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Sotomayor CG, Benjamens S, Dijkstra H, Yakar D, Moers C, Bakker SJL, Pol RA. Introduction of the Grayscale Median for Ultrasound Tissue Characterization of the Transplanted Kidney. Diagnostics (Basel) 2021; 11:diagnostics11030390. [PMID: 33668900 PMCID: PMC7996582 DOI: 10.3390/diagnostics11030390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
Ultrasound examination is advised for early post-kidney transplant assessment. Grayscale median (GSM) quantification is novel in the kidney transplant field, with no systematic assessment previously reported. In this prospective cohort study, we measured the post-operative GSM in a large cohort of adult kidney transplant recipients (KTR) who consecutively underwent Doppler ultrasound directly after transplantation (within 24 h), compared it with GSM in nontransplanted patients, and investigated its association with baseline and follow-up characteristics. B-mode images were used to calculate the GSM in KTR and compared with GSM data in nontransplanted patients, as simulated from summary statistics of the literature using a Mersenne twister algorithm. The association of GSM with baseline and 1-year follow-up characteristics were studied by means of linear regression analyses. In 282 KTR (54 ± 15 years old, 60% male), the median (IQR) GSM was 55 (45–69), ranging from 22 to 124 (coefficient of variation = 7.4%), without differences by type of donation (p = 0.28). GSM in KTR was significantly higher than in nontransplanted patients (p < 0.001), and associated with systolic blood pressure, history of cardiovascular disease, and donor age (std. β = 0.12, −0.20, and 0.13, respectively; p < 0.05 for all). Higher early post-kidney transplant GSM was not associated with 1-year post-kidney transplant function parameters (e.g., measured and estimated glomerular filtration rate). The data provided in this study could be used as first step for further research on the application of early postoperative ultrasound in KTR.
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Affiliation(s)
- Camilo G. Sotomayor
- Department of Internal Medicine, Division of Nephrology, University of Groningen, 9700 RB Groningen, The Netherlands; (C.G.S.); (S.J.L.B.)
- Department of Radiology, Clinical Hospital of the University of Chile, University of Chile, CP 8380453 Santiago, Chile
| | - Stan Benjamens
- Department of Surgery, Division of Transplant Surgery, University of Groningen, 9700 RB Groningen, The Netherlands; (S.B.); (C.M.)
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging & Department of Radiology, University of Groningen, 9700 RB Groningen, The Netherlands; (H.D.); (D.Y.)
| | - Hildebrand Dijkstra
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging & Department of Radiology, University of Groningen, 9700 RB Groningen, The Netherlands; (H.D.); (D.Y.)
| | - Derya Yakar
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging & Department of Radiology, University of Groningen, 9700 RB Groningen, The Netherlands; (H.D.); (D.Y.)
| | - Cyril Moers
- Department of Surgery, Division of Transplant Surgery, University of Groningen, 9700 RB Groningen, The Netherlands; (S.B.); (C.M.)
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, 9700 RB Groningen, The Netherlands; (C.G.S.); (S.J.L.B.)
| | - Robert A. Pol
- Department of Surgery, Division of Transplant Surgery, University of Groningen, 9700 RB Groningen, The Netherlands; (S.B.); (C.M.)
- Correspondence:
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Huang Z, Feng S, Guan Q, Lin T, Zhao J, Nguan CYC, Zeng H, Harriman D, Li H, Du C. Correlation of surface-enhanced Raman spectroscopic fingerprints of kidney transplant recipient urine with kidney function parameters. Sci Rep 2021; 11:2463. [PMID: 33510308 PMCID: PMC7843595 DOI: 10.1038/s41598-021-82113-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/06/2021] [Indexed: 02/05/2023] Open
Abstract
Routine monitoring of kidney transplant function is required for the standard care in post-transplantation management, including frequent measurements of serum creatinine with or without kidney biopsy. However, the invasiveness of these methods with potential for clinically significant complications makes them less than ideal. The objective of this study was to develop a non-invasive tool to monitor the kidney transplant function by using Surface-Enhanced Raman Spectroscopy (SERS). Urine and blood samples were collected from kidney transplant recipients after surgery. Silver nanoparticle-based SERS spectra of the urine were measured and evaluated using partial least squires (PLS) analysis. The SERS spectra were compared with conventional chemical markers of kidney transplant function to assess its predictive ability. A total of 110 kidney transplant recipients were included in this study. PLS results showed significant correlation with urine protein (R2 = 0.4660, p < 0.01), creatinine (R2 = 0.8106, p < 0.01), and urea (R2 = 0.7808, p < 0.01). Furthermore, the prediction of the blood markers of kidney transplant function using the urine SERS spectra was indicated by R2 = 0.7628 (p < 0.01) for serum creatinine and R2 = 0.6539 (p < 0.01) for blood urea nitrogen. This preliminary study suggested that the urine SERS spectral