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Ruidas S, Lal H, Prasad R, Sharma S, Agarwal S, Singh R, Prasad N, Patel MR, Kushwaha RS, Jain M. Role of Shear Wave Elastography for Assessment of Renal-Allograft Fibrosis and its Correlation With Histopathology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39076034 DOI: 10.1002/jum.16532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/05/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVES To investigate whether shear wave elastography (SWE) can accurately identify interstitial fibrosis and tubular atrophy (IFTA) in chronic renal allograft injury (CRAI) and whether it can differentiate between different grades of IFTA. MATERIALS AND METHODS Prospective observational study on renal transplant recipients who presented with CRAI. Patient selection was done on the basis of clinical presentation, serum creatinine, and eGFR levels. Biopsy and SWE were performed and SWE values were correlated with histopathological findings according to Banff schema. Receiver operating characteristic (ROC) was also analyzed to assess the diagnostic efficacy of SWE. RESULTS Sxity-one patients were evaluated. Ten patients had no IFTA, 33 patients had mild IFTA, 16 patients had moderate IFTA, and 2 patients had severe IFTA. Mean parenchymal stiffness values in no IFTA, mild IFTA, moderate IFTA and severe IFTA were 39.86 ± 2.17 kPa (3.64 ± 0.09 m/s), 41.59 ± 3.36 kPa (3.71 ± 0.15 m/s), 47.59 ± 3.34 kPa (3.98 ± 0.14 m/s), and 53.83 ± 1.41 kPa (4.25 ± 0.03 m/s), respectively. SWE values of parenchymal stiffness reached statistical significance to differentiate between mild, moderate, and severe IFTA. ROC analysis revealed cut-off values of 45.09 kPa (3.89 m/s) to differentiate between mild IFTA and moderate IFTA, 52.06 kPa (4.18 m/s) to differentiate between moderate IFTA and severe IFTA with acceptable sensitivity and specificity. CONCLUSION SWE is a non-invasive and cost-effective imaging tool to evaluate the disease status of renal allografts affected by CRAI. Thus, it can be of paramount importance if added to the regular follow-up imaging protocol of renal allograft along with grayscale and Doppler imaging.
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Affiliation(s)
| | - Hira Lal
- Department of Radiodiagnosis, SGPGIMS, Lucknow, India
| | | | | | | | | | | | | | | | - Manoj Jain
- Department of Pathology, SGPGIMS, Lucknow, India
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2
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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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Katwal S, Suwal S, Bhandari RM, Chataut D, Ansari MA, Lamichhane S. Prospective quantitative study: Doppler ultrasound in the evaluation of chronic renal allograft disease and correlation with histopathological finding. Ann Med Surg (Lond) 2023; 85:4811-4815. [PMID: 37811074 PMCID: PMC10553132 DOI: 10.1097/ms9.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background and Objectives Renal allograft biopsy is the gold standard for diagnosing chronic allograft nephropathy, but noninvasive methods are needed to avoid unnecessary biopsies. Doppler ultrasonography, particularly the resistive index (RI), correlates with renal allograft dysfunction. This study aims to assess the relationship between renal sonographic parameters and biochemical parameters in diagnosing graft interstitial fibrosis. Methods The study evaluated 60 renal allograft recipients for sonographic renal morphological features and Doppler indices. The estimated glomerular filtration rate (eGFR) was calculated, and cortical fibrosis after the biopsy was determined using the Banff score. Continuous variables like mean and SD were calculated, and categorical variables were reported using frequencies and proportions. Associations were examined using independent sample t-tests, χ 2tests, and multivariate regression analysis. Results The mean eGFR was 75.23±25.45 ml/min/1.73 m2. A significant correlation of eGFR with RI (r=0.341, P=0.008) was seen. A significant difference in mean RI (F=10.167; df=2,57; P<0.001) was seen among the histological grades of fibrosis. Among the histological grades of fibrosis, significant differences in RI among mild and moderate (S.E. 0.033, P=0.043), mild and severe (S.E. 0.026, P=0.001) as well as moderate and severe (S.E. 0.036, P=0.029) was seen. Conclusion Doppler was able to noninvasively predict allograft fibrosis and could be used as a complementary imaging tool during the follow-up of renal allograft patients. Future research is needed to improve evidence, diagnostic criteria, guidelines, and long-term impact.
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Affiliation(s)
| | - Sundar Suwal
- Tribhuvan University Teaching Hospital, Maharajgunj
| | - Rajan M. Bhandari
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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4
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Klinkhammer BM, Boor P. Kidney fibrosis: Emerging diagnostic and therapeutic strategies. Mol Aspects Med 2023; 93:101206. [PMID: 37541106 DOI: 10.1016/j.mam.2023.101206] [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: 04/28/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
An increasing number of patients worldwide suffers from chronic kidney disease (CKD). CKD is accompanied by kidney fibrosis, which affects all compartments of the kidney, i.e., the glomeruli, tubulointerstitium, and vasculature. Fibrosis is the best predictor of progression of kidney diseases. Currently, there is no specific anti-fibrotic therapy for kidney patients and invasive renal biopsy remains the only option for specific detection and quantification of kidney fibrosis. Here we review emerging diagnostic approaches and potential therapeutic options for fibrosis. We discuss how translational research could help to establish fibrosis-specific endpoints for clinical trials, leading to improved patient stratification and potentially companion diagnostics, and facilitating and optimizing development of novel anti-fibrotic therapies for kidney patients.
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Affiliation(s)
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany; Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany; Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany.
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5
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Elsingergy MM, Viteri B, Otero HJ, Bhatti T, Morales T, Roberts TPL, Amaral S, Hartung E, Serai SD. Imaging fibrosis in pediatric kidney transplantation: A pilot study. Pediatr Transplant 2023; 27:e14540. [PMID: 37166372 PMCID: PMC10824264 DOI: 10.1111/petr.14540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Noninvasive alternatives to biopsy for assessment of interstitial fibrosis and tubular atrophy (IFTA), the major determinant of kidney transplant failure, remain profoundly limited. Elastography is a noninvasive technique that propagates shear waves across tissues to measure their stiffness. We aimed to test utility of elastography for early detection of IFTA in pediatric kidney allografts. METHODS We compared ultrasound (USE) and MR elastography (MRE) stiffness measurements, performed on pediatric transplant recipients referred for clinically indicated biopsies, and healthy controls. RESULTS Ten transplant recipients (median age 16 years) and eight controls (median age 16.5 years) were enrolled. Three transplant recipients had "stable" allografts and seven had Banff Grade 1 IFTA. Median time from transplantation to biopsy was 12 months. Mean estimated glomerular filtration rate was 61.5 mL/min/1.73m2 by creatinine-cystatin-C CKiD equation at time of biopsy. Mean stiffness, calculated through one-way ANOVA, was higher for IFTA allografts (23.4 kPa USE/5.6 kPa MRE) than stable allografts (13.7 kPa USE/4.4 kPa MRE) and controls (9.1 kPa USE/3.6 kPa MRE). Pearson's coefficient between USE and MRE stiffness values was strong (r = .97). AUC for fibrosis prediction in transplanted kidneys was high for both modalities (0.91 USE and 0.89 MRE), although statistically nonsignificant (p > .05). Stiffness cut-off values for USE and MRE were 13.8 kPa and 4.6 kPa, respectively. Both values yielded a sensitivity of 100% but USE specificity (72%) was slightly higher than MRE (67%). CONCLUSION Elastography shows potential for detection of low-grade IFTA in allografts although a larger sample is imperative for clinical validation.
