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Zhang Z, Shao K, Zhou C, Zhou P, Zhou Q, An H, Ji R. Using 1/2 Descending Time in CEUS to Identify Renal Allograft Rejection. Acad Radiol 2024:S1076-6332(24)00048-5. [PMID: 38418346 DOI: 10.1016/j.acra.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
RATIONALE AND OBJECTIVES This study investigates the potential of quantitative Contrast-Enhanced Ultrasound (CEUS) parameters to distinguish between graft dysfunction due to rejection and non-rejection in kidney transplant recipients. METHODS In this retrospective study, 50 kidney transplant patients who presented elevated serum creatinine or proteinuria were analyzed. They were categorized as rejection or non-rejection based on biopsy outcomes. These classifications were applied in both derivation (n = 33) and validation cohorts (n = 17). Prior to the biopsy, all patients underwent a CEUS. Quantitative parameters derived from the CEUS were further analyzed for their consistency and reliability. Additionally, the relationship between the Banff scores, a standard for diagnosing transplant rejections, and these CEUS parameters was explored. RESULTS Significant differences between rejection and non-rejection groups were observed in the CEUS parameters of derivation cohorts. Specifically, Peak Intensity (PI), 1/2 Descending Time (DT/2), Area Under Curve (AUC), and Mean Transit Time (MTT) stood out. Sensitivity and specificity for these parameters were 76.5% and 87.5% for PI, 76.5% and 81.2% for DT/2, 76.5% and 87.5% for AUC, and 68.8% and 94.1% for MTT, respectively. DT/2 and MTT showed superior interobserver agreement compared to PI and AUC. When extrapolating the cutoff values from the derivation cohort to the validation group, DT/2 and AUC exhibited optimal diagnostic precision with positive and negative predictive values being 91.7% vs. 100% and 100% vs. 85.7%, respectively. Additionally, DT/2 effectively differentiated between mild and moderate to severe microvascular inflammation, pivotal in diagnosing antibody-mediated renal transplant rejection. CONCLUSION DT/2 from CEUS parameters presents as a reliable tool to differentiate rejection from non-rejection causes in renal transplant dysfunction. Yet, large-scale, multi-center studies are essential for further validation.
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Affiliation(s)
- Zhe Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Shao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peijun Zhou
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quan Zhou
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin An
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ri Ji
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Chen R, Gao B, Wang X, Zhao H, Wang X, Liu D. Ultrasonographic assessment of renal microcirculation is a new vision for the treatment of intensive care unit associated acute kidney injury. Eur J Med Res 2024; 29:115. [PMID: 38341556 PMCID: PMC10858548 DOI: 10.1186/s40001-024-01704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Rongping Chen
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Beijun Gao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xinchen Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Zhao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
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Wolf M, Darwish O, Neji R, Eder M, Sunder-Plassmann G, Heinz G, Robinson SD, Schmid AI, Moser EV, Sinkus R, Meyerspeer M. Magnetic resonance elastography resolving all gross anatomical segments of the kidney during controlled hydration. Front Physiol 2024; 15:1327407. [PMID: 38384795 PMCID: PMC10880033 DOI: 10.3389/fphys.2024.1327407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction: Magnetic resonance elastography (MRE) is a non-invasive method to quantify biomechanical properties of human tissues. It has potential in diagnosis and monitoring of kidney disease, if established in clinical practice. The interplay of flow and volume changes in renal vessels, tubule, urinary collection system and interstitium is complex, but physiological ranges of in vivo viscoelastic properties during fasting and hydration have never been investigated in all gross anatomical segments simultaneously. Method: Ten healthy volunteers underwent two imaging sessions, one following a 12-hour fasting period and the second after a drinking challenge of >10 mL per kg body weight (60-75 min before the second examination). High-resolution renal MRE was performed using a novel driver with rotating eccentric mass placed at the posterior-lateral wall to couple waves (50 Hz) to the kidney. The biomechanical parameters, shear wave speed (cs in m/s), storage modulus (Gd in kPa), loss modulus (Gl in kPa), phase angle ( Υ = 2 π atan G l G d ) and attenuation (α in 1/mm) were derived. Accurate separation of gross anatomical segments was applied in post-processing (whole kidney, cortex, medulla, sinus, vessel). Results: High-quality shear waves coupled into all gross anatomical segments of the kidney (mean shear wave displacement: 163 ± 47 μm, mean contamination of second upper harmonics <23%, curl/divergence: 4.3 ± 0.8). Regardless of the hydration state, median Gd of the cortex and medulla (0.68 ± 0.11 kPa) was significantly higher than that of the sinus and vessels (0.48 ± 0.06 kPa), and consistently, significant differences were found in cs, Υ , and Gl (all p < 0.001). The viscoelastic parameters of cortex and medulla were not significantly different. After hydration sinus exhibited a small but significant reduction in median Gd by -0.02 ± 0.04 kPa (p = 0.01), and, consequently, the cortico-sinusoidal-difference in Gd increased by 0.04 ± 0.07 kPa (p = 0.05). Only upon hydration, the attenuation in vessels became lower (0.084 ± 0.013 1/mm) and differed significantly from the whole kidney (0.095 ± 0.007 1/mm, p = 0.01). Conclusion: High-resolution renal MRE with an innovative driver and well-defined 3D segmentation can resolve all renal segments, especially when including the sinus in the analysis. Even after a prolonged hydration period the approach is sensitive to small hydration-related changes in the sinus and in the cortico-sinusoidal-difference.
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Affiliation(s)
- Marcos Wolf
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Omar Darwish
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Michael Eder
- Department of Medicine III, Division of Nephrology and Dialysis, General Hospital and Medical University of Vienna, Vienna, Austria
| | - Gere Sunder-Plassmann
- Department of Medicine III, Division of Nephrology and Dialysis, General Hospital and Medical University of Vienna, Vienna, Austria
| | - Gertraud Heinz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum St. Pölten, Sankt Pölten, Austria
| | - Simon Daniel Robinson
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre of Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - Albrecht Ingo Schmid
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ewald V. Moser
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ralph Sinkus
- Institut National de La Santé et de La Recherche Médicale, U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Martin Meyerspeer
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Sharma A, Oluyemi E, Myers K, Ambinder E, Bell MAL. Spatial Coherence Approaches to Distinguish Suspicious Mass Contents in Fundamental and Harmonic Breast Ultrasound Images. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:70-84. [PMID: 37956000 PMCID: PMC10851341 DOI: 10.1109/tuffc.2023.3332207] [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] [Indexed: 11/15/2023]
Abstract
When compared to fundamental B-mode imaging, coherence-based beamforming, and harmonic imaging are independently known to reduce acoustic clutter, distinguish solid from fluid content in indeterminate breast masses, and thereby reduce unnecessary biopsies during a breast cancer diagnosis. However, a systematic investigation of independent and combined coherence beamforming and harmonic imaging approaches is necessary for the clinical deployment of the most optimal approach. Therefore, we compare the performance of fundamental and harmonic images created with short-lag spatial coherence (SLSC), M-weighted SLSC (M-SLSC), SLSC combined with robust principal component analysis with no M-weighting (r-SLSC), and r-SLSC with M-weighting (R-SLSC), relative to traditional fundamental and harmonic B-mode images, when distinguishing solid from fluid breast masses. Raw channel data acquired from 40 total breast masses (28 solid, 7 fluid, 5 mixed) were beamformed and analyzed. The contrast of fluid masses was better with fundamental rather than harmonic coherence imaging, due to the lower spatial coherence within the fluid masses in the fundamental coherence images. Relative to SLSC imaging, M-SLSC, r-SLSC, and R-SLSC imaging provided similar contrast across multiple masses (with the exception of clinically challenging complicated cysts) and minimized the range of generalized contrast-to-noise ratios (gCNRs) of fluid masses, yet required additional computational resources. Among the eight coherence imaging modes compared, fundamental SLSC imaging best identified fluid versus solid breast mass contents, outperforming fundamental and harmonic B-mode imaging. With fundamental SLSC images, the specificity and sensitivity to identify fluid masses using the reader-independent metrics of contrast difference, mean lag one coherence (LOC), and gCNR were 0.86 and 1, 1 and 0.89, and 1 and 1, respectively. Results demonstrate that fundamental SLSC imaging and gCNR (or LOC if no coherence image or background region of interest is introduced) have the greatest potential to impact clinical decisions and improve the diagnostic certainty of breast mass contents. These observations are additionally anticipated to extend to masses in other organs.
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Abstract
As a sign of chronic kidney disease (CKD) progression, renal fibrosis is an irreversible and alarming pathological change. The accurate diagnosis of renal fibrosis depends on the widely used renal biopsy, but this diagnostic modality is invasive and can easily lead to sampling error. With the development of imaging techniques, an increasing number of noninvasive imaging techniques, such as multipara meter magnetic resonance imaging (MRI) and ultrasound elastography, have gained attention in assessing kidney fibrosis. Depending on their ability to detect changes in tissue stiffness and diffusion of water molecules, ultrasound elastography and some MRI techniques can indirectly assess the degree of fibrosis. The worsening of renal tissue oxygenation and perfusion measured by blood oxygenation level-dependent MRI and arterial spin labeling MRI separately is also an indirect reflection of renal fibrosis. Objective and quantitative indices of fibrosis may be available in the future by using novel techniques, such as photoacoustic imaging and fluorescence microscopy. However, these imaging techniques are susceptible to interference or may not be convenient. Due to the lack of sufficient specificity and sensitivity, these imaging techniques are neither widely accepted nor proposed by clinicians. These obstructions must be overcome by conducting technology research and more prospective studies. In this review, we emphasize the recent advancement of these noninvasive imaging techniques and provide clinicians a continuously updated perspective on the assessment of kidney fibrosis.
