety-eight patients, including 45 with DN (29 male; mean age ± SD, 57.76 ± 10.47 years) and 53 with NDRD (40 male; mean age, 48.7 ± 13.88 years) were included in this study. The peak enhancement (PE), wash-in the area under the curve (AUC), wash-in rate, wash-in perfusion index, wash-out AUC, wash-in and wash-out AUC, and wash-out rate were significantly different between the groups (P < .05). There were no differences in time-related parameters between the DN and NDRD groups (P > .05). The receiver operating characteristic curve analysis showed that the AUC for PE was 0.727, and PE lower than 7712.426 had diagnostic potential, with sensitivity of 81% and specificity of 40% in discriminating between NDRD and DN. CONCLUSIONS The quantification of CEUS parameters can discriminate DN in diabetic patients with kidney injury. The PE and AUC may be feasible parameters.
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Affiliation(s)
- Yiru Wang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaoqi Tian
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin Lin
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuyuan Liang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ping Zhao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zheyi Dong
- Department of Nephrology, First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Diseases, Beijing, China
- State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Qian Wang
- Department of Nephrology, First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Diseases, Beijing, China
- State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Qiuyang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
- State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
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Ran X, Chen L, Lin L, Zou Y. Reply to the letter to the Editor from Professor Cianci Rosario. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1423-1427. [PMID: 33549382 DOI: 10.1016/j.ultrasmedbio.2020.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Xu Ran
- Department of Ultrasound Medicine, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound Medicine, Peking University First Hospital, Beijing, China
| | - Letao Lin
- Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional, Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
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Wong A, Yusuf GT, Malbrain MLNG. Future developments in the imaging of the gastrointestinal tract: the role of ultrasound. Curr Opin Crit Care 2021; 27:147-156. [PMID: 33560015 DOI: 10.1097/mcc.0000000000000815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the utilization and most recent developments with regard to the use of ultrasound when imaging the abdomen and gastrointestinal tract. RECENT FINDINGS Although the use of ultrasound to assess the anatomy of the various abdominal organs is well established within radiology and critical care, its use as part of functional and physiological assessment is still evolving. Recent developments have extended the use of ultrasound beyond standard B-mode/2D imaging techniques to incorporate more functional and haemodynamic assessment. These include the use of contrast-enhanced ultrasound (CEUS), elastography, and colour Doppler techniques. SUMMARY Whilst Doppler techniques are reasonably well established within critical care ultrasound (CCUS), especially in echocardiography, CEUS and elastography are less well known. CEUS utilizes a purely intravascular contrast agent whilst elastography measures the degree of deformation or stiffness in various organs. Whilst their use individually may be limited; they may play a role in a multiparametric assessment. Mirroring the overall trends in critical care ultrasound development, abdominal ultrasound assessment is best integrated in a holistic approach and adapted to the individual patient.
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Affiliation(s)
| | | | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics, VUB, Brussels, Belgium
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Garessus J, Brito W, Loncle N, Vanelli A, Hendriks-Balk M, Wuerzner G, Schneider A, Burnier M, Pruijm M. Cortical perfusion as assessed with contrast-enhanced ultrasound is lower in patients with chronic kidney disease than in healthy subjects but increases under low salt conditions. Nephrol Dial Transplant 2021; 37:705-712. [DOI: 10.1093/ndt/gfab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
Disturbances in renal microcirculation play an important role in the pathophysiology of chronic kidney disease (CKD), but the lack of easy accessible techniques hampers our understanding of the regulation of the renal microcirculation in humans. We assessed whether contrast-enhanced ultrasound (CEUS) can identify differences in cortical perfusion and alterations induced by different dietary salt intakes in CKD patients and controls.
Methods
Participants underwent CEUS twice: once after 5 days of high-salt (HS) intake, and again after 5 days of low salt (LS) diet. Sonovue® (0.015 mL/kg/min) was perfused as contrast agent and four consecutive destruction–reperfusion sequences were analysed per visit. The primary outcome measure was the (change in) mean perfusion index (PI) of the renal cortex.