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Affiliation(s)
| | - Bernarda Viteri
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J. Otero
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tricia Bhatti
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tatiana Morales
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy P L Roberts
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Amaral
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erum Hartung
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suraj D. Serai
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Cè M, Felisaz PF, Alì M, Re Sartò GV, Cellina M. Ultrasound elastography in chronic kidney disease: a systematic review and meta-analysis. J Med Ultrason (2001) 2023; 50:381-415. [PMID: 37186192 DOI: 10.1007/s10396-023-01304-z] [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: 11/16/2022] [Accepted: 03/07/2023] [Indexed: 05/17/2023]
Abstract
Ultrasound elastography (USE) is a noninvasive technique for assessing tissue elasticity, and its application in nephrology has aroused growing interest in recent years. The purpose of this article is to systematically review the clinical application of USE in patients with chronic kidney disease (CKD), including native and transplanted kidneys, and quantitatively investigate differences in elasticity values between healthy individuals and CKD patients. Furthermore, we provide a qualitative analysis of the studies included, discussing the potential interplay between renal stiffness, estimated glomerular filtration rate, and fibrosis. In January 2022, a systematic search was carried out on the MEDLINE (PubMed) database, concerning studies on the application of USE in patients with CKD, including patients with transplanted kidneys. The results of the included studies were extracted by two independent researchers and presented mainly through a formal narrative summary. A meta-analysis of nine study parts from six studies was performed. A total of 647 studies were screened for eligibility and, after applying the exclusion and inclusion criteria, 69 studies were included, for a total of 6728 patients. The studies proved very heterogeneous in terms of design and results. The shear wave velocity difference of - 0.82 m/s (95% CI: - 1.72-0.07) between CKD patients and controls was not significant. This result agrees with the qualitative evaluation of included studies that found controversial results for the relationship between renal stiffness and glomerular filtration rate. On the contrary, a clear relationship seems to emerge between USE values and the degree of fibrosis. At present, due to the heterogeneity of results and technical challenges, large-scale application in the monitoring of CKD patients remains controversial.
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Affiliation(s)
- Maurizio Cè
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, Milan, Italy.
| | - Paolo Florent Felisaz
- Division of Radiology, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Marco Alì
- Centro Diagnostico Italiano, Milan, Italy
- Bracco Imaging S.P.A., Milan, Italy
| | - Giulia Vanessa Re Sartò
- Division of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Michaela Cellina
- Division of Radiology, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
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7
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Gonçalves LM, Forte GC, Holz TG, Libermann LL, Figueiredo CEPD, Hochhegger B. Shear wave elastography and Doppler ultrasound in kidney transplant recipients. Radiol Bras 2022; 55:19-23. [PMID: 35210660 PMCID: PMC8864684 DOI: 10.1590/0100-3984.2020.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the association between shear wave elastography parameters and arterial
resistance in kidney transplant recipients. Materials and Methods This was a prospective cross-sectional study involving consecutive adult kidney transplant
recipients. All patients underwent color Doppler to evaluate the resistive index (RI) and
ultrasound shear wave elastography for the quantification of renal allograft stiffness. Results We evaluated 55 patients, of whom 9 (16.4%) had an RI defined as abnormal (≥ 0.79)
and 46 (83.6%) had an RI defined as normal (< 0.79). The mean age was higher in the
abnormal RI group than in the normal RI group (68.0 ± 8.6 years vs. 42.6 ± 14.1
years; p < 0.001), as was the mean shear wave velocity (2.6 ± 0.4
m/s vs. 2.2 ± 0.4 m/s; p = 0.013). Multivariate analysis identified
two independent predictors of arterial resistance: age (OR = 1.169; 95% CI: 1.056 to 1.294;
p = 0.003) and shear wave velocity (OR = 17.1; 95% CI: 1.137 to 257.83;
p = 0.040). Conclusion We observed an association between rigidity in the cortex of the transplanted kidney, as
evaluated by shear wave elastography, and arterial resistance, as evaluated by color Doppler,
in kidney transplant recipients.
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Affiliation(s)
| | | | - Tiago Garcia Holz
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | | | | | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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Martinez-Vidal L, Murdica V, Venegoni C, Pederzoli F, Bandini M, Necchi A, Salonia A, Alfano M. Causal contributors to tissue stiffness and clinical relevance in urology. Commun Biol 2021; 4:1011. [PMID: 34446834 PMCID: PMC8390675 DOI: 10.1038/s42003-021-02539-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Mechanomedicine is an emerging field focused on characterizing mechanical changes in cells and tissues coupled with a specific disease. Understanding the mechanical cues that drive disease progression, and whether tissue stiffening can precede disease development, is crucial in order to define new mechanical biomarkers to improve and develop diagnostic and prognostic tools. Classically known stromal regulators, such as fibroblasts, and more recently acknowledged factors such as the microbiome and extracellular vesicles, play a crucial role in modifications to the stroma and extracellular matrix (ECM). These modifications ultimately lead to an alteration of the mechanical properties (stiffness) of the tissue, contributing to disease onset and progression. We describe here classic and emerging mediators of ECM remodeling, and discuss state-of-the-art studies characterizing mechanical fingerprints of urological diseases, showing a general trend between increased tissue stiffness and severity of disease. Finally, we point to the clinical potential of tissue stiffness as a diagnostic and prognostic factor in the urological field, as well as a possible target for new innovative drugs.
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Affiliation(s)
- Laura Martinez-Vidal
- Vita-Salute San Raffaele University, Milan, Italy.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Valentina Murdica
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Venegoni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Pederzoli
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Bandini
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
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Abstract
PURPOSE OF REVIEW Fibrosis is an important biomarker of chronic kidney injury, and a powerful predictor of renal outcome. Currently, the only method for measuring fibrotic burden is histologic analysis, which requires a kidney biopsy in humans, or kidney removal in animal models. These requirements have not only hindered our ability to manage patients effectively, but have also prevented a full understanding of renal fibrosis pathogenesis, and slowed the translation of new antifibrotic agents. The development of noninvasive fibrosis imaging tools could thus transform both clinical care and renal fibrosis research. RECENT FINDINGS Conventional imaging modalities have historically failed to image fibrosis successfully. However, recent exciting technological advances have greatly enhanced their capabilities. New techniques, for example, may allow imaging of the physical consequences of scarring, as surrogate measures of renal fibrosis. Similarly, other groups have developed ways to directly image extracellular matrix, either with the use of contrast-enhanced probes, or using matrix components as endogenous contrast agents. SUMMARY New developments in imaging technology have the potential to transform our ability to visualize renal fibrosis and to monitor its progression. In doing so, these advances could have major implications for kidney disease care, the development of new antiscarring agents, and our understanding of renal fibrosis in general.