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Affiliation(s)
- Buchun Jiang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China
| | - Fei Liu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China,CONTACT Haidong Fu
| | - Jianhua Mao
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China,Jianhua Mao The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, 3333 Bingsheng Rd, Hangzhou, Zhejiang310052, China
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Su X, Lin S, Huang Y. Value of radiomics-based two-dimensional ultrasound for diagnosing early diabetic nephropathy. Sci Rep 2023; 13:20427. [PMID: 37993534 PMCID: PMC10665410 DOI: 10.1038/s41598-023-47449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
Despite efforts to diagnose diabetic nephropathy (DN) using biochemical data or ultrasound imaging separately, a significant gap exists regarding the development of integrated models combining both modalities for enhanced early DN diagnosis. Therefore, we aimed to assess the ability of machine learning models containing two-dimensional ultrasound imaging and biochemical data to diagnose early DN in patients with type 2 diabetes mellitus (T2DM). This retrospective study included 219 patients, divided into a training or test group at an 8:2 ratio. Features were selected using minimum redundancy maximum relevance and random forest-recursive feature elimination. The predictive performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) for sensitivity, specificity, Matthews Correlation Coefficient, F1 score, and accuracy. K-nearest neighbor, support vector machine, and logistic regression models could diagnose early DN, with AUC values of 0.94, 0.85, and 0.85 in the training cohort and 0.91, 0.84, and 0.84 in the test cohort, respectively. Early DN diagnosing using two-dimensional ultrasound-based radiomics models can potentially revolutionize T2DM patient care by enabling proactive interventions, ultimately improving patient outcomes. Our integrated approach showcases the power of artificial intelligence in medical imaging, enhancing early disease detection strategies with far-reaching applications across medical disciplines.
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Affiliation(s)
- Xuee Su
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
- Department of Anaesthesia, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Yinqiong Huang
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
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7
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Staub E. Current and potential methods to assess kidney structure and morphology in term and preterm neonates. Anat Rec (Hoboken) 2023. [PMID: 36883787 DOI: 10.1002/ar.25195] [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: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Zhu L, Huang R, Zhou Z, Fan Q, Yan J, Wan X, Zhao X, He Y, Dong F. Prediction of Renal Function 1 Year After Transplantation Using Machine Learning Methods Based on Ultrasound Radiomics Combined With Clinical and Imaging Features. ULTRASONIC IMAGING 2023; 45:85-96. [PMID: 36932907 DOI: 10.1177/01617346231162910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Kidney transplantation is the most effective treatment for advanced chronic kidney disease (CKD). If the prognosis of transplantation can be predicted early after transplantation, it might improve the long-term survival of patients with transplanted kidneys. Currently, studies on the assessment and prediction of renal function by radiomics are limited. Therefore, the present study aimed to explore the value of ultrasound (US)-based imaging and radiomics features, combined with clinical features to develop and validate the models for predicting transplanted kidney function after 1 year (TKF-1Y) using different machine learning algorithms. A total of 189 patients were included and classified into the abnormal TKF-1Y group, and the normal TKF-1Y group based on their estimated glomerular filtration rate (eGFR) levels 1 year after transplantation. The radiomics features were derived from the US images of each case. Three machine learning methods were employed to establish different models for predicting TKF-1Y using selected clinical and US imaging as well as radiomics features from the training set. Two US imaging, four clinical, and six radiomics features were selected. Then, the clinical (including clinical and US image features), radiomics, and combined models were developed. The area under the curves (AUCs) of the models was 0.62 to 0.82 within the test set. Combined models showed statistically higher AUCs than the radiomics models (all p-values <.05). The prediction performance of different models was not significantly affected by the different machine learning algorithms (all p-values >.05). In conclusion, US imaging features combined with clinical features could predict TKF-1Y and yield an incremental value over radiomics features. A model integrating all available features may further improve the predictive efficacy. Different machine learning algorithms may not have a significant impact on the predictive performance of the model.
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Affiliation(s)
- Lili Zhu
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Renjun Huang
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Zhiyong Zhou
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou City, Jiangsu Province, P.R. China
| | - Qingmin Fan
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Junchen Yan
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Xiaojing Wan
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Xiaojun Zhao
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Yao He
- Suzhou Key Laboratory of Nanotechnology and Biomedicine, Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Institute of Functional Nano & Soft Materials (FUNSOM), Soochow University, Suzhou City, Jiangsu Province, P.R. China
| | - Fenglin Dong
- Department of Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, P.R. China
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Zhu L, Huang R, Li M, Fan Q, Zhao X, Wu X, Dong F. Machine Learning-Based Ultrasound Radiomics for Evaluating the Function of Transplanted Kidneys. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1441-1452. [PMID: 35599077 DOI: 10.1016/j.ultrasmedbio.2022.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study described here was to investigate the value of different machine learning models based on the clinical and radiomic features of 2-D ultrasound images to evaluate post-transplant renal function (pTRF). We included 233 patients who underwent ultrasound examination after renal transplantation and divided them into the normal pTRF group (group 1) and the abnormal pTRF group (group 2) based on their estimated glomerular filtration rates. The patients with abnormal pTRF were further subdivided into the non-severe renal function impairment group (group 2A) and the severe impairment group (group 2B). The radiomic features were extracted from the 2-D ultrasound images of each case. The clinical and ultrasound image features as well as radiomic features from the training set were selected, and then five machine learning algorithms were used to construct models for evaluating pTRF. Receiver operating characteristic curves were used to evaluate the discriminatory ability of each model. A total of 19 radiomic features and one clinical feature (age) were retained for discriminating group 1 from group 2. The area under the receiver operating characteristic curve (AUC) values of the models ranged from 0.788 to 0.839 in the test set, and no significant differences were found between the models (all p values >0.05). A total of 17 radiomic features and 1 ultrasound image feature (thickness) were retained for discriminating group 2A from group 2B. The AUC values of the models ranged from 0.689 to 0.772, and no significant differences were found between the models (all p values >0.05). Machine learning models based on clinical and ultrasound image features, as well as radiomics features, from 2-D ultrasound images can be used to evaluate pTRF.
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Affiliation(s)
- Lili Zhu
- Department of Ultrasound, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Renjun Huang
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Ming Li
- Department of Nephrology, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Qingmin Fan
- Department of Ultrasound, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Xiaojun Zhao
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Xiaofeng Wu
- Department of Ultrasound, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Fenglin Dong
- Department of Ultrasound, First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China.
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He L, Li Z, Zhang Q, Chen Y, Gao Y, Chen T, Wang N, Jiang L, Fan Y. Evaluation of renal microperfusion in hyperuricemic nephropathy by Contrast-Enhanced Ultrasound imaging. Dis Model Mech 2022; 15:276106. [PMID: 35645166 PMCID: PMC9346517 DOI: 10.1242/dmm.049382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Diagnostic tools for the early detection of renal injury caused by hyperuricemia are still lacking. Here, we investigated whether contrast-enhanced ultrasound (CEUS) could be used as a diagnostic tool for hyperuricemic nephropathy (HN). In the HN rat model, CEUS detected a significant decline in renal cortical perfusion compared with that in control rats. Peak intensity (PI) values correlated significantly with serum KIM-1 levels and fibrosis scores in HN rats. An early decline in PI values was also observed in chronic kidney disease (CKD) stage 1 patients with HN compared with the controls (61.1±4.52 dB versus 65.80±7.10 dB) and correlated with renal function in the patients with HN. In contrast, an increase in time to reach PI values was detected in HN patients with stage 1 CKD (15.14±1.75 s versus 14.52±4.75 s) and was more pronounced in CKD stage 4 patients (67.32±3.29 s). CEUS was able to detect abnormal renal perfusion in early CKD with HN, which correlated with renal function decline, suggesting that CEUS could be used as a noninvasive tool for assessing renal function in patients with HN.