Results
Forty healthy volunteers (mean age ± standard deviation 50 ± 8 years) and 18 CKD Stages 2–4 patients [aged 55 ± 11 years, estimated glomerular filtration rate (eGFR) 54 ± 28 mL/min/1.73 m2] were included and underwent CEUS without side effects. Under HS conditions, cortical PI was significantly lower in CKD patients [1618 ± 1352 versus 3176 ± 2278 arbitrary units (a.u) in controls, P = 0.034]. Under LS, renal PI increased in CKD patients (with +1098 to 2716 ± 1540 a.u., P = 0.048), whereas PI remained stable in controls. In the continuous analysis, PI correlated with eGFR (Spearman’s r = 0.54, P = 0.005) but not with age, sex, blood pressure or aldosterone levels.
Conclusions
CEUS identified important reductions in cortical micro-perfusion in patients with moderate CKD. Lowering salt intake increased perfusion in CKD patients, but not in controls, underlining the benefits of an LS diet in CKD patients. Whether a low PI is an early sign of kidney damage and predicts renal function decline needs further study.
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Affiliation(s)
- Jonas Garessus
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Wendy Brito
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Loncle
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Anna Vanelli
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Marielle Hendriks-Balk
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care Unit, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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22
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Selby NM, Williams JP, Phillips BE. Application of dynamic contrast enhanced ultrasound in the assessment of kidney diseases. Curr Opin Nephrol Hypertens 2021; 30:138-143. [PMID: 33186215 DOI: 10.1097/mnh.0000000000000664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Many forms of acute and chronic disease are linked to changes in renal blood flow, perfusion, vascular density and hypoxia, but there are no readily available methods to assess these parameters in clinical practice. Dynamic contrast enhanced ultrasound (DCE-US) is a method that provides quantitative assessments of organ perfusion without ionising radiation or risk of nephrotoxicity. It can be performed at the bedside and is suitable for repeated measurements. The purpose of this review is to provide updates from recent publications on the utility of DCE-US in the diagnosis or assessment of renal disease, excluding the evaluation of benign or malignant renal masses. RECENT FINDINGS DCE-US has been applied in clinical studies of acute kidney injury (AKI), renal transplantation, chronic kidney disease (CKD), diabetic kidney disease and to determine acute effects of pharmacological agents on renal haemodynamics. DCE-US can detect changes in renal perfusion across these clinical scenarios and can differentiate healthy controls from those with CKD. In sepsis, reduced DCE-US measures of perfusion may indicate those at increased risk of developing AKI, but this requires confirmation in larger studies as there can be wide individual variation in perfusion measures in acutely unwell patients. Recent studies in transplantation have not provided robust evidence to show that DCE-US can differentiate between different causes of graft dysfunction, although it may show more promise as a prognostic indicator of graft function 1 year after transplant. DCE-US can detect acute haemodynamic changes in response to medication that correlate with changes in renal plasma flow as measured by para-aminohippurate clearance. SUMMARY DCE-US shows promise and has a number of advantages that make it suitable for the assessment of patients with various forms of kidney disease. However, further research is required to evidence its reproducibility and utility before clinical use can be advocated.