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10
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Fang JX, Chen XY, Yang QM, Xue MH. Factors Influencing Renal Parenchymal Stiffiness in Patients with Diabetic Nephropathy. Int J Gen Med 2021; 14:1911-1917. [PMID: 34040423 PMCID: PMC8140885 DOI: 10.2147/ijgm.s311420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal resilience. The purpose of this study is to determine the factors influencing renal resilience in patients with diabetic nephropathy (DN). Methods We recruited 56 healthy volunteers and 187 patients with DN. All the participants were evaluated using shear-wave elastography (SWE), and the size of their kidneys and Young's modulus values for the parenchyma were recorded. A total of 187 patients with DN are allocated to three groups according to their urinary albumin-to-creatinine ratio: normoalbuminuric (<30 mg/g creatinine), microalbuminuric (30-300 mg/g), and macroalbuminuric (≥300 mg/g) groups. Renal resilience is compared between the stages of diabetic nephropathy and the healthy control group, and the factors affecting the stiffiness of the renal parenchyma in DN are analyzed. Results The renal parenchyma is harder in participants with DN than in healthy participants (P < 0.001), and the stiffiness increases with the progression of the disease (P < 0.001). Multivariate logistic regression analysis shows that disease stage (β = 0.789, P < 0.001), duration of diabetes (β = 0.028, P < 0.001), and serum creatinine (SCr) concentration (β = 0.001, p < 0.001) influence the stiffiness of the renal parenchyma. Conclusion We show that SWE can be used to measure changes in the stiffiness of the renal parenchyma in patients with DN. Furthermore, Young's modulus of the renal parenchyma is related to the duration of diabetes, urinary albumin excretion, and SCr concentration. Thus, SWE can be used to objectively and non-invasively stage DN.
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Affiliation(s)
- Jian-Xiu Fang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Xiao-Yan Chen
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Qing-Mei Yang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Meng-Hua Xue
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
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Turgutalp K, Balcı Y, Özer C, Bardak S, Gürses İ, Karabulut Y, Helvacı İ, Dölarslan E, Demir S, Kıykım A. Shear wave elastography findings in Immunoglobulin A Nephropathy patients: is it more specific and sensitive for interstitial fibrosis or interstitial fibrosis/tubular atrophy? Ren Fail 2021; 42:590-599. [PMID: 32597278 PMCID: PMC7946010 DOI: 10.1080/0886022x.2020.1779087] [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] [Indexed: 12/19/2022] Open
Abstract
Background Prediction of prognosis in Immunoglobulin A Nephropathy (IgAN) and taking appropriate precautions may reduce annual incidence of chronic kidney disease. This may be possible by close follow-up for the development and progression of interstitial fibrosis (IF) or interstitial fibrosis/tubular atrophy (IFTA) in IgAN patients. Aim To investigate whether Young’s elastic modulus (YM) which measured shear wave elastography (SWE) might be used for follow-up of IF or IFTA in IgAN patients. Methods Prospective study was approved by Human Research Ethics Committee. Group 1 consisted of patients with IgAN. Group 2 consisted of healthy control participants. Young’s elastic modulus which is a value of stiffness along with longitudinal stiffness was used to evaluate tissue elasticity. Specificity, sensitivity, positive predictive value (PPV) of YM for the presence of IF and IFTA were evaluated. Results Group 1 consisted of 30 participants, and group 2 consisted of 32 participants. Sensitivity and specificity of SWE to diagnose presence of IF for YM > 15 kPa were 89% and 90%, respectively. PPV among the ones whom IF was diagnosed by YM >15 kPa was 91%. Sensitivity and specificity of SWE to diagnose presence of IFTA for YM > 15 were 65% and 51%, respectively. PPV among the ones whom IFTA was diagnosed by YM >15 kPa was 78.1%. Conclusions YM which measured SWE is highly specific and sensitive in the diagnosis of IF, but not for IFTA in IgAN patients. Therefore, progression for IF in IgAN may be followed by SWE.
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Affiliation(s)
- Kenan Turgutalp
- Department of Internal Medicine, School of Medicine, Division of Nephrology, Mersin University, Mersin, Turkey
| | - Yüksel Balcı
- Department of Radiology, School of Medicine, Mersin University, Mersin, Turkey
| | - Caner Özer
- Department of Radiology, School of Medicine, Mersin University, Mersin, Turkey
| | - Simge Bardak
- Department of Nephrology, Lefkosa BN State Hospital, Lefkosa, Cyprus
| | - İclal Gürses
- Department of Pathology Cerrahpasa School of Medicine, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Yasemin Karabulut
- Department of Pathology, School of Medicine, Mersin University, Mersin, Turkey
| | - İlter Helvacı
- Department of Business Information and Biostatistic Management, Silifke School of Applied Technology and Management, Mersin University, Mersin, Turkey
| | - Esra Dölarslan
- Department of Internal Medicine, School of Medicine, Division of Nephrology, Mersin University, Mersin, Turkey
| | - Serap Demir
- Department of Internal Medicine, School of Medicine, Division of Nephrology, Mersin University, Mersin, Turkey
| | - Ahmet Kıykım
- Department of Internal Medicine, School of Medicine, Division of Nephrology, Mersin University, Mersin, Turkey
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Srivastava A, Tomar B, Prajapati S, Gaikwad AB, Mulay SR. Advanced non-invasive diagnostic techniques for visualization and estimation of kidney fibrosis. Drug Discov Today 2021; 26:2053-2063. [PMID: 33617976 DOI: 10.1016/j.drudis.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 12/17/2022]
Abstract
Kidney fibrosis is marked by excessive extracellular matrix deposition during disease progression. Unfortunately, existing kidney function parameters do not predict the extent of kidney fibrosis. Moreover, the traditional histology methods for the assessment of kidney fibrosis require liquid and imaging biomarkers as well as needle-based biopsies, which are invasive and often associated with kidney injury. The repetitive analyses required to monitor the disease progression are therefore difficult. Hence, there is an unmet medical need for non-invasive and informative diagnostic approaches to monitor kidney fibrosis during the progression of chronic kidney disease. Here, we summarize the modern advances in diagnostic imaging techniques that have shown promise for non-invasive estimation of kidney fibrosis in pre-clinical and clinical studies.
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Affiliation(s)
- Anjali Srivastava
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Bhawna Tomar
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Smita Prajapati
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Anil Bhanudas Gaikwad
- Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, 333031, India
| | - Shrikant R Mulay
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India.