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Affiliation(s)
- Li He
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ze Li
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Qunzi Zhang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yini Chen
- Ultrasonic department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yihui Gao
- Ultrasonic department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Teng Chen
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Lixin Jiang
- Ultrasonic department, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ying Fan
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Srivastava A, Sridharan A, Walmer RW, Kasoji SK, Burke LM, Dayton PA, Johnson KA, Chang EH. Association of Contrast-Enhanced Ultrasound-Derived Kidney Cortical Microvascular Perfusion with Kidney Function. KIDNEY360 2022; 3:647-656. [PMID: 35721623 PMCID: PMC9136891 DOI: 10.34067/kid.0005452021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/26/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Individuals with chronic kidney disease (CKD) have decreased kidney cortical microvascular perfusion, which may lead to worsening kidney function over time, but methods to quantify kidney cortical microvascular perfusion are not feasible to incorporate into clinical practice. Contrast-enhanced ultrasound (CEUS) may quantify kidney cortical microvascular perfusion, which requires further investigation in individuals across the spectrum of kidney function. METHODS We performed CEUS on a native kidney of 83 individuals across the spectrum of kidney function and calculated quantitative CEUS-derived kidney cortical microvascular perfusion biomarkers. Participants had a continuous infusion of the microbubble contrast agent (Definity) with a flash-replenishment sequence during their CEUS scan. Lower values of the microbubble velocity (β) and perfusion index (β×A) may represent lower kidney cortical microvascular perfusion. Multivariable linear regression models tested the associations of the microbubble velocity (β) and perfusion index (β×A) with estimated glomerular filtration rate (eGFR). RESULTS Thirty-eight individuals with CKD (mean age±SD 65.2±12.6 years, median [IQR] eGFR 31.5 [18.9-41.5] ml/min per 1.73 m2), 37 individuals with end stage kidney disease (ESKD; age 54.8±12.3 years), and eight healthy volunteers (age 44.1±15.0 years, eGFR 117 [106-120] ml/min per 1.73 m2) underwent CEUS without side effects. Individuals with ESKD had the lowest microbubble velocity (β) and perfusion index (β×A) compared with individuals with CKD and healthy volunteers. The microbubble velocity (β) and perfusion index (β×A) had moderate positive correlations with eGFR (β: rs=0.44, P<0.001; β×A: rs=0.50, P<0.001). After multivariable adjustment, microbubble velocity (β) and perfusion index (β×A) remained significantly associated with eGFR (change in natural log transformed eGFR per 1 unit increase in natural log transformed biomarker: β, 0.38 [95%, CI 0.17 to 0.59]; β×A, 0.79 [95% CI, 0.45 to 1.13]). CONCLUSIONS CEUS-derived kidney cortical microvascular perfusion biomarkers are associated with eGFR. Future studies are needed to determine if CEUS-derived kidney cortical microvascular perfusion biomarkers have prognostic value.
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Affiliation(s)
- Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anush Sridharan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel W. Walmer
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sandeep K. Kasoji
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren M.B. Burke
- Deparatment of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Paul A. Dayton
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kennita A. Johnson
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily H. Chang
- University of North Carolina Kidney Center, Chapel Hill, North Carolina
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Hamelink TL, Ogurlu B, De Beule J, Lantinga VA, Pool MBF, Venema LH, Leuvenink HGD, Jochmans I, Moers C. Renal Normothermic Machine Perfusion: The Road Toward Clinical Implementation of a Promising Pretransplant Organ Assessment Tool. Transplantation 2022; 106:268-279. [PMID: 33979315 DOI: 10.1097/tp.0000000000003817] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The increased utilization of high-risk renal grafts for transplantation requires optimization of pretransplant organ assessment strategies. Current decision-making methods to accept an organ for transplantation lack overall predictive power and always contain an element of subjectivity. Normothermic machine perfusion (NMP) creates near-physiological conditions, which might facilitate a more objective assessment of organ quality before transplantation. NMP is rapidly gaining popularity, with various transplant centers developing their own NMP protocols and renal viability criteria. However, to date, no validated sets of on-pump viability markers exist nor are there unified NMP protocols. This review provides a critical overview of the fundamentals of current renal NMP protocols and proposes a framework to approach further development of ex vivo organ evaluation. We also comment on the potential logistical implications of routine clinical use of NMP, which is a more complex procedure compared with static cold storage or even hypothermic machine perfusion.
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Affiliation(s)
- Tim L Hamelink
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Baran Ogurlu
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Julie De Beule
- Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Veerle A Lantinga
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Merel B F Pool
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Leonie H Venema
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Henri G D Leuvenink
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ina Jochmans
- Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Cyril Moers
- Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Bandara MS, Gurunayaka B, Lakraj G, Pallewatte A, Siribaddana S, Wansapura J. Ultrasound Based Radiomics Features of Chronic Kidney Disease. Acad Radiol 2022; 29:229-235. [PMID: 33589307 DOI: 10.1016/j.acra.2021.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Interstitial fibrosis, common to most chronic kidney diseases, can potentially affect the speckle patterns of kidney ultrasound (US). Here we use Radiomics features derived from US images to identify kidneys with chronic kidney disease. MATERIALS AND METHODS B-mode US without speckle reduction was performed on a cohort of CKD patients (n = 75) and healthy subjects (n = 27). Images of the patients with renal cysts, agenesis and calculi were excluded. After background subtraction, regions of interest were selected from each kidney. Four hundred and sixty-five Radiomics features including first and second-order gray level statistics were calculated on the selected regions. Second-order features were also calculated on wavelet transformed images. A random forest model was used to identify the most important features that can differentiate healthy and diseased kidneys. The ten most important features, based on the Gini index, were used to train a support vector machine. Synthetic minority oversampling technique was used to remove over fitting. RESULTS Wavelet transformed, Gray Level Run Length Matrix based Normalized Run Length Non-uniformity, WT (LH) (GRLN) was identified as the most significant feature in differentiating CKD and healthy kidneys (accuracy - 0.85, sensitivity - 1.0). The mean WT (LH) GRLN of healthy kidneys (0.40 ± 0.01) was significantly higher (p < 0.01) than that of the CKD kidneys (0.24 ± 0.01). According to the Gini Index, the differentiability of WT (LH) GRLN was highest when the long axis of the kidney was oriented perpendicular to the columns of the image matrix. CONCLUSION Radiomics features based on wavelet transformation are sensitive to directionality of US speckle patters and can be successfully used to differentiate CKD and healthy US kidney images.
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Affiliation(s)
| | - Buddika Gurunayaka
- Department of Radiology, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
| | - Gamage Lakraj
- Department of Statistic, University of Colombo, Colombo, Sri Lanka
| | - Aruna Pallewatte
- Department of Neuroradiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Janaka Wansapura
- Department of Physics, University of Colombo, Colombo, Sri Lanka; Advanced Imaging Research Center, UT Southwestern Medical center, 5323 Harry Hines Blvd, Dallas, TX.
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LIM C, LEE S, CHUNG W, KIM H, JEON S, KIM YH. Effects of intraoperative hypotension on postoperative renal function in arthroscopic shoulder surgery: a retrospective study. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Hwang J, Kim HW, Kim PH, Suh CH, Yoon HM. Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2639-2653. [PMID: 33599306 DOI: 10.1002/jum.15654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To estimate the technical performance of acoustic radiation force impulse (ARFI) imaging (two-dimensional shear wave elastography [2D-SWE] and point shear wave elastography [p-SWE]) for measuring renal parenchymal stiffness. METHODS EMBASE and PubMed databases were searched for studies reporting technical performance of ARFI imaging in terms of technical failure, interobserver agreement, and/or intraobserver agreement. The proportion of technical failure and intraclass correlation coefficients (ICCs) for interobserver and intraobserver agreement was pooled. The pooled estimates of native and transplanted kidneys were obtained separately. Meta-regression and subgroup analyses were conducted to explore heterogeneity. RESULTS Twenty-four studies (2993 patients) were included. The pooled proportions of technical failure were 4.3% (95% confidence interval [CI] 2.2-8.5%) and 6.6% (95% CI 4.0-10.7%) in native and transplanted kidneys, respectively. The pooled ICCs of interobserver agreement were 0.70 (95% CI 0.68-0.83) and 0.81 (95% CI 0.68-0.89), indicating moderate and good agreement in native and transplanted kidneys, respectively. The pooled ICC showed good (0.77; 95% CI 0.49-0.91) intraobserver agreement in native kidneys. Regarding interobserver agreement in transplanted kidneys, ROI location (mid pole only versus others) was a significant factor of heterogeneity (P = .04). CONCLUSIONS The ARFI-based SWE techniques show good technical performance for measuring renal parenchymal stiffness. The wide range of SWE protocols necessitates development of standardized guidelines on the use of renal ARFI imaging.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Republic of Korea
| | - Hae Won Kim
- Department of Radiology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Comparison of Urinary Tract Dilatation and Society of Fetal Urology systems in the detection of vesicourethral reflux and renal scar. Pol J Radiol 2021; 86:e449-e454. [PMID: 34429792 PMCID: PMC8369818 DOI: 10.5114/pjr.2021.107609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The presence and degree of hydronephrosis is very important in the management of many diseases of the urinary tract. In this study, we aim to compare the sensitivity and specificity of 2 classification systems that are used for hydro-nephrosis grading in ultrasound, for reflux and scar detection. The classification systems were the Society of Fetal Urology (SFU) and Urinary Tract Dilatation (UTD). Material and methods Ultrasounds and dimercaptosuccinic acid scintigraphies (DMSA) of all patients who underwent voiding cystourethrogram (VCUG) due to urinary tract infection were examined retrospectively. DMSA was accepted for scar detection and VCUG for reflux detection as reference methods. SFU classification was used for hydronephrosis in ultrasound reports, and UTD classification was made over the reports. Sensitivity, specificity, and positive and negative predictive values of UTD and SFU classification systems for reflux and scar detection were calculated, and these 2 systems were compared. Results 103 (39%) of the patients were male and 162 (61%) were female. Pathologies were detected in 192 (35%) of 530 kidneys in ultrasound. In 110 (42%) of the children, reflux was detected in VCUG. Scars in DMSA were detected in only 16% (44) of 266 kidneys. Sensitivity, positive and negative predictive values of the UTD classification system were statistically significantly higher than the SFU system for scar and reflux detection (p < 0.01). Conclusions If we use the UTD system in ultrasounds of patients with urinary tract infections, children reported as UTD 0 may not need VCUG, which reduces radiation exposure to children and the cost of the diagnostic interventions.