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Affiliation(s)
- Nicholas M Selby
- Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, University of Nottingham, Royal Derby Hospital Centre
- Department of Renal Medicine, Royal Derby Hospital
| | - John P Williams
- Division of Medical Sciences and Graduate Entry Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre
- Department of Anaesthesia and Critical Care, Royal Derby Hospital, Derby, UK
| | - Bethan E Phillips
- Division of Medical Sciences and Graduate Entry Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital Centre
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Wang X, Wang S, Pang YP, Jiang T, Yu C, Li Y, Shi B. Contrast-Enhanced Ultrasound Assessment of Renal Parenchymal Perfusion in Patients with Atherosclerotic Renal Artery Stenosis to Predict Renal Function Improvement After Revascularization. Int J Gen Med 2020; 13:1713-1721. [PMID: 33408509 PMCID: PMC7781108 DOI: 10.2147/ijgm.s293316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/15/2020] [Indexed: 12/29/2022] Open
Abstract
Background Identifying patients with atherosclerotic renal artery stenosis (ARAS) who will be improved in renal function after percutaneous transluminal renal artery stenting (PTRAS) is crucial since most patients show no worthwhile benefit of PTRAS. Although the assessment of renal parenchymal perfusion is useful for the identification, few studies predict the renal functional improvement by evaluating the characteristics of renal perfusion. Objective The aim of this study was to assess the renal parenchymal perfusion in ARAS patients with contrast-enhanced ultrasonography (CEUS) and predict the benefits of renal function after PTRAS utilizing time-intensity curve (TIC) parameters. Methods Thirty-eight kidneys in 30 ARAS patients received PTRAS in this study. They were divided into moderate stenosis group (n=25) and severe stenosis group (n=13) and mild dysfunction group (n=14) and moderate dysfunction group (n=24) according to the degree of renal stenosis and radioisotope glomerular filtration rate (rGFR). The baseline assessment of renal function and renal parenchymal perfusion were performed for all patients. rGFR was repeated to evaluate the renal outcome at 4 months after PTRAS. The outcome of PTRAS was classified as improved, stable, or deteriorated compared to the baseline. Time-intensity curve (TIC) parameters obtained from CEUS were analyzed to evaluate the predictive accuracy. Results TIC parameters (AUC and PI) were positively correlated with renal function (r=0.617, 0.663; P<0.05) but weakly and negatively correlated with the stenosis (r=−0.360, −0.435; P<0.05). Baseline rGFR was not accurate in predicting improved renal function after PTRAS (0.670). The accuracy of the combined prediction model of baseline AUC and PI (0.889) was higher than the individual indicators (baseline AUC: 0.855 and PI: 0.782). Conclusion CEUS could accurately assess renal parenchymal perfusion and identify ARAS patients with potential benefit after PTRAS. The combination of TIC parameters (AUC and PI) is valuable in the prediction of improved renal function after PTRAS.
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Affiliation(s)
- Xiuyan Wang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Shuo Wang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Yan-Ping Pang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Tian Jiang
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Yuan Li
- Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Baomin Shi
- Department of General Surgery, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
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Li N, Wang YR, Tian XQ, Lin L, Liang SY, Li QY, Fei X, Tang J, Luo YK. Potential value of three-dimensional ultrasonography in diagnosis of diabetic nephropathy in Chinese diabetic population with kidney injury. BMC Nephrol 2020; 21:243. [PMID: 32600283 PMCID: PMC7325142 DOI: 10.1186/s12882-020-01902-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background To explore the potential value of three-dimensional ultrasonography (3DUS) and contrast-enhanced ultrasound (CEUS) in the diagnosis of diabetic nephropathy (DN) in Chinese diabetic patients with kidney injury. Methods Patients with type 2 diabetes mellitus and kidney injury in our hospital were enrolled, and the clinical characteristics as well as the laboratory data of patients were collected; 3DUS and CEUS were used to evaluate the morphological structure and blood perfusion of kidneys. Eligible patients were categorized into two groups based on renal biopsy results: DN group and non-diabetic renal diseases (NDRD) group. Correlation analysis and logistic regression analysis were applied to identify the risk factors of DN development. Results A total of 115 patients aged from 24 to 78 years old were recruited in the experiment, of which 64 patients (55.65%) and 51 patients (44.35%) were in the DN group and NDRD group, respectively. After correction to CKD stage, BMI and right kidney volume index were retained to identify patients with DN. The ROC of the logistic regression model had an AUC of 0.703 (95% CI: 0.591–0.815) and it was higher than both indicators. Conclusion 3DUS has potential value in the diagnosis of diabetic nephropathy in Chinese diabetic population with kidney injury and may act as an auxiliary diagnosis for DN. More prospective and well-designed studies with larger samples are needed to verify the result.