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Qi R, Yang C, Zhu T. Advances of Contrast-Enhanced Ultrasonography and Elastography in Kidney Transplantation: From Microscopic to Microcosmic. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:177-184. [PMID: 33143970 DOI: 10.1016/j.ultrasmedbio.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Kidney transplantation is the best choice for patients with end-stage renal disease. To date, allograft biopsy remains the gold standard for revealing pathologic changes and predicting long-term outcomes. However, the invasive nature of transplant biopsy greatly limits its application. Ultrasound has been a first-line examination for evaluating kidney allografts for a long time. Advances in ultrasound in recent years, especially the growing number of studies in elastography and contrast-enhanced ultrasonography (CEUS), have shed new light on its application in kidney transplantation. Elastography, including strain elastography and shear wave elastography, is used mainly to assess allograft stiffness and, thus, predict renal fibrosis. CEUS has been used extensively in evaluating blood microperfusion, assessing acute kidney injury and detecting different complications after transplantation. Requiring the use of microbubbles also makes CEUS a novel method of gene transfer and drug delivery, enabling promising targeted diagnosis and therapy. In this review, we summarize the advances of elastography and CEUS in kidney transplantation and evaluate their potential efficiency in becoming a better complement to or even substitute for transplant biopsy in the future.
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Affiliation(s)
- Ruochen Qi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Cheng Yang
- 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.
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14
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Alnazer I, Bourdon P, Urruty T, Falou O, Khalil M, Shahin A, Fernandez-Maloigne C. Recent advances in medical image processing for the evaluation of chronic kidney disease. Med Image Anal 2021; 69:101960. [PMID: 33517241 DOI: 10.1016/j.media.2021.101960] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/18/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Assessment of renal function and structure accurately remains essential in the diagnosis and prognosis of Chronic Kidney Disease (CKD). Advanced imaging, including Magnetic Resonance Imaging (MRI), Ultrasound Elastography (UE), Computed Tomography (CT) and scintigraphy (PET, SPECT) offers the opportunity to non-invasively retrieve structural, functional and molecular information that could detect changes in renal tissue properties and functionality. Currently, the ability of artificial intelligence to turn conventional medical imaging into a full-automated diagnostic tool is widely investigated. In addition to the qualitative analysis performed on renal medical imaging, texture analysis was integrated with machine learning techniques as a quantification of renal tissue heterogeneity, providing a promising complementary tool in renal function decline prediction. Interestingly, deep learning holds the ability to be a novel approach of renal function diagnosis. This paper proposes a survey that covers both qualitative and quantitative analysis applied to novel medical imaging techniques to monitor the decline of renal function. First, we summarize the use of different medical imaging modalities to monitor CKD and then, we show the ability of Artificial Intelligence (AI) to guide renal function evaluation from segmentation to disease prediction, discussing how texture analysis and machine learning techniques have emerged in recent clinical researches in order to improve renal dysfunction monitoring and prediction. The paper gives a summary about the role of AI in renal segmentation.
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Affiliation(s)
- Israa Alnazer
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France; AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon.
| | - Pascal Bourdon
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
| | - Thierry Urruty
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
| | - Omar Falou
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon; American University of Culture and Education, Koura, Lebanon; Lebanese University, Faculty of Science, Tripoli, Lebanon
| | - Mohamad Khalil
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon
| | - Ahmad Shahin
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon
| | - Christine Fernandez-Maloigne
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
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15
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Abstract
Magnetic resonance elastography (MRE) is an emerging imaging modality that maps the elastic properties of tissue such as the shear modulus. It allows for noninvasive assessment of stiffness, which is a surrogate for fibrosis. MRE has been shown to accurately distinguish absent or low stage fibrosis from high stage fibrosis, primarily in the liver. Like other elasticity imaging modalities, it follows the general steps of elastography: (1) apply a known cyclic mechanical vibration to the tissue; (2) measure the internal tissue displacements caused by the mechanical wave using magnetic resonance phase encoding method; and (3) infer the mechanical properties from the measured mechanical response (displacement), by generating a simplified displacement map. The generated map is called an elastogram.While the key interest of MRE has traditionally been in its application to liver, where in humans it is FDA approved and commercially available for clinical use to noninvasively assess degree of fibrosis, this is an area of active research and there are novel upcoming applications in brain, kidney, pancreas, spleen, heart, lungs, and so on. A detailed review of all the efforts is beyond the scope of this chapter, but a few specific examples are provided. Recent application of MRE for noninvasive evaluation of renal fibrosis has great potential for noninvasive assessment in patients with chronic kidney diseases. Development and applications of MRE in preclinical models is necessary primarily to validate the measurement against "gold-standard" invasive methods, to better understand physiology and pathophysiology, and to evaluate novel interventions. Application of MRE acquisitions in preclinical settings involves challenges in terms of available hardware, logistics, and data acquisition. This chapter will introduce the concepts of MRE and provide some illustrative applications.This publication is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by another separate chapter describing the experimental protocol and data analysis.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Guazzaroni M, Ferrari D, Lamacchia F, Salimei F, Marsico S, Citraro D, Campagnuolo T, Girardi V, Orlacchio A. Biomechanical properties of optic nerve and retrobulbar structures with 2D and 3D shear wave elastography in patients affected by glaucoma. Clin Imaging 2020; 61:106-114. [PMID: 32036260 DOI: 10.1016/j.clinimag.2020.01.015] [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: 09/15/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
This study consists of an elastosonography evaluation of both eyes of 40 glaucomatous patients and 40 healthy subjects. We used shear wave elastography with a one-dimensional-array probe to capture two-dimensional images in order to study the optic nerve near the papilla, chorioretinal complex, lateral rectus muscle, and periorbital fat tissue. Furthermore, we used a two-dimensional array probe to capture three-dimensional images to study the optic nerve in toto with multilevel sampling. We obtained qualitative and quantitative data ("absolute" stiffness values). Then, we have investigated these tissue also measuring the "stiffness ratio" values. Statistically significant differences (p < 0.05), between glaucomatous patients and healthy patients, were noted in "absolute" stiffness values in the two-dimensional analysis at the emergence of the optic nerve and chorioretinal complex, and in the three-dimensional analysis at the emergence of the optic nerve (level I°). This result was supported by the statistically significant differences in the "stiffness ratio" values between the optic nerve and the adjacent adipose tissue, obtained both in two- and three-dimensional analyses. Data were subsequently compared with diagnostic tests currently used for glaucoma, which showed a sensitivity of 83% and specificity of 80% relative to those of elastosonography. We propose the use of elastosonography to verify the existence of pathological changes in the mechanical and elastic properties of peri-ocular structures and their variations as a complementary tool in the diagnosis of glaucoma and for follow-up during treatment.