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Near-infrared spectrometry: the future of renal graft perfusion monitoring? COR ET VASA 2021. [DOI: 10.33678/cor.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Urban MW, Rule AD, Atwell TD, Chen S. Novel Uses of Ultrasound to Assess Kidney Mechanical Properties. KIDNEY360 2021; 2:1531-1539. [PMID: 34939037 PMCID: PMC8691758 DOI: 10.34067/kid.0002942021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ultrasound is a key imaging tool for evaluating the kidney. Over the last two decades, methods to measure the mechanical properties of soft tissues have been developed and used in clinical practice, although use in the kidney has not been as widespread as for other applications. The mechanical properties of the kidney are determined by the structure and composition of the renal parenchyma and perfusion characteristics. Because pathologic processes change these factors, the mechanical properties change and can be used for diagnostic purposes and for monitoring treatment or disease progression. Ultrasound-based elastography methods for evaluating the mechanical properties of the kidney use focused ultrasound beams to perturb the kidney and then high frame-rate ultrasound methods are used to measure the resulting motion. The motion is analyzed to estimate the mechanical properties. This review will describe the principles of these methods and discuss several seminal studies related to characterizing the kidney. Additionally, an overview of the clinical use of elastography methods in native and kidney allografts will be provided. Perspectives on future developments and uses of elastography technology along with other complementary ultrasound imaging modalities will be provided.
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Affiliation(s)
| | - Andrew D. Rule
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Perspectives on the Role of Magnetic Resonance Imaging (MRI) for Noninvasive Evaluation of Diabetic Kidney Disease. J Clin Med 2021; 10:jcm10112461. [PMID: 34199385 PMCID: PMC8199575 DOI: 10.3390/jcm10112461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/09/2023] Open
Abstract
Renal magnetic resonance imaging (MRI) techniques are currently in vogue, as they provide in vivo information on renal volume, function, metabolism, perfusion, oxygenation, and microstructural alterations, without the need for exogenous contrast media. New imaging biomarkers can be identified using these tools, which represent a major advance in the understanding and study of the different pathologies affecting the kidney. Diabetic kidney disease (DKD) is one of the most important diseases worldwide due to its high prevalence and impact on public health. However, its multifactorial etiology poses a challenge for both basic and clinical research. Therefore, the use of novel renal MRI techniques is an attractive step forward in the comprehension of DKD, both in its pathogenesis and in its detection and surveillance in the clinical practice. This review article outlines the most promising MRI techniques in the study of DKD, with the purpose of stimulating their clinical translation as possible tools for the diagnosis, follow-up, and monitoring of the clinical impacts of new DKD treatments.
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20
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Jiang W, Xu D, Zhang X, Wu M, Wu K. Colored Doppler Ultrasound Diagnosis and Pathological Analysis of Superficial Organ and Vascular Diseases. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper proposes a fully digital signal processing scheme for ultrasonic Doppler endoscope imaging. 200 patients with superficial tissue lumps were randomly divided into two groups: the control group and the experimental group. These two groups used conventional ultrasound examination
and colored Doppler ultrasound imaging technology, respectively, to observe and compare the test method and the surgical pathological examination results. Compared with the results of the two groups, the diagnostic compliance rate of the patients in the experimental group was 99.0% significantly
higher than the diagnostic compliance rate of 86.0%. At the same time, 300 patients with surgery and pathologically confirmed superficial organ lesions were selected in the hospital, and all patients were diagnosed by ultrasound to observe the diagnosis. The clinical effects of colored Doppler
ultrasound to diagnose vascular lesions in the lower extremities of diabetes were discussed. The rate of arteriosclerosis in the lower extremities of the observation group was 92.32%. The more than 50% vascular stenosis rate was 45.16%. The vascular blocking rate was 16. 13% and thrombosis
rate 6.45% were significantly higher than the control group 12.90%, 8.06%, 0.00%, 0.00%. In the diagnosis of superficial tissue lesions, the resolution of colored Doppler ultrasound imaging technology is relatively high, which can significantly improve the clinical diagnosis rate and has clinical
application value.
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Affiliation(s)
- Wenting Jiang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Duxing Xu
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Xiaofeng Zhang
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Mingyuan Wu
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
| | - Kunbin Wu
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, China
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21
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Xia D, Peng E, Yu Y, Yang X, Liu H, Tong Y, Wang X, Xu H, Ye Z, Tang K, Chen Z. Comparison of contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with nondilated collecting system: a randomized controlled trial. Eur Radiol 2021; 31:6736-6746. [PMID: 33638020 DOI: 10.1007/s00330-021-07804-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/31/2020] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the safety, effectiveness, and feasibility of contrast-enhanced ultrasound (CEUS) versus conventional ultrasound-guided percutaneous nephrolithotomy (PCNL) in patients with nondilated collecting system. METHODS Between July 2018 and July 2020, 160 kidney stone patients with nondilated collecting system planned for PCNL were randomly assigned into two groups, CEUS with retrograde ureteral contrast injection and conventional ultrasound with retrograde ureteral normal saline injection. Patient's demographics, the success rate of puncture, success rate of a single-needle puncture, number of punctures, puncture time, perioperative outcomes, stone-free rate, and incidence of complications were compared. RESULTS The success rate of a single-needle puncture for CEUS-guided PCNL was higher than that in the conventional ultrasound group (88.5% vs. 73.7%, p = 0.02). Patients performed with CEUS-guided PCNL required less needle passes (p = 0.02), shorter needle puncture time (p = 0.031), and shorter channel establishment time (p = 0.04) than those guided with conventional ultrasound. The postoperative hemoglobin decrease in the CEUS-guided PCNL group was less than that of the control group (p = 0.02). There was no significant difference in operating time, length of hospital stays, kidney function change, and complications between the two groups (p > 0.05). The 1-month stone-free rate was 94.9% in the CEUS group and 90.8% in the control group (p > 0.05). CONCLUSIONS Compared with conventional ultrasound, CEUS-guided PCNL may facilitate ultrasound-guided PCNL for patients without hydronephrosis, and benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1800016981 KEY POINTS: • Compared with conventional ultrasound, CEUS-guided PCNL is a safe and efficacious procedure for kidney stone patients with nondilated collecting system. • Compared with conventional ultrasound, CEUS-guided PCNL benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. • CEUS-guided PCNL associated with the more accurate needle puncture and acceptable complications.
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Affiliation(s)
- Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Yu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoqi Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hailang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yonghua Tong
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xinguang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Hubei Institute of Urology, Wuhan, 430030, China.
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Hubei Institute of Urology, Wuhan, 430030, China.
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22
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Gabbiadini R, Zacharopoulou E, Furfaro F, Craviotto V, Zilli A, Gilardi D, Roda G, Loy L, Fiorino G, Peyrin-Biroulet L, Danese S, Allocca M. Application of Ultrasound Elastography for Assessing Intestinal Fibrosis in Inflammatory Bowel Disease: Fiction or Reality? Curr Drug Targets 2021; 22:347-355. [PMID: 33213341 DOI: 10.2174/1389450121666201119142919] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intestinal fibrosis and subsequent strictures represent an important burden in inflammatory bowel disease (IBD). Both the detection and evaluation of the degree of fibrosis in stricturing Crohn's disease (CD) are important when deciding the best therapeutic strategy (medical anti-inflammatory therapy, endoscopic dilation, surgery). Ultrasound elastography (USE) is a non-invasive technique that has been proposed in the field of IBD for evaluating intestinal stiffness as a biomarker of intestinal fibrosis. OBJECTIVE The aim of this review is to discuss the ability and current role of ultrasound elastography in the assessment of intestinal fibrosis. RESULTS AND CONCLUSION Data on USE in IBD are provided by pilot and proof-of-concept studies with small sample size. The first type of USE investigated was strain elastography, while shear wave elastography has been introduced recently. Despite the heterogeneity of the methods of the studies, USE has been proven to be able to assess intestinal fibrosis in patients with stricturing CD. However, before introducing this technique in current practice, further studies with larger sample sizes are needed. In addition, the use of homogeneous parameters, the assessment of reproducibility, and the identification of validated cut-off values are essential.
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Affiliation(s)
- Roberto Gabbiadini
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Eirini Zacharopoulou
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Vincenzo Craviotto
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Daniela Gilardi
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Giulia Roda
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Laura Loy
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
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Wang Y, Liu K, Xie X, Song B. Potential role of imaging for assessing acute pancreatitis-induced acute kidney injury. Br J Radiol 2021; 94:20200802. [PMID: 33237803 DOI: 10.1259/bjr.20200802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is a common complication of acute pancreatitis (AP) that is associated with increased mortality. Conventional assessment of AKI is based on changes in serum creatinine concentration and urinary output. However, these examinations have limited accuracy and sensitivity for the diagnosis of early-stage AKI. This review summarizes current evidence on the use of advanced imaging approaches and artificial intelligence (AI) for the early prediction and diagnosis of AKI in patients with AP. CT scores, CT post-processing technology, Doppler ultrasound, and AI technology provide increasingly valuable information for the diagnosis of AP-induced AKI. Magnetic resonance imaging (MRI) also has potential for the evaluation of AP-induced AKI. For the accurate diagnosis of early-stage AP-induced AKI, more studies are needed that use these new techniques and that use AI in combination with advanced imaging technologies.