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Affiliation(s)
- Nan Li
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Yi-Ru Wang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiao-Qi Tian
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Lin Lin
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Shu-Yuan Liang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qiu-Yang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiang Fei
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jie Tang
- Medical School of Chinese PLA, Beijing, 100853, China.
| | - Yu-Kun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Yoon HE, Kim DW, Kim D, Kim Y, Shin SJ, Shin YR. A pilot trial to evaluate the clinical usefulness of contrast-enhanced ultrasound in predicting renal outcomes in patients with acute kidney injury. PLoS One 2020; 15:e0235130. [PMID: 32579595 PMCID: PMC7313752 DOI: 10.1371/journal.pone.0235130] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives Contrast-enhanced ultrasound (CEUS) enables the assessment of real-time renal microcirculation. This study investigated CEUS-driven parameters as hemodynamic predictors for renal outcomes in patients with acute kidney injury (AKI). Methods Forty-eight patients who were diagnosed with AKI were prospectively enrolled and underwent CEUS at the occurrence of AKI. Parameters measured were the wash-in slope (WIS), time to peak intensity, peak intensity (PI), area under the time–intensity curve (AUC), mean transit time (MTT), time for full width at half maximum, and rise time (RT). The predictive performance of the CEUS-driven parameters for Kidney Disease Improving Global Outcomes (KDIGO) AKI stage, initiation of renal replacement therapy (RRT), AKI recovery, and chronic kidney disease (CKD) progression was assessed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of CEUS. Results Cortical RT (Odds ratio [OR] = 1.21) predicted the KDIGO stage 3 AKI. Cortical MTT (OR = 1.07) and RT (OR = 1.20) predicted the initiation of RRT. Cortical WIS (OR = 76.23) and medullary PI (OR = 1.25) predicted AKI recovery. Medullary PI (OR = 0.78) and AUC (OR = 1.00) predicted CKD progression. The areas under the ROC curves showed reasonable performance for predicting the initiation of RRT and AKI recovery. The sensitivity and specificity of the quantitative CEUS parameters were 60–83% and 62–77%, respectively, with an area under the curve of 0.69–0.75. Conclusion CEUS may be a supplemental tool in diagnosing the severity of AKI and predicting renal prognosis in patients with AKI.
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Affiliation(s)
- Hye Eun Yoon
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Da Won Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dongryul Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yaeni Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Seok Joon Shin
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chen LL, Zhai JX, Kang J, Li YS. Utility of Contrast-Enhanced Ultrasound for the Assessment of Skeletal Muscle Perfusion in Diabetes Mellitus: A Meta-Analysis. Med Sci Monit 2019; 25:4535-4543. [PMID: 31211767 PMCID: PMC6597144 DOI: 10.12659/msm.915252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluated the effectiveness of contrast-enhanced ultrasonography for the assessment of skeletal muscle perfusion in diabetes mellites. MATERIAL AND METHODS Electronic databases (Embase, Google Scholar, Ovid, and PubMed) were searched for required articles, and studies were selected by following pre-determined eligibility criteria. Meta-analyses of mean differences or standardized mean differences (SMD) were performed to evaluate the significance of difference in contrast-enhanced ultrasonography measured muscle perfusion indices between patients with diabetes and healthy individuals or between basal and final values of perfusion indices after insulin manipulation or physical exercise in patients with diabetes or healthy individuals. RESULTS There were 15 studies included, with 279 patients with diabetes and 230 healthy individuals in total. The age of the study patients with diabetes mellitus was 55.8 years (95% CI: 49.6 years, 61.9 years) and these patients had disease for 11.4 years (95% CI: 7.7 years, 15.1 years). The percentage of males in group of patients with diabetes was 66% (95% CI: 49%, 84%), body mass index was 29.4 kg/m² (95% CI: 26.5 kg/m², 32.3 kg/m²), hemoglobin A1c was 7.3% (95% CI: 6.7%, 7.9%), and fasting plasma glucose was 149 kg/m² (95% CI: 118 kg/m², 179 kg/m²). Time to peak intensity after provocation was significantly higher in patients with diabetes than in healthy individuals (SMD 1.18 [95% CI: 0.60, 1.76]; P<0.00001). In patients with diabetes, insulin administration did not improve contrast-enhanced ultrasonography measured muscle perfusion indices but exercise improved muscle perfusion but at a level that was statistically non-significant (SMD between basal and post-exercise values (1.03 [95% CI: -0.14, 2.20]; P=0.08). In healthy individuals, lipids in addition to insulin administration was associated with significantly reduced blood volume and blood flow. CONCLUSIONS Our review showed that the use of contrast-enhanced ultrasonography showed that diabetes mellitus was associated with altered muscle perfusion in which insulin-mediated metabolic changes played an important role.