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Affiliation(s)
- Manlio Guazzaroni
- Department of Surgery, University of Rome "Tor Vergata", Viale Oxford 81, Rome 00133, Italy
| | - Donatella Ferrari
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Fabio Salimei
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Salvatore Marsico
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Daniele Citraro
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Tanio Campagnuolo
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
| | - Valentina Girardi
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Antonio Orlacchio
- Department of Surgery, University of Rome "Tor Vergata", Viale Oxford 81, Rome 00133, Italy
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Jiang K, Ferguson CM, Lerman LO. Noninvasive assessment of renal fibrosis by magnetic resonance imaging and ultrasound techniques. Transl Res 2019; 209:105-120. [PMID: 31082371 PMCID: PMC6553637 DOI: 10.1016/j.trsl.2019.02.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
Renal fibrosis is a useful biomarker for diagnosis and guidance of therapeutic interventions of chronic kidney disease (CKD), a worldwide disease that affects more than 10% of the population and is one of the major causes of death. Currently, tissue biopsy is the gold standard for assessment of renal fibrosis. However, it is invasive, and prone to sampling error and observer variability, and may also result in complications. Recent advances in diagnostic imaging techniques, including magnetic resonance imaging (MRI) and ultrasonography, have shown promise for noninvasive assessment of renal fibrosis. These imaging techniques measure renal fibrosis by evaluating its impacts on the functional, mechanical, and molecular properties of the kidney, such as water mobility by diffusion MRI, tissue hypoxia by blood oxygenation level dependent MRI, renal stiffness by MR and ultrasound elastography, and macromolecule content by magnetization transfer imaging. Other MR techniques, such as T1/T2 mapping and susceptibility-weighted imaging have also been explored for measuring renal fibrosis. Promising findings have been reported in both preclinical and clinical studies using these techniques. Nevertheless, limited specificity, sensitivity, and practicality in these techniques may hinder their immediate application in clinical routine. In this review, we will introduce methodologies of these techniques, outline their applications in fibrosis imaging, and discuss their limitations and pitfalls.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
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18
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Hossain MM, Detwiler RK, Chang EH, Caughey MC, Fisher MW, Nichols TC, Merricks EP, Raymer RA, Whitford M, Bellinger DA, Wimsey LE, Gallippi CM. Mechanical Anisotropy Assessment in Kidney Cortex Using ARFI Peak Displacement: Preclinical Validation and Pilot In Vivo Clinical Results in Kidney Allografts. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:551-562. [PMID: 30106723 PMCID: PMC8232042 DOI: 10.1109/tuffc.2018.2865203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The kidney is an anisotropic organ, with higher elasticity along versus across nephrons. The degree of mechanical anisotropy in the kidney may be diagnostically relevant if properly exploited; however, if improperly controlled, anisotropy may confound stiffness measurements. The purpose of this study is to demonstrate the clinical feasibility of acoustic radiation force (ARF)-induced peak displacement (PD) measures for both exploiting and obviating mechanical anisotropy in the cortex of human kidney allografts, in vivo. Validation of the imaging methods is provided by preclinical studies in pig kidneys, in which ARF-induced PD values were significantly higher ( , Wilcoxon) when the transducer executing asymmetric ARF was oriented across versus along the nephrons. The ratio of these PD values obtained with the transducer oriented across versus along the nephrons strongly linearly correlated ( R2 = 0.95 ) to the ratio of shear moduli measured by shear wave elasticity imaging. On the contrary, when a symmetric ARF was implemented, no significant difference in PD was observed ( p > 0.01 ). Similar results were demonstrated in vivo in the kidney allografts of 14 patients. The symmetric ARF produced PD measures with no significant difference ( p > 0.01 ) between along versus across alignments, but the asymmetric ARF yielded PD ratios that remained constant over a six-month observation period post-transplantation, consistent with stable serum creatinine level and urine protein-to-creatinine ratio in the same patient population ( p > 0.01 ). The results of this pilot in vivo clinical study suggest the feasibility of 1) implementing symmetrical ARF to obviate mechanical anisotropy in the kidney cortex when anisotropy is a confounding factor and 2) implementing asymmetric ARF to exploit mechanical anisotropy when mechanical anisotropy is a potentially relevant biomarker.
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19
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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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20
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Walraven M, Hinz B. Therapeutic approaches to control tissue repair and fibrosis: Extracellular matrix as a game changer. Matrix Biol 2018; 71-72:205-224. [DOI: 10.1016/j.matbio.2018.02.020] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 02/08/2023]
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21
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Marticorena Garcia SR, Guo J, Dürr M, Denecke T, Hamm B, Sack I, Fischer T. Comparison of ultrasound shear wave elastography with magnetic resonance elastography and renal microvascular flow in the assessment of chronic renal allograft dysfunction. Acta Radiol 2018; 59:1139-1145. [PMID: 29249167 DOI: 10.1177/0284185117748488] [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: 12/17/2022]
Abstract
Background Monitoring of renal allograft function is essential for early identification of dysfunction and improvement of kidney transplant (KTX) outcome. Purpose To non-invasively assess renal stiffness in KTX recipients using ultrasound shear wave elastography (USE) in correlation with multifrequency magnetic resonance elastography (MRE), renal allograft function, and renal microvascular flow determined using a novel ultrasound microvascular imaging technique. Material and Methods This prospective study investigated 25 KTXs (functional KTX [FCT], n = 14; chronic KTX insufficiency [DYS], n = 11) in 20 KTX recipients (mean age = 43 ± 14 years). USE was performed using a high-frequency broadband linear transducer and compared with MRE. Shear wave velocity (SWV) was correlated with the estimated glomerular filtration rate (eGFR). Qualitative differences in renal microvascular flow were obtained using SMI. Results FCT had higher SWV than DYS in both cortex and pyramids (cortex, FCT: 3.75 ± 0.82 m/s vs. DYS: 2.79 ± 0.73 m/s, P = 0.0002; pyramid, FCT: 2.89 ± 0.46 m/s vs. DYS: 2.39 ± 0.34 m/s, P = 0.044). Cutoff values of 3.265 m/s for cortex, 2.535 m/s for pyramids, and 2.985 m/s for combined non-hilar parenchyma provided sensitivities of 72.7%, 77.8%, and 90.9% and specificities of 71.4%, 78.6%, and 85.7% for detecting renal allograft dysfunction with area under the receiver operating characteristic curve (AUC) values of 0.831, 0.841, 0.925 (95% confidence interval [CI] = 0.67-0.99, 0.66-1.02, 0.83-1.03). USE correlated positively with eGFR ( r = 0.741, P = 0.0004) and with MRE-derived SWV ( r = 0.562, P = 0.004). Renal microvascular flow was decreased in DYS. Conclusion USE is sensitive to renal allograft dysfunction, which is characterized by reduced SWV and renal perfusion. USE has higher image resolution than MRE, while MRE has slightly better diagnostic accuracy.
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Affiliation(s)
| | - Jing Guo
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Dürr
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timm Denecke
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Hossain MM, Selzo MR, Hinson RM, Baggesen LM, Detwiler RK, Chong WK, Burke LM, Caughey MC, Fisher MW, Whitehead SB, Gallippi CM. Evaluating Renal Transplant Status Using Viscoelastic Response (VisR) Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1573-1584. [PMID: 29754702 PMCID: PMC6026561 DOI: 10.1016/j.ultrasmedbio.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/20/2018] [Accepted: 03/16/2018] [Indexed: 05/03/2023]
Abstract
Chronic kidney disease is most desirably and cost-effectively treated by renal transplantation, but graft survival is a major challenge. Although irreversible graft damage can be averted by timely treatment, intervention is delayed when early graft dysfunction goes undetected by standard clinical metrics. A more sensitive and specific parameter for delineating graft health could be the viscoelastic properties of the renal parenchyma, which are interrogated non-invasively by Viscoelastic Response (VisR) ultrasound, a new acoustic radiation force (ARF)-based imaging method. Assessing the performance of VisR imaging in delineating histologically confirmed renal transplant pathologies in vivo is the purpose of the study described here. VisR imaging was performed in patients with (n = 19) and without (n = 25) clinical indication for renal allograft biopsy. The median values of VisR outcome metrics (τ, relative elasticity [RE] and relative viscosity [RV]) were calculated in five regions of interest that were manually delineated in the parenchyma (outer, center and inner) and in the pelvis (outer and inner). The ratios of a given VisR metric for all possible region-of-interest combinations were calculated, and the corresponding ratios were statistically compared between biopsied patients subdivided by diagnostic categories versus non-biopsied, control allografts using the two-sample Wilcoxon test (p <0.05). Although τ ratios non-specifically differentiated allografts with vascular disease, tubular/interstitial scarring, chronic allograft nephropathy and glomerulonephritis from non-biopsied control allografts, RE distinguished only allografts with vascular disease and tubular/interstitial scarring, and RV distinguished only vascular disease. These results suggest that allografts with scarring and vascular disease can be identified using non-invasive VisR RE and RV metrics.