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Affiliation(s)
- Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaixiang Liu
- Department of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People' s Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Nephrology, Nanchong Central Hospital, The Second Affiliated Medical College of North Sichuan Medical College, Nanchong, China
| | - Xisheng Xie
- Department of Nephrology, Nanchong Central Hospital, The Second Affiliated Medical College of North Sichuan Medical College, Nanchong, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Su CH, Hsu YC, Thangudu S, Chen WY, Huang YT, Yu CC, Shih YH, Wang CJ, Lin CL. Application of multiparametric MR imaging to predict the diversification of renal function in miR29a-mediated diabetic nephropathy. Sci Rep 2021; 11:1909. [PMID: 33479331 PMCID: PMC7820287 DOI: 10.1038/s41598-021-81519-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the major leading cause of kidney failure. To identify the progression of chronic kidney disease (CKD), renal function/fibrosis is playing a crucial role. Unfortunately, lack of sensitivities/specificities of available clinical biomarkers are key major issues for practical healthcare applications to identify the renal functions/fibrosis in the early stage of DN. Thus, there is an emerging approach such as therapeutic or diagnostic are highly desired to conquer the CKD at earlier stages. Herein, we applied and examined the application of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging (DWI) to identify the progression of fibrosis between wild type (WT) and miR29a transgenic (Tg) mice during streptozotocin (STZ)-induced diabetes. Further, we also validate the potential renoprotective role of miR29a to maintain the renal perfusion, volume, and function. In addition, Ktrans values of DCE-MRI and apparent diffusion coefficient (ADC) of DWI could significantly reflect the level of fibrosis between WT and Tg mice at identical conditions. As a result, we strongly believed that the present non-invasive MR imaging platforms have potential to serveas an important tool in research and clinical imaging for renal fibrosis in diabetes, and that microenvironmental changes could be identified by MR imaging acquisition prior to histological biopsy and diabetic podocyte dysfunction.
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Affiliation(s)
- Chia-Hao Su
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Yung-Chien Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, 6 West, Chia-Pu Road, Putzu City, Chiayi, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Suresh Thangudu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Yu Chen
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Department of Nephrology, Chang Gung Memorial Hospital, 6 West, Chia-Pu Road, Putzu City, Chiayi, Taiwan
| | - Chun-Chieh Yu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ya-Hsueh Shih
- Department of Nephrology, Chang Gung Memorial Hospital, 6 West, Chia-Pu Road, Putzu City, Chiayi, Taiwan
- Kidney Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ching-Jen Wang
- Department of Medical Research, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, 6 West, Chia-Pu Road, Putzu City, Chiayi, Taiwan.
- Kidney Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
- College of Medicine, Chang Gung University, Taipei, Taiwan.
- Department of Medical Research, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung, Taiwan.
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25
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Relationship between Vesicoureteral Reflux and Glomerular Filtration Rate in Children. Curr Med Sci 2020; 40:845-850. [PMID: 33123900 DOI: 10.1007/s11596-020-2267-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/09/2020] [Indexed: 10/23/2022]
Abstract
Vesicoureteral reflux (VUR) is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare. We recruited 35 primary VUR patients with recurrent urinary tract infection (UTI) and 10 non-VUR patients with recurrent UTI. Contrast-enhanced voiding urosonography (ceVUS) was performed for VUR grading, and renal dynamic imaging was used for evaluating glomerular filtration rate (GFR, mL/min). Standardized GFR (sGFR), namely GFR/BSA (mL·min-1·m-2), was calculated based on the body surface area (BSA). Total sGFR (tsGFR, mL·min-1·m-2) was obtained from the sum of sGFR on the left and right sides of all the children. The risk of renal regurgitation was equal in the unilateral reflux group. The sGFR of children with grade IV (45.74±18.05 mL·min-1·m-2) and grade V (49.67±23.63 mL·min-1·m-2) reflux was significantly lower than that in children with grade III (77.69 ±22.21 mL·min-1·m-2). The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group, which was higher than that in the control group and level II, IV and V of reflux group respectively. In VUR group of the same grade, sGFR decreased with the age at diagnosis. In unilateral grade V reflux group, the tsGFR was lower than that in the unilateral grade III reflux group (133.51±48.21 vs. 186.87±53.49 mL·min-1·m-2). The patients with VUR of unilateral grade II were significantly older than those with VUR of unilateral grades III and IV. This study indicates that severe VUR is significantly associated with decreased renal function. Therefore, VUR should be diagnosed early and managed individually.
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26
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Rudnick MR, Wahba IM, Leonberg-Yoo AK, Miskulin D, Litt HI. Risks and Options With Gadolinium-Based Contrast Agents in Patients With CKD: A Review. Am J Kidney Dis 2020; 77:517-528. [PMID: 32861792 DOI: 10.1053/j.ajkd.2020.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs that bind free gadolinium more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for free gadolinium in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating gadolinium deposition in brain and a possible systemic syndrome attributed to GBCAs. Radiologic advances have resulted in several new imaging modalities that can be used in the severe CKD population and that do not require GBCA administration. In this article, we critically review GBCA use in patients with severe CKD and provide recommendations regarding GBCA use in this population.
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Affiliation(s)
- Michael R Rudnick
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA.
| | - Ihab M Wahba
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA; Corporal Michael J Crescenz Philadelphia Veterans Affairs Hospital Philadelphia, PA
| | - Amanda K Leonberg-Yoo
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA
| | - Dana Miskulin
- Division of Nephrology, Tufts University School of Medicine, Boston, MA
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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27
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Ran X, Lin L, Yang M, Niu G, Chen L, Shao Y, Zou Y, Wang B. Contrast-Enhanced Ultrasound Evaluation of Renal Blood Perfusion Changes After Percutaneous Transluminal Renal Angioplasty and Stenting for Severe Atherosclerotic Renal Artery Stenosis. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1872-1879. [PMID: 32451193 DOI: 10.1016/j.ultrasmedbio.2020.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/05/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
This study used contrast-enhanced ultrasound (CEUS) to evaluate changes in renal cortical blood perfusion after percutaneous transluminal renal angioplasty and stenting (PTRAS) for severe renal artery stenosis (RAS) (≥70%). CEUS was performed in 21 patients with 24 severe RASs that underwent PTRAS. Renal cortical perfusion was quantitatively evaluated by comparing time intensity curve (TIC) parameters for SonoVue (Bracco, Milan, Italy) contrast enhancement, including peak intensity (PI), time to peak (TTP), mean transmit time (MTT), curve ascending slope (S), area under the curve (AUC), AUC-wash-in and AUC-wash-out. The parameters PI, TTP, MTT and S differed significantly between the pre-intervention and post-intervention TIC analysis (p < 0.05). Of the 24 pre-intervention curve appearances, 58.3% (14/24) improved after operation. The PI difference correlated positively with the estimated glomerular filtration rate difference (r = 0.433, p < 0.05). In conclusion, changes in some ultrasound perfusion parameters on CEUS and the shape of the TIC can be used to quantitatively and intuitively evaluate renal cortical blood perfusion change after PTRAS.
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Affiliation(s)
- Xu Ran
- Department of Ultrasound Medicine, Peking University First Hospital, Beijing, P.R. 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, P.R. China
| | - Min Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China
| | - Guochen Niu
- 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, P.R. China
| | - Luzeng Chen
- Department of Ultrasound Medicine, Peking University First Hospital, Beijing, P.R. China
| | - Yuhong Shao
- Department of Ultrasound Medicine, Peking University First Hospital, Beijing, P.R. China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China.
| | - Bin Wang
- Department of Ultrasound Medicine, Peking University First Hospital, Beijing, P.R. China
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28
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Bülow RD, Boor P. Extracellular Matrix in Kidney Fibrosis: More Than Just a Scaffold. J Histochem Cytochem 2019; 67:643-661. [PMID: 31116062 DOI: 10.1369/0022155419849388] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Kidney fibrosis is the common histological end-point of progressive, chronic kidney diseases (CKDs) regardless of the underlying etiology. The hallmark of renal fibrosis, similar to all other organs, is pathological deposition of extracellular matrix (ECM). Renal ECM is a complex network of collagens, elastin, and several glycoproteins and proteoglycans forming basal membranes and interstitial space. Several ECM functions beyond providing a scaffold and organ stability are being increasingly recognized, for example, in inflammation. ECM composition is determined by the function of each of the histological compartments of the kidney, that is, glomeruli, tubulo-interstitium, and vessels. Renal ECM is a dynamic structure undergoing remodeling, particularly during fibrosis. From a clinical perspective, ECM proteins are directly involved in several rare renal diseases and indirectly in CKD progression during renal fibrosis. ECM proteins could serve as specific non-invasive biomarkers of fibrosis and scaffolds in regenerative medicine. The gold standard and currently only specific means to measure renal fibrosis is renal biopsy, but new diagnostic approaches are appearing. Here, we discuss the localization, function, and remodeling of major renal ECM components in healthy and diseased, fibrotic kidneys and the potential use of ECM in diagnostics of renal fibrosis and in tissue engineering.