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Affiliation(s)
- Lin-Lin Chen
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Jun-Xiu Zhai
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Jie Kang
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - You-Shan Li
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
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Gray Scale Ultrasound, Color Doppler Ultrasound, and Contrast-Enhanced Ultrasound in Renal Parenchymal Diseases. Ultrasound Q 2018; 34:250-267. [DOI: 10.1097/ruq.0000000000000383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Contrast-enhanced ultrasonography for assessment of tubular atrophy/interstitial fibrosis in immunoglobulin A nephropathy: a preliminary clinical study. Abdom Radiol (NY) 2018; 43:1423-1431. [PMID: 29110052 DOI: 10.1007/s00261-017-1301-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the potential of contrast-enhanced ultrasonography (CEUS) for evaluating the severity of tubular atrophy/interstitial fibrosis (TA/IF) in immunoglobulin A nephropathy (IgAN) patients. MATERIALS AND METHODS A total of 80 patients with IgAN and 33 healthy adults were investigated. Patients were divided into three groups according to the TA/IF (T) grade of the Oxford classification: T0 (n = 28), T1 (n = 35), and T2 (n = 17). Patients and control subjects underwent conventional ultrasound (US) and CEUS. Time-intensity curves of CEUS were drawn for regions of interest located in the renal cortex and medulla using QLab software. Conventional US and CEUS quantitative parameters were analyzed. One-way analysis of variance (ANOVA), binary logistic regression, and receiver operating characteristic (ROC) curves were used. RESULTS There were no significant differences in renal size, cortical thickness, and medullary perfusion parameters (P > 0.05), whereas the differences in peak intensity (PI), area under the time-intensity curve (AUC) and wash-in slope (WIS) of cortical perfusion parameters between the control subjects and patients were significant (P < 0.05). PI was significantly lower with the increasing degree of T (P < 0.05). PI was associated independently with the degree of T in IgAN patients (P < 0.05). ROC analysis revealed that using the optimal cutoff values of 15.38 dB for diagnosis of T0-T1 (sensitivity 83.30% and specificity 63.00%) and 14.69 dB for diagnosis of T2 (sensitivity 100.00% and specificity 66.70%), the corresponding areas under the ROC curve were found to be 0.782 and 0.952, respectively. CONCLUSIONS CEUS can potentially be used as a noninvasive imaging marker to evaluate the severity of TA/IF in IgAN patients.