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Affiliation(s)
- Md Murad Hossain
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Mallory R Selzo
- Ultrasound Business Unit, Siemens Healthcare, Issaquah, Washington, USA
| | - Robert M Hinson
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Leslie M Baggesen
- Kaiser Permanente, Northern California Regional Program Office, Berkeley, California, USA
| | - Randal K Detwiler
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Wui K Chong
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren M Burke
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melissa C Caughey
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melrose W Fisher
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Sonya B Whitehead
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caterina M Gallippi
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA; Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina, USA; Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina, USA.
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23
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Early HM, Cheang EC, Aguilera JM, Hirschbein JSW, Fananapazir G, Wilson MD, McGahan JP. Utility of Shear Wave Elastography for Assessing Allograft Fibrosis in Renal Transplant Recipients: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1455-1465. [PMID: 29143363 DOI: 10.1002/jum.14487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To evaluate the utility of ultrasound-based shear wave elastography (SWE) as a noninvasive method to accurately detect and potentially stage the severity of renal allograft fibrosis and assess its user reproducibility. METHODS In this Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 70 renal transplant recipients underwent an SWE evaluation of their allograft followed directly by biopsy. Two radiologists performed separate SWE measurement acquisitions and the mean, median, and standard deviation of 10 SWE measurements, obtained separately within the cortex and the medulla, were automatically computed. Each patient's SWE results were subsequently compared to their histologic fibrosis scores. The Fisher exact test and univariate logistic regression models were fit to test for associations between the presence of fibrosis (yes/no) as well as categorical SWE results based on the fibrosis severity, ranging from F0 (no fibrosis) to F3 (severe fibrosis), correlating with histologic scores according to the 2007 Banff classification system. Interobserver and intraobserver correlations were also examined. RESULTS Our median medulla SWE values reached statistical significance (P = .04) in association with fibrosis. Furthermore, for every unit increase in the median medulla SWE measurement, the odds of fibrosis increased by approximately 20%. No statistical significance was found for mean cortical, median cortical, or mean medullary SWE values (P = .32, .37, and .06, respectively) in association with fibrosis. CONCLUSIONS The use of SWE for assessing renal allograft fibrosis is challenging but promising. Further investigation with a larger sample size remains to validate our initial results and establish clinical relevance.
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Affiliation(s)
- Heather M Early
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen C Cheang
- Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA
| | - Jorge M Aguilera
- Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA
| | - Jonah S W Hirschbein
- Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA
| | - Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA
| | - Machelle D Wilson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis School of Medicine, Sacramento, California, USA
| | - John P McGahan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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24
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Abstract
Tissue stiffness has long been known to be a biomarker of tissue pathology. Ultrasound elastography measures tissue mechanical properties by monitoring the response of tissue to acoustic energy. Different elastographic techniques have been applied to many different tissues and diseases. Depending on the pathology, patient-based factors, and ultrasound operator-based factors, these techniques vary in accuracy and reliability. In this review, we discuss the physical principles of ultrasound elastography, discuss differences between different ultrasound elastographic techniques, and review the advantages and disadvantages of these techniques in clinical practice.
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Affiliation(s)
- Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL, USA
| | - Manish Dhyani
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Brian W Anthony
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
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25
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Tang Y, Zhao J, Liu D, Niu N, Yu H. Evaluation of Early Kidney Damage Caused by Brain Death Using Real-Time Ultrasound Elastography in a Bama Pig Model. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2395-2401. [PMID: 28756900 DOI: 10.1016/j.ultrasmedbio.2017.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the value of real-time tissue elastography (RTE) in the evaluation of early graft damage resulting from brain death. We performed RTE before and 0, 3, 6 and 9 h after brain death in a Bama pig model. Eleven RTE parameters were compared among time groups, and their correlations with electron microscopic findings were analyzed. Receiver operating characteristic curve analysis was used to find the RTE parameter cutoff values. The mean relative strain value within the region of interest (MEAN), standard deviation of the relative strain value within the region of interest (SD), percentage area of low strain within the region of interest (%AREA), complexity of low-strain area within the region of interest (COMP), kurtosis (KURT), skewness (SKEW), contrast (CONT) and entropy (ENT) and inverse difference moment (IDM) differed statistically significantly between groups (p < 0.05). Electron microscopy of kidney tissue revealed that irreversible damage gradually occurred with longer brain death duration and was marked at 9 h (p < 0.05). These findings correlated best with MEAN (r = 0.632, p < 0.05). Receiver operating characteristic curve analysis of RTE parameters identified a cutoff value of 63.43 for MEAN for optimal diagnostic performance. RTE allows non-invasive, preliminary evaluation of early renal graft damage resulting from brain death.
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Affiliation(s)
- Ying Tang
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China.
| | - Jingwen Zhao
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Dongyang Liu
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Ningning Niu
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
| | - Huimin Yu
- Department of Ultrasound, Tianjin First Center Hospital, Tianjin, China
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26
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Wang Z, Yang H, Suo C, Wei J, Tan R, Gu M. Application of Ultrasound Elastography for Chronic Allograft Dysfunction in Kidney Transplantation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1759-1769. [PMID: 28503746 DOI: 10.1002/jum.14221] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 05/21/2023]
Abstract
Interstitial fibrosis is the main characteristic of chronic allograft dysfunction, which remains the key factor affecting long-term allograft survival after kidney transplantation. Ultrasound elastography (UE), including real-time elastography, transient elastography, and acoustic radiation force impulse, has been applied widely in breast, thyroid, and liver diseases, especially in the assessment of liver fibrosis. Recently, numerous studies have reported the efficacy of UE methods in evaluating renal allograft fibrosis. This review aims to investigate the clinical applications, limitations, and future roles of UE in current clinical practice in light of changing management paradigms. In current clinical practice, UE methods, especially transient elastographic measurement, appear to be useful for ruling out fibrosis but do not have sufficient accuracy to distinguish between various stages of allograft fibrosis. Moreover, there remain considerable issues to be solved for the application of UE in kidney transplantation. Thus, UE methods cannot replace the crucial role of renal allograft biopsy in the diagnosis and evaluation of allograft fibrosis in kidney transplantation. Perhaps UE methods could be of more importance in the long-term observation and evaluation of allograft fibrosis during follow-up.