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Affiliation(s)
- Roman David Bülow
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
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29
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Yang C, Wu S, Yang P, Shang G, Qi R, Xu M, Rong R, Zhu T, He W. Prediction of renal allograft chronic rejection using a model based on contrast-enhanced ultrasonography. Microcirculation 2019; 26:e12544. [PMID: 30887637 PMCID: PMC6767498 DOI: 10.1111/micc.12544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/31/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
Objective To evaluate the application of contrast‐enhanced ultrasonography (CEUS) for the diagnosis of renal allograft chronic rejection (CR). Methods A total of 104 patients who were suspected to have AR or CR were enrolled in this study (derivation group, n = 66; validation group, n = 38). Before biopsy, all patients received an ultrasound examination. Results In the CR group, rising time (RT) and time to peak (TTP) of medulla (RTm and TTPm, respectively) were significantly longer compared to those in the AR group. The kidney volume was significantly decreased in the CR group but was increased in the AR group. In the derivation group, age, change in kidney volume, and TTPm were identified as independent predictors by multivariate analysis. Based on the multivariate analysis results and area under receiver operating characteristic (ROC) curves (AUROCs) of individual markers, we constructed a new index as follows: P = −5.424 + 0.074 × age −9.818 × kidney volume change + 0.115 × TTPm; New Index = eP/(1 + eP). The new index discriminates CR from AR and had better AUROCs than any other parameters. Conclusion In conclusion, the new index provides a new diagnosis model for CR.
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Affiliation(s)
- Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Shengdi Wu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Imaging Medicine, Shanghai, China
| | - Guoguo Shang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ruochen Qi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical College, Fudan University, Shanghai, China
| | - Ming Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ruiming Rong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Imaging Medicine, Shanghai, China
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30
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Tsao TF, Liang KW, Huang HH, Tyan YS, Chao YH. Sonography of perinephric fluid collections: A pictorial essay. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:150-160. [PMID: 30635920 DOI: 10.1002/jcu.22680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/11/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Hui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hua Chao
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Pediatrics, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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31
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Abassi Z, Rosen S, Lamothe S, Heyman SN. Why Have Detection, Understanding and Management of Kidney Hypoxic Injury Lagged Behind those for the Heart? J Clin Med 2019; 8:jcm8020267. [PMID: 30795640 PMCID: PMC6406359 DOI: 10.3390/jcm8020267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022] Open
Abstract
The outcome of patients with acute myocardial infarction (AMI) has dramatically improved over recent decades, thanks to early detection and prompt interventions to restore coronary blood flow. In contrast, the prognosis of patients with hypoxic acute kidney injury (AKI) remained unchanged over the years. Delayed diagnosis of AKI is a major reason for this discrepancy, reflecting the lack of symptoms and diagnostic tools indicating at real time altered renal microcirculation, oxygenation, functional derangement and tissue injury. New tools addressing these deficiencies, such as biomarkers of tissue damage are yet far less distinctive than myocardial biomarkers and advanced functional renal imaging technologies are non-available in the clinical practice. Moreover, our understanding of pathogenic mechanisms likely suffers from conceptual errors, generated by the extensive use of the wrong animal model, namely warm ischemia and reperfusion. This model parallels mechanistically type I AMI, which properly represents the rare conditions leading to renal infarcts, whereas common scenarios leading to hypoxic AKI parallel physiologically type II AMI, with tissue hypoxic damage generated by altered oxygen supply/demand equilibrium. Better understanding the pathogenesis of hypoxic AKI and its management requires a more extensive use of models of type II-rather than type I hypoxic AKI.
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Affiliation(s)
- Zaid Abassi
- Department of Physiology, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, 31096, Israel.
- Department of Laboratory Medicine, Rambam Health Care campus, Haifa, 31096, Israel.
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
| | - Simon Lamothe
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
| | - Samuel N Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, 91240, Israel.
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32
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Berchtold L, Friedli I, Crowe LA, Martinez C, Moll S, Hadaya K, de Perrot T, Combescure C, Martin PY, Vallée JP, de Seigneux S. Validation of the corticomedullary difference in magnetic resonance imaging-derived apparent diffusion coefficient for kidney fibrosis detection: a cross-sectional study. Nephrol Dial Transplant 2019; 35:937-945. [DOI: 10.1093/ndt/gfy389] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Kidney cortical interstitial fibrosis (IF) is highly predictive of renal prognosis and is currently assessed by the evaluation of a biopsy. Diffusion magnetic resonance imaging (MRI) is a promising tool to evaluate kidney fibrosis via the apparent diffusion coefficient (ADC), but suffers from inter-individual variability. We recently applied a novel MRI protocol to allow calculation of the corticomedullary ADC difference (ΔADC). We here present the validation of ΔADC for fibrosis assessment in a cohort of 164 patients undergoing biopsy and compare it with estimated glomerular filtration rate (eGFR) and other plasmatic parameters for the detection of fibrosis.
Methods
This monocentric cross-sectional study included 164 patients undergoing renal biopsy at the Nephrology Department of the University Hospital of Geneva between October 2014 and May 2018. Patients underwent diffusion-weighted imaging, and T1 and T2 mappings, within 1 week after biopsy. MRI results were compared with gold standard histology for fibrosis assessment.
Results
Absolute cortical ADC or cortical T1 values correlated poorly to IF assessed by the biopsy, whereas ΔADC was highly correlated to IF (r=−0.52, P < 0.001) and eGFR (r = 0.37, P < 0.01), in both native and allograft patients. ΔT1 displayed a lower, but significant, correlation to IF and eGFR, whereas T2 did not correlate to IF nor to eGFR. ΔADC, ΔT1 and eGFR were independently associated with kidney fibrosis, and their combination allowed detection of extensive fibrosis with good specificity.
Conclusion
ΔADC is better correlated to IF than absolute cortical or medullary ADC values. ΔADC, ΔT1 and eGFR are independently associated to IF and allow the identification of patients with extensive IF.
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Affiliation(s)
- Lena Berchtold
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Iris Friedli
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Lindsey A Crowe
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Chantal Martinez
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Solange Moll
- Department of Clinical Pathology, Institute of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Thomas de Perrot
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- CRC & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre-Yves Martin
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
| | - Jean-Paul Vallée
- Service of Radiology, Department for Statistics, Department of Radiology and Medical Informatics, University Hospital and University of Geneva, Geneva, Switzerland
| | - Sophie de Seigneux
- Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland
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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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34
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Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy. Eur Urol Focus 2018; 4:960-968. [DOI: 10.1016/j.euf.2017.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/29/2017] [Indexed: 12/22/2022]
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35
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Morgan TA, Jha P, Poder L, Weinstein S. Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow. Abdom Radiol (NY) 2018; 43:2604-2614. [PMID: 29632989 DOI: 10.1007/s00261-018-1585-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound is routinely used as the first imaging exam for evaluation of renal transplants and can identify most major surgical complications and evaluate vascularity with color Doppler. Ultrasound is limited, however, in the detection of parenchymal disease processes and Doppler evaluation is also prone to technical errors. Multiple new ultrasound applications have been developed and are under ongoing investigation which could add additional diagnostic capability to the routine ultrasound exam with minimal additional time, cost, and patient risk. Contrast-enhanced ultrasound (CEUS) can be used off-label in the transplant kidney, and can assist in detection of infection, trauma, and vascular complications. CEUS also can demonstrate perfusion of the transplant assessed quantitatively with generation of time-intensity curves. Future directions of CEUS include monitoring treatment response and microbubble targeted medication delivery. Elastography is an ultrasound application that can detect changes in tissue elasticity, which is useful to diagnose diffuse parenchymal disease, such as fibrosis, otherwise unrecognizable with ultrasound. Elastography has been successfully applied in other organs including the liver, thyroid, and breast; however, it is still under development for use in the transplant kidney. Unique properties of the transplant kidney including its heterogeneity, anatomic location, and other technical factors present challenges in the development of reference standard measurements. Lastly, B-flow imaging is a flow application derived from B-mode. This application can show the true lumen size of a vessel which is useful to depict vascular anatomy and bypasses some of the pitfalls of color Doppler such as demonstration of slow flow.
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36
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Nestola M, De Matthaeis N, Ferraro PM, Fuso P, Costanzi S, Zannoni GF, Pizzolante F, Vasquez Quadra S, Gambaro G, Rapaccini GL. Contrast-enhanced ultrasonography in chronic glomerulonephritides: correlation with histological parameters of disease activity. J Ultrasound 2018; 21:81-87. [PMID: 29691759 DOI: 10.1007/s40477-018-0298-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare contrast-enhanced ultrasonography (CEUS)-derived time-intensity (TI) curves with histological findings in kidneys of patients affected by chronic glomerulonephritides (GN) in the early stage of disease. METHODS Research ethics committee approval and patient written informed consent were obtained. Thirty-one patients who showed clinical and laboratory signs of GN, with preserved renal function, were consecutively enrolled. They underwent kidney CEUS, from which TI curves were obtained, and kidney biopsy. TI curves were compared with clinical data, ultrasound (US) Doppler, and histological parameters. RESULTS The persistence of contrast agent signal during the wash-out phase was found to be correlated with the degree of disease activity (p = 0.016) and in particular with the presence of mesangial hyperplasia (p = 0.008). No correlation was observed between TI curves and clinical or Doppler US-derived parameters. CONCLUSIONS The persistence of contrast agent signal in the wash-out phase of CEUS appears to reflect a disturbance of perfusion in glomerular capillaries in the early stages of GN. We found that the histological element directly correlated with the prolonged wash-out was mesangial hyperplasia.