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Yang WQ, Mou S, Xu Y, Xu L, Li FH, Li HL. Quantitative parameters of contrast-enhanced ultrasonography for assessment of renal pathology: A preliminary study in chronic kidney disease. Clin Hemorheol Microcirc 2018; 68:71-82. [PMID: 29036800 DOI: 10.3233/ch-170303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the severity of renal pathology in patients with chronic kidney disease (CKD) using contrast-enhanced ultrasonography (US). METHODS 275 patients with CKD who were proven by renal biopsy and 30 healthy adults were examined using conventional US and contrast-enhanced US. Ultrasonic parameters included renal length, cortical thickness, rise time (RT), peak intensity (PI), area under the time-intensity curve (AUC), wash-in slope (WIS) and time to peak (TTP). Based on pathological scores, CKD patients were classified into mild, and moderate to severe CKD groups. The logistic regression analysis and receiver operating characteristic (ROC) curves were used. RESULTS PI and AUC differed significantly among the controls, mild and moderate to severe CKD groups (P < 0.05). There was significant difference in PI among the different pathology types (P < 0.05). The multivariate logistic regression analysis showed that PI was associated independently with the severity of renal pathology in patients with CKD (P < 0.05). PI less than 13.87 dB had a certain diagnostic ability, and the sensitivity and specificity were 72.5% and 64.0%, respectively. CONCLUSIONS Contrast-enhanced US may be useful for noninvasive assessment of the severity of renal pathology. PI may be potentially valuable for guiding therapy and follow-up in patients with CKD.
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Affiliation(s)
- Wen-Qi Yang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yao Xu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Li Xu
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Feng-Hua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hong-Li Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Kasoji SK, Rivera JN, Gessner RC, Chang SX, Dayton PA. Early Assessment of Tumor Response to Radiation Therapy using High-Resolution Quantitative Microvascular Ultrasound Imaging. Am J Cancer Res 2018; 8:156-168. [PMID: 29290799 PMCID: PMC5743466 DOI: 10.7150/thno.19703] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/22/2017] [Indexed: 12/18/2022] Open
Abstract
Measuring changes in tumor volume using anatomical imaging weeks to months post radiation therapy (RT) is currently the clinical standard for indicating treatment response to RT. For patients whose tumors do not respond successfully to treatment, this approach is suboptimal as timely modification of the treatment approach may lead to better clinical outcomes. We propose to use tumor microvasculature as a biomarker for early assessment of tumor response to RT. Acoustic angiography is a novel contrast ultrasound imaging technique that enables high-resolution microvascular imaging and has been shown to detect changes in microvascular structure due to cancer growth. Data suggest that acoustic angiography can detect longitudinal changes in the tumor microvascular environment that correlate with RT response. Methods: Three cohorts of Fisher 344 rats were implanted with rat fibrosarcoma tumors and were treated with a single fraction of RT at three dose levels (15 Gy, 20 Gy, and 25 Gy) at a dose rate of 300 MU/min. A simple treatment condition was chosen for testing the feasibility of our imaging technique. All tumors were longitudinally imaged immediately prior to and after treatment and then every 3 days after treatment for a total of 30 days. Both acoustic angiography (using in-house produced microbubble contrast agents) and standard b-mode imaging was performed at each imaging time point using a pre-clinical Vevo770 scanner and a custom modified dual-frequency transducer. Results: Results show that all treated tumors in each dose group initially responded to treatment between days 3-15 as indicated by decreased tumor growth accompanied with decreased vascular density. Untreated tumors continued to increase in both volume and vascular density until they reached the maximum allowable size of 2 cm in diameter. Tumors that displayed complete control (no tumor recurrence) continued to decrease in size and vascular density, while tumors that progressed after the initial response presented an increase in tumor volume and volumetric vascular density. The increase in tumor volumetric vascular density in recurring tumors can be detected 10.25 ± 1.5 days, 6 ± 0 days, and 4 ± 1.4 days earlier than the measurable increase in tumor volume in the 15, 20, and 25 Gy dose groups, respectively. A dose-dependent growth rate for tumor recurrence was also observed. Conclusions: In this feasibility study we have demonstrated the ability of acoustic angiography to detect longitudinal changes in vascular density, which was shown to be a potential biomarker for tumor response to RT.