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Affiliation(s)
- Zijie Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haiwei Yang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chuanjian Suo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jifu Wei
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Beamish JA, Chen E, Putnam AJ. Engineered extracellular matrices with controlled mechanics modulate renal proximal tubular cell epithelialization. PLoS One 2017; 12:e0181085. [PMID: 28715434 PMCID: PMC5513452 DOI: 10.1371/journal.pone.0181085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) is common and associated with significant morbidity and mortality. Recovery from many forms of AKI involves the proliferation of renal proximal tubular epithelial cells (RPTECs), but the influence of the microenvironment in which this recovery occurs remains poorly understood. Here we report the development of a poly(ethylene glycol) (PEG) hydrogel platform to study the influence of substrate mechanical properties on the proliferation of human RPTECs as a model for recovery from AKI. PEG diacrylate based hydrogels were generated with orthogonal control of mechanics and cell-substrate interactions. Using this platform, we found that increased substrate stiffness promotes RPTEC spreading and proliferation. RPTECs showed similar degrees of apoptosis and Yes-associated protein (YAP) nuclear localization regardless of stiffness, suggesting these were not key mediators of the effect. However, focal adhesion formation, cytoskeletal organization, focal adhesion kinase (FAK) activation, and extracellular signal-regulated kinase (ERK) activation were all enhanced with increasing substrate stiffness. Inhibition of ERK activation substantially attenuated the effect of stiffness on proliferation. In long-term culture, hydrogel stiffness promoted the formation of more complete epithelial monolayers with tight junctions, cell polarity, and an organized basement membrane. These data suggest that increased stiffness potentially may have beneficial consequences for the renal tubular epithelium during recovery from AKI.
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Affiliation(s)
- Jeffrey A. Beamish
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Evan Chen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrew J. Putnam
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
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Sigrist RM, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017; 7:1303-1329. [PMID: 28435467 PMCID: PMC5399595 DOI: 10.7150/thno.18650] [Citation(s) in RCA: 921] [Impact Index Per Article: 131.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 12/15/2022] Open
Abstract
Elastography-based imaging techniques have received substantial attention in recent years for non-invasive assessment of tissue mechanical properties. These techniques take advantage of changed soft tissue elasticity in various pathologies to yield qualitative and quantitative information that can be used for diagnostic purposes. Measurements are acquired in specialized imaging modes that can detect tissue stiffness in response to an applied mechanical force (compression or shear wave). Ultrasound-based methods are of particular interest due to its many inherent advantages, such as wide availability including at the bedside and relatively low cost. Several ultrasound elastography techniques using different excitation methods have been developed. In general, these can be classified into strain imaging methods that use internal or external compression stimuli, and shear wave imaging that use ultrasound-generated traveling shear wave stimuli. While ultrasound elastography has shown promising results for non-invasive assessment of liver fibrosis, new applications in breast, thyroid, prostate, kidney and lymph node imaging are emerging. Here, we review the basic principles, foundation physics, and limitations of ultrasound elastography and summarize its current clinical use and ongoing developments in various clinical applications.
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Affiliation(s)
- Rosa M.S. Sigrist
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Joy Liau
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Maria Cristina Chammas
- Department of Ultrasound, Institute of Radiology, Hospital das Clínicas, Medical School of University of São Paulo
| | - Juergen K. Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
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Association of Renal Elasticity and Renal Function Progression in Patients with Chronic Kidney Disease Evaluated by Real-Time Ultrasound Elastography. Sci Rep 2017; 7:43303. [PMID: 28240304 PMCID: PMC5327389 DOI: 10.1038/srep43303] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/24/2017] [Indexed: 12/13/2022] Open
Abstract
Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal elasticity. This study was designed to evaluate the predictive ability of renal elasticity in patients with chronic kidney disease (CKD). 148 non-CKD patients and 227 patients with CKD were recruited. 145 (38.7%) were female, 166 (73.1%) had diabetes, the mean estimated glomerular filtration rate (eGFR) was 33.9 ± 15.8 ml/min/1.73 m2 and the median urinary protein-to-creatinine ratio (UPCR) 502 (122–1491) mg/g. Patients with later stages of CKD had lower renal elasticity values, indicating stiffer kidneys (p < 0.001), and smaller kidney (p < 0.001). Renal elasticity correlated with log-transformed UPCR (β = −7.544, P < 0.001). Renal length correlated with age (β = −0.231, P < 0.001), sex (β = −3.730, P < 0.001), serum albumin level (β = −3.024, P = 0.001), body mass index (β = 0.390, P = 0.009) and eGFR (β = 0.146, P < 0.001). In fully-adjusted logistic regression model, the odds ratio (OR) per 10 unit change in renal elasticity for rapid renal deterioration was 0.928 (95% CI, 0.864–0.997; P = 0.042). The OR per 1 mm change in renal length for rapid renal deterioration was 1.022 (95% CI, 0.994–1.050; P = 0.125). Renal elasticity is associated with proteinuria and rapid renal deterioration in patients with CKD.
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Hassan K, Loberant N, Abbas N, Fadi H, Shadia H, Khazim K. Shear wave elastography imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease. Ther Clin Risk Manag 2016; 12:1615-1622. [PMID: 27853373 PMCID: PMC5106220 DOI: 10.2147/tcrm.s118465] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective The assessment of the grade of renal fibrosis in diabetic kidney disease (DKD) requires renal biopsy, which may be associated with certain risks. To assess the severity of chronic pathologic changes in DKD, we performed a quantitative analysis of renal parenchymal stiffness in advanced DKD, using shear wave elastography (SWE) imaging. Patients and methods Twenty-nine diabetic patients with chronic kidney disease (CKD) grades 3–4 due to DKD, and 23 healthy subjects were enrolled. Combined conventional ultrasound and SWE imaging were performed on all participants. The length, width, and cortical thickness and stiffness were recorded for each kidney. Results Cortical thickness was lower in patients with DKD than in healthy subjects (13.8±2.2 vs 14.8±1.6 mm; P=0.002) and in DKD patients with CKD grade 4 than in those with grade 3 (13.0±3.5 vs 14.7±2.1 mm; P<0.001). Cortical stiffness was greater in patients with DKD than in healthy subjects (23.72±14.33 vs 9.02±2.42 kPa; P<0.001), in DKD patients with CKD grade 4 than in those with grade 3 (30.4±16.2 vs 14.6±8.1 kPa; P<0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (15.7±6.7 vs 11.0±4.2 kPa; P=0.03). Daily proteinuria was higher in DKD patients with CKD grade 4 than in those with grade 3 (5.52±0.96 vs 1.13±0.72; P=0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (1.59±0.59 vs 0.77±0.48; P<0.001). Cortical stiffness was inversely correlated with the estimated glomerular filtration rate (r=−0.65, P<0.001) and with cortical thickness (r=−0.43, P<0.001) in patients with DKD. Conclusions In patients with advanced DKD, SWE imaging may be utilized as a simple and practical method for quantitative evaluation of the chronic morphological changes and for the differentiation between CKD grades.