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Affiliation(s)
| | - Nicoletta De Matthaeis
- Gastroenterology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Pietro Manuel Ferraro
- Nephrology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Paola Fuso
- Department of Woman and Child Health, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Stefano Costanzi
- Nephrology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Fabrizio Pizzolante
- Gastroenterology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Sabina Vasquez Quadra
- Radiology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Giovanni Gambaro
- Nephrology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Gian Ludovico Rapaccini
- Gastroenterology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Liu B, Zhan Y, Chen X, Xie Q, Wu B. Laparoscopic ultrasonography: The wave of the future in renal cell carcinoma? Endosc Ultrasound 2018; 7:161-167. [PMID: 29941724 PMCID: PMC6032702 DOI: 10.4103/eus.eus_27_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic or robotic surgery is the main method of treating renal cell carcinoma (RCC). Laparoscopic surgery can accurately target lesions and shorten patient recovery time. Renal endogenous tumors or inferior vena cava tumor thrombi are very difficult to remove using the laparoscopic approach. The emergence of laparoscopic ultrasonography (LUS) has solved this problem. LUS can assist in the detection of tumor boundaries and the extent of tumor thrombi. The lack of tactile feedback may hinder the development of laparoscopic surgery for the treatment of renal cancer. LUS has become an important tool that has improved the rates of successful surgery. LUS is applied in not only early and locally advanced RCC treatment but also in monitoring ablation therapy, testing renal blood perfusion, and exposing renal pedicles. Sonographic techniques used for LUS include initial B-mode, Doppler, and contrast-enhanced ultrasound (CEUS). Contrast agents applied for CEUS do not induce nephrotoxicity and can display renal perfusion more accurately than the regular color Doppler ultrasound. According to current literature, LUS is a promising technique for the treatment of RCC, especially for endogenous RCC or RCC with thrombosis, and for monitoring the effectiveness of radiofrequency ablation, although further well-designed studies are warranted.
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Affiliation(s)
- Bitian Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yunhong Zhan
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qingpeng Xie
- Department of Urology, Cancer Hospital of China Medial University, Liaoning Cancer Hospital, Shenyang, Liaoning Province, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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38
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Molony DA, Yee J. Measurement of Glomerular Filtration Rate as a Diagnostic Test: Old Limitations and New Directions and Challenges Worthy of an Olympic Gold Medal. Adv Chronic Kidney Dis 2018; 25:1-3. [PMID: 29499880 DOI: 10.1053/j.ackd.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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39
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Fibrosis imaging: Current concepts and future directions. Adv Drug Deliv Rev 2017; 121:9-26. [PMID: 29108860 DOI: 10.1016/j.addr.2017.10.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023]
Abstract
Fibrosis plays an important role in many different pathologies. It results from tissue injury, chronic inflammation, autoimmune reactions and genetic alterations, and it is characterized by the excessive deposition of extracellular matrix components. Biopsies are routinely employed for fibrosis diagnosis, but they suffer from several drawbacks, including their invasive nature, sampling variability and limited spatial information. To overcome these limitations, multiple different imaging tools and technologies have been evaluated over the years, including X-ray imaging, computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT). These modalities can provide anatomical, functional and molecular imaging information which is useful for fibrosis diagnosis and staging, and they may also hold potential for the longitudinal assessment of therapy responses. Here, we summarize the use of non-invasive imaging techniques for monitoring fibrosis in systemic autoimmune diseases, in parenchymal organs (such as liver, kidney, lung and heart), and in desmoplastic cancers. We also discuss how imaging biomarkers can be integrated in (pre-) clinical research to individualize and improve anti-fibrotic therapies.
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40
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Bob F, Grosu I, Sporea I, Bota S, Popescu A, Sima A, Şirli R, Petrica L, Timar R, Schiller A. Ultrasound-Based Shear Wave Elastography in the Assessment of Patients with Diabetic Kidney Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2159-2166. [PMID: 28720285 DOI: 10.1016/j.ultrasmedbio.2017.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 05/28/2023]
Abstract
In previous studies of acoustic radiation force impulse (ARFI) elastography, using Virtual Touch tissue quantification (VTQ) (Siemens Acuson S2000), it was reported that the measurement of renal shear wave speed in patients with chronic kidney disease (CKD) is not influenced exclusively by renal fibrosis. The purpose of the present study was to analyze the role of VTQ in patients with diabetic kidney disease, considered the main cause of CKD. The study group included 164 patients: 80 patients with diabetic kidney disease (DKD) and 84 without renal disease or diabetes mellitus. In each subject in lateral decubitus, five valid VTQ measurements were performed in each kidney and a median value was calculated, the result being expressed in meters/second. The following means of the median values were obtained In DKD patients, the means of the median values were for VTQ right kidney, 2.21 ± 0.71 m/s, and for VTQ left kidney, 2.13 ± 0.72 m/s, whereas in the normal controls statistically significant higher values were obtained: 2.58 ± 0.78 m/s for VTQ right kidney (p = 0.0017) and 2.46 ± 0.81 m/s for VTQ left kidney (p = 0.006). Patients with an estimated glomerular filtration rate (eGFR) >60 mL/min (DKD stages 1 and 2 together with normal controls) had a significantly higher kidney shear wave speed compared with patients with an eGFR <60 mL/min (2.53 m/s vs. 2.09 m/s, p < 0.05). In the DKD group, there was a significant correlation between eGFR and VTQ levels for the right kidney (r = 0.28, p = 0.04). There was no correlation of VTQ values with proteinuria level, stage of diabetic retinopathy or glycated hemoglobin. Our study indicates that shear wave speed values in patients with diabetic kidney disease and eGFRs <60 mL/min are significantly lower compared with those of patients with eGFRs >60 mL/min (either normal controls or diabetic patients with DKD stages 1 and 2), and values decrease with the decrease in eGFR. However, proteinuria, diabetic retinopathy and glycated hemoglobin have no influence on VTQ.
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Affiliation(s)
- Flaviu Bob
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Iulia Grosu
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania.
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Simona Bota
- Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt am Worthersee, Klagenfurt am Wortersee, Austria
| | - Alina Popescu
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Alexandra Sima
- Department of Diabetes, Nutrition and Metabolic Diseases, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Roxana Şirli
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Ligia Petrica
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Romulus Timar
- Department of Diabetes, Nutrition and Metabolic Diseases, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Adalbert Schiller
- Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
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Alaini A, Malhotra D, Rondon-Berrios H, Argyropoulos CP, Khitan ZJ, Raj DSC, Rohrscheib M, Shapiro JI, Tzamaloukas AH. Establishing the presence or absence of chronic kidney disease: Uses and limitations of formulas estimating the glomerular filtration rate. World J Methodol 2017; 7:73-92. [PMID: 29026688 PMCID: PMC5618145 DOI: 10.5662/wjm.v7.i3.73] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
The development of formulas estimating glomerular filtration rate (eGFR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease (CKD), which is based on eGFR values and albuminuria. This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based eGFR values and between eGFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all eGFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and, particularly, biomarkers of early renal tissue injury.
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Affiliation(s)
- Ahmed Alaini
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Helbert Rondon-Berrios
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Dominic S C Raj
- Division of Nephrology, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Joseph I Shapiro
- Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Antonios H Tzamaloukas
- Nephrology Section, Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM 87108, United States
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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42
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Hull TD, Agarwal A, Hoyt K. New Ultrasound Techniques Promise Further Advances in AKI and CKD. J Am Soc Nephrol 2017; 28:3452-3460. [PMID: 28923914 DOI: 10.1681/asn.2017060647] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AKI and CKD are important clinical problems because they affect many patients and the associated diagnostic and treatment paradigms are imperfect. Ultrasound is a cost-effective, noninvasive, and simple imaging modality that offers a multitude of means to improve the diagnosis, monitoring, and treatment of both AKI and CKD, especially considering recent advances in this technique. Ultrasound alone can attenuate AKI and prevent CKD by stimulating the splenic cholinergic anti-inflammatory pathway. Additionally, microbubble contrast agents are improving the sensitivity and specificity of ultrasound for diagnosing kidney disease, especially when these agents are conjugated to ligand-specific mAbs or peptides, which make the dynamic assessment of disease progression and response to treatment possible. More recently, drug-loaded microbubbles have been developed and the load release by ultrasound exposure has been shown to be a highly specific treatment modality, making the potential applications of ultrasound even more promising. This review focuses on the multiple strategies for using ultrasound with and without microbubble technology for enhancing our understanding of the pathophysiology of AKI and CKD.