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Kasoji SK, Chang EH, Mullin LB, Chong WK, Rathmell WK, Dayton PA. A Pilot Clinical Study in Characterization of Malignant Renal-cell Carcinoma Subtype with Contrast-enhanced Ultrasound. ULTRASONIC IMAGING 2017; 39:126-136. [PMID: 27659687 PMCID: PMC5599099 DOI: 10.1177/0161734616666383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Malignant renal cell carcinoma (RCC) is a diverse set of diseases, which are independently difficult to characterize using conventional MRI and CT protocols due to low temporal resolution to study perfusion characteristics. Because different disease subtypes have different prognoses and involve varying treatment regimens, the ability to determine RCC subtype non-invasively is a clinical need. Contrast-enhanced ultrasound (CEUS) has been assessed as a tool to characterize kidney lesions based on qualitative and quantitative assessment of perfusion patterns, and we hypothesize that this technique might help differentiate disease subtypes. Twelve patients with RCC confirmed pathologically were imaged using contrast-enhanced ultrasound. Time intensity curves were generated and analyzed quantitatively using 10 characteristic metrics. Results showed that peak intensity ( p = 0.001) and time-to-80% on wash-out ( p = 0.004) provided significant differences between clear cell, papillary, and chromophobe RCC subtypes. These results suggest that CEUS may be a feasible test for characterizing RCC subtypes.
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Affiliation(s)
- Sandeep K. Kasoji
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill/North Carolina State University, 333 S. Columbia St, Chapel Hill, NC 27517 USA/911 Oval Dr, Raleigh, NC 27606 USA
| | - Emily H. Chang
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599 USA
| | - Lee B. Mullin
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill/North Carolina State University, 333 S. Columbia St, Chapel Hill, NC 27517 USA/911 Oval Dr, Raleigh, NC 27606 USA
| | - Wui K. Chong
- UNC Hospitals Dept. of Radiology, 101 Manning Dr #2, Chapel Hill, NC 27514 USA
| | - W. Kimryn Rathmell
- UNC Hospitals Dept. of Radiology, 101 Manning Dr #2, Chapel Hill, NC 27514 USA
- Vanderbilt University Hospitals Dept. of Medicine/Hematology & Oncology, 2200 Pierce Ave, Nashville, TN 37232 USA
| | - Paul A. Dayton
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill/North Carolina State University, 333 S. Columbia St, Chapel Hill, NC 27517 USA/911 Oval Dr, Raleigh, NC 27606 USA
- UNC Hospitals Dept. of Radiology, 101 Manning Dr #2, Chapel Hill, NC 27514 USA
- Biomedical Research Imaging Center, 125 Mason Farm Road, Chapel Hill, NC 27599 USA
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Wang L, Mohan C. Contrast-enhanced ultrasound: A promising method for renal microvascular perfusion evaluation. J Transl Int Med 2016; 4:104-108. [PMID: 28191530 DOI: 10.1515/jtim-2016-0033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This article reviews the application of contrast-enhanced ultrasound (CEUS) in gauging renal microvascular perfusion in diverse renal diseases. The unique nature of the contrast agents used in CEUS provides real-time and quantitative imaging of the vasculature. In addition to the traditional use of CEUS for evaluation of kidney masses, it also emerges as a safe and effective imaging approach to assess microvascular perfusion in diffuse renal lesions, non-invasively. Although the precise CEUS parameters that may best predict disease still warrant systematic evaluation, animal models and limited clinical trials in humans raise hopes that CEUS could outcompete competing modalities as a first-line tool for assessing renal perfusion non-invasively, even in ailments such as acute kidney injury and chronic kidney disease.
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Affiliation(s)
- Ling Wang
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Chandra Mohan
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China; Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States of America
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Grenier N, Merville P, Combe C. Radiologic imaging of the renal parenchyma structure and function. Nat Rev Nephrol 2016; 12:348-59. [DOI: 10.1038/nrneph.2016.44] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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