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Affiliation(s)
- Kamal Hassan
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed; Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center
| | | | - Nur Abbas
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | - Hassan Fadi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hassan Shadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khaled Khazim
- Department of Nephrology and Hypertension, Peritoneal Dialysis Unit - Galilee Medical Center
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31
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Multifrequency Magnetic Resonance Elastography for the Assessment of Renal Allograft Function. Invest Radiol 2016; 51:591-5. [DOI: 10.1097/rli.0000000000000271] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Rose EM, Kennedy SE, Mackie FE. Surveillance biopsies after paediatric kidney transplantation: A review. Pediatr Transplant 2016; 20:748-55. [PMID: 27306873 DOI: 10.1111/petr.12733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Abstract
Kidney transplantation is the most effective means of treating children with end-stage kidney disease, and yet, there continues to be a limited "life span" of transplanted kidneys in paediatric recipients. Early graft monitoring, using the surveillance biopsy, has the potential to extend renal allograft survival in paediatric recipients. The surveillance biopsy provides important and timely information about acute and chronic graft pathology, particularly SCR and calcineurin inhibitor-induced nephrotoxicity, which can subsequently guide management decisions and improve long-term graft survival. The ostensible value of the surveillance biopsy is furthered by the limitations of conventional renal functional studies. However, there is still much debate surrounding the surveillance biopsy in paediatric recipients, particularly in regard to its overall utility, safety and timing. This review discusses the current literature regarding the utility, safety, and potential predictive value of surveillance biopsies for guiding post-transplant management in paediatric renal allograft recipients, as well as the viability of other potentially newer non-invasive strategies for renal allograft monitoring.
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Affiliation(s)
- Edward M Rose
- School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sean E Kennedy
- School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Nephrology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Fiona E Mackie
- School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Nephrology, Sydney Children's Hospital, Randwick, NSW, Australia
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33
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Grenier N, Merville P, Combe C. Radiologic imaging of the renal parenchyma structure and function. Nat Rev Nephrol 2016; 12:348-59. [DOI: 10.1038/nrneph.2016.44] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Anvari A, Barr RG, Dhyani M, Samir AE. Clinical application of sonoelastography in thyroid, prostate, kidney, pancreas, and deep venous thrombosis. ACTA ACUST UNITED AC 2015; 40:709-22. [PMID: 25750099 DOI: 10.1007/s00261-015-0383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article reviews the clinical applications of current ultrasound elastography methods in non-hepatic conditions including thyroid nodules, prostate cancer, chronic kidney disease, solid renal lesions, pancreatic lesions, and deep vein thrombosis. Pathophysiology alters tissue mechanical properties via ultrastructural changes including fibrosis, increased cellularity, bleeding, and necrosis, creating a target biomarker, which can be imaged qualitatively or quantitatively with US elastography. US elastography methods can add information to conventional US methods and improve the diagnostic performance of conventional US in a range of disease processes.
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Affiliation(s)
- Arash Anvari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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35
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Gao J, Rubin JM, Weitzel W, Lee J, Dadhania D, Kapur S, Min R. Comparison of Ultrasound Corticomedullary Strain with Doppler Parameters in Assessment of Renal Allograft Interstitial Fibrosis/Tubular Atrophy. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2631-2639. [PMID: 26219696 DOI: 10.1016/j.ultrasmedbio.2015.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/05/2015] [Accepted: 06/10/2015] [Indexed: 05/28/2023]
Abstract
To compare the capability of ultrasound strain and Doppler parameters in the assessment of renal allograft interstitial fibrosis/tubular atrophy (IF/TA), we prospectively measured ultrasound corticomedullary strain (strain) and intra-renal artery Doppler end-diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI) in 45 renal transplant recipients before their kidney biopsies. We used 2-D speckle tracking to estimate strain, the deformation ratio of renal cortex to medulla produced by external compression using the ultrasound transducer. We also measured Doppler EDV, PSV and RI at the renal allograft inter-lobar artery. Using the Banff scoring system for renal allograft IF/TA, 45 patients were divided into the following groups: group 1 with ≤5% (n = 12) cortical IF/TA; group 2 with 6%-25% (n = 12); group 3 with 26%-50% (n = 11); and group 4 with >50% (n = 10). We performed receiver operating characteristic curve analysis to test the accuracy of these ultrasound parameters and duration of transplantation in determining >26% cortical IF/TA. In our results, strain was statistically significant in all paired groups (all p < 0.005) and inversely correlated with the grade of cortical IF/TA (p < 0.001). However, the difference in PSV and EDV was significant only between high-grade (>26%, including 26%-50% and >50%) and low-grade (≤25%, including <5% and 6%-25%) cortical IF/TA (p < 0.001). RI did not significantly differ in any paired group (all p > 0.05). The areas under the receiver operating characteristic curve for strain, EDV, PSV, RI and duration of transplantation in determining >26% cortical IF/TA were 0.99, 0.94, 0.88, 0.52 and 0.92, respectively. Our results suggest that corticomedullary strain seems to be superior to Doppler parameters and duration of transplantation in assessment of renal allograft cortical IF/TA.
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Affiliation(s)
- Jing Gao
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.
| | - Jonathan M Rubin
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - William Weitzel
- University of Michigan Hospitals, VA Medical Center, Ann Arbor, Michigan, USA
| | - Jun Lee
- Rogosin Institute, Weill Cornell Medical College, New York, New York, USA
| | - Darshana Dadhania
- Rogosin Institute, Weill Cornell Medical College, New York, New York, USA
| | - Sandip Kapur
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Robert Min
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
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36
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Boor P, Floege J. Renal allograft fibrosis: biology and therapeutic targets. Am J Transplant 2015; 15:863-86. [PMID: 25691290 DOI: 10.1111/ajt.13180] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/30/2014] [Accepted: 12/19/2014] [Indexed: 01/25/2023]
Abstract
Renal tubulointerstitial fibrosis is the final common pathway of progressive renal diseases. In allografts, it is assessed with tubular atrophy as interstitial fibrosis/tubular atrophy (IF/TA). IF/TA occurs in about 40% of kidney allografts at 3-6 months after transplantation, increasing to 65% at 2 years. The origin of renal fibrosis in the allograft is complex and includes donor-related factors, in particular in case of expanded criteria donors, ischemia-reperfusion injury, immune-mediated damage, recurrence of underlying diseases, hypertensive damage, nephrotoxicity of immunosuppressants, recurrent graft infections, postrenal obstruction, etc. Based largely on studies in the non-transplant setting, there is a large body of literature on the role of different cell types, be it intrinsic to the kidney or bone marrow derived, in mediating renal fibrosis, and the number of mediator systems contributing to fibrotic changes is growing steadily. Here we review the most important cellular processes and mediators involved in the progress of renal fibrosis, with a focus on the allograft situation, and discuss some of the challenges in translating experimental insights into clinical trials, in particular fibrosis biomarkers or imaging modalities.
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Affiliation(s)
- P Boor
- Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany; Department of Pathology, RWTH University of Aachen, Aachen, Germany; Institute of Molecular Biomedicine, Bratislava, Slovakia
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