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Affiliation(s)
- Travis D Hull
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anupam Agarwal
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas; and .,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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43
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Liu X, Li N, Xu T, Sun F, Li R, Gao Q, Chen L, Wen C. Effect of renal perfusion and structural heterogeneity on shear wave elastography of the kidney: an in vivo and ex vivo study. BMC Nephrol 2017; 18:265. [PMID: 28789641 PMCID: PMC5547675 DOI: 10.1186/s12882-017-0679-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate the effect of perfusion status on elasticity measurements of different compartments in the kidney using shear wave elastography (SWE) both in vivo and ex vivo. Methods Thirty-two rabbit kidneys were used to observe the elasticity variation caused by renal artery stenosis and vein ligation in vivo, and six beagle kidneys were studied ex vivo to explore the effect of renal perfusion on elasticity. Supersonic SWE was applied to quantify the elasticity values of different renal compartments (cortex, medulla and sinus). Additionally, histopathological examination was performed to explore the possible mechanisms. Results The elasticity of the cortex was higher than that of the medulla, and the elasticity of the sinus was lowest among the compartments in native kidneys. The Young’s modulus (YM) of the cortex, medulla and sinus increased gradually as the duration of renal vein ligation increased, from 16.34 ± 1.01 kPa to 55.06 ± 5.61 kPa, 13.71 ± 1.16 kPa to 39.63 ± 2.91 kPa, and 12.61 ± 0.84 kPa to 29.30 ± 2.04 kPa, respectively. In contrast, the YM of the three compartments respectively decreased with progressive artery stenosis, from 16.34 ± 1.83 kPa to 11.21 ± 1.79 kPa, 13.31 ± 1.67 kPa to 8.07 ± 1.37 kPa, and 12.78 ± 2.66 kPa to 6.72 ± 0.95 kPa. Artery perfusion was the main factor influencing elasticity in ex vivo. The cortical elasticity was more prone to change with renal perfusion both in vivo and ex vivo. Histopathological examination showed progressive changes in the structure and content of the three compartments, consistent with the elasticity variation. Conclusions Both the complex structure/anisotropy and the perfusion of the kidney obviously influence the evaluation of renal elasticity. The measurement of SWE should be performed at a specific location along a certain angle or direction, and renal perfusion status should also be taken into account to ensure reproducible detection.
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Affiliation(s)
- Xiaona Liu
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China.,Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Na Li
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China.,Department of Auxiliary Diagnosis, The 463rd Hospital of Shenyang Military Region, Shenyang, Liaoning, 110042, People's Republic of China
| | - Tao Xu
- Department of Ultrasound, Chinese PLA Navy General Hospital, Beijing, 100048, People's Republic of China
| | - Fang Sun
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Rui Li
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Qimin Gao
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Lianxiang Chen
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, People's Republic of China
| | - Chaoyang Wen
- Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, People's Republic of China. .,Department of Ultrasound, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, 572013, People's Republic of China.
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44
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Translational science in chronic kidney disease. Clin Sci (Lond) 2017; 131:1617-1629. [PMID: 28667063 DOI: 10.1042/cs20160395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 12/16/2022]
Abstract
The KDIGO definition of chronic kidney disease (CKD) allowed a more detailed characterization of CKD causes, epidemiology and consequences. The picture that has emerged is worrisome from the point of view of translation. CKD was among the fastest growing causes of death in the past 20 years in age-adjusted terms. The gap between recent advances and the growing worldwide mortality appears to result from sequential roadblocks that limit the flow from basic research to clinical development (translational research type 1, T1), from clinical development to clinical practice (translational research T2) and result in deficient widespread worldwide implementation of already available medical advances (translational research T3). We now review recent advances and novel concepts that have the potential to change the practice of nephrology in order to improve the outcomes of the maximal number of individuals in the shortest possible interval. These include: (i) updating the CKD concept, shifting the emphasis to the identification, risk stratification and care of early CKD and redefining the concept of aging-associated 'physiological' decline of renal function; (ii) advances in the characterization of aetiological factors, including challenging the concept of hypertensive nephropathy, the better definition of the genetic contribution to CKD progression, assessing the role of the liquid biopsy in aetiological diagnosis and characterizing the role of drugs that may be applied to the earliest stages of injury, such as SGLT2 inhibitors in diabetic kidney disease (DKD); (iii) embracing the complexity of CKD as a network disease and (iv) exploring ways to optimize implementation of existing knowledge.
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45
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Mora-Gutiérrez JM, Garcia-Fernandez N, Slon Roblero MF, Páramo JA, Escalada FJ, Wang DJ, Benito A, Fernández-Seara MA. Arterial spin labeling MRI is able to detect early hemodynamic changes in diabetic nephropathy. J Magn Reson Imaging 2017; 46:1810-1817. [PMID: 28383796 DOI: 10.1002/jmri.25717] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate whether arterial spin labeling (ASL) MRI could detect renal hemodynamic impairment in diabetes mellitus (DM) along different stages of chronic kidney disease (CKD). MATERIALS AND METHODS Three Tesla (3T) ASL-MRI was performed to evaluate renal blood flow (RBF) in 91 subjects (46 healthy volunteers and 45 type 2 diabetic patients). Patients were classified according to their estimated glomerular filtration rate (eGFR) as group I (eGFR > 60 mL/min/1.73 m2 ), group II (60 ≥ eGFR>30 mL/min/1.73 m2 ), or group III (eGFR ≤ 30 mL/min/1.73 m2 ), to determine differences depending on renal function. Studies were performed at 3T using a 12-channel flexible body array combined with the spine array coil as receiver. RESULTS A 28% reduction in cortical RBF was seen in diabetics in comparison with healthy controls (185.79 [54.60] versus 258.83 [37.96] mL/min/100 g, P < 3 × 10-6 ). Differences were also seen between controls and diabetic patients despite normal eGFR and absence of overt albuminuria (RBF [mL/min/100 g]: controls=258.83 [37.96], group I=208.89 [58.83], P = 0.0018; eGFR [mL/min/1.73 m2 ]: controls = 95.50 [12.60], group I = 82.00 [20.76], P > 0.05; albumin-creatinine ratio [mg/g]: controls = 3.50 [4.45], group I = 17.50 [21.20], P > 0.05). A marked decrease in RBF was noted a long with progression of diabetic nephropathy (DN) through the five stages of CKD (χ2 = 43.58; P = 1.85 × 10-9 ). Strong correlation (r = 0.62; P = 4 × 10-10 ) was obtained between RBF and GFR estimated by cystatin C. CONCLUSION ASL-MRI is able to quantify early renal perfusion impairment in DM, as well as changes according to different CKD stages of DN. In addition, we demonstrated a correlation of RBF quantified by ASL and GFR estimated by cystatin C. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1810-1817.
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Affiliation(s)
| | | | | | - Jose A Páramo
- Atherosclerosis Research Laboratory, CIMA, University of Navarra, Pamplona, Spain
| | | | - Danny Jj Wang
- Laboratory of Functional MRI Technology (LOFT) Stevens Neuroimaging and Informatics Institute University of Southern California, Los Angeles, California, USA
| | | | - María A Fernández-Seara
- Radiology, Clínica Universidad de Navarra, Spain.,Adjunct Associate Professor of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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46
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Hains DS, Cohen HL, McCarville MB, Ellison EE, Huffman A, Glass S, Qureshi AH, Pierce KR, Cahill AL, Dixon A, Santos ND. Elucidation of Renal Scars in Children With Vesicoureteral Reflux Using Contrast-Enhanced Ultrasound: A Pilot Study. Kidney Int Rep 2017; 2:420-424. [PMID: 29142969 PMCID: PMC5678645 DOI: 10.1016/j.ekir.2017.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/19/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Vesicoureteral reflux is a common disorder in children but can result in kidney scarring following acute pyelonephritis. The gold standard diagnostic to detect renal scars in children is 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. DMSA has a number of limitations including radiation exposure, need for sedation, and radiotracer supply shortages. Contrast-enhanced ultrasound (CEUS) is a technique whereby biocompatible microspheres of inert gas are administered i.v. that reflect ultrasonography sound waves and do not involve radiation. Because the contrast agent is rapidly cleared, contrast images must be obtained within minutes of administration. CEUS has been used in a variety of organ systems, but its use in pediatric kidney diseases is limited. Methods In this study, we performed CEUS in 7 children with documented renal scars by radiographic imaging consistent with reflux nephropathy. Results In all subjects, CEUS detected all previously known radiologic abnormalities as well as detecting new areas of hypoenhancing renal parenchyma. None of the patients experienced any serious adverse events. Discussion This study represents the first report of using CEUS to characterize renal scars in children with reflux nephropathy. We conclude that CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal scars in children with vesicoureteral reflux.
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Affiliation(s)
- David S. Hains
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Correspondence: David S. Hains, Department of Pediatrics, University of Tennessee Health Science Center, Center for Innate Immunity Translational Research, Children’s Foundation Research, 50 N. Dunlap, 369R, Memphis, Tennessee, USA 38103.Department of PediatricsUniversity of Tennessee Health Science CenterCenter for Innate Immunity Translational ResearchChildren’s Foundation Research50 N. Dunlap, 369RMemphisTennesseeUSA 38103
| | - Harris L. Cohen
- Department of Radiology, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - M. Beth McCarville
- Department of Diagnostic Imaging (MS 220), St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ellen E. Ellison
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amy Huffman
- Department of Radiology, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Stacey Glass
- Department of Radiology, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Aslam H. Qureshi
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Keith R. Pierce
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ashlyn L. Cahill
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ashley Dixon
- Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Noel Delos Santos
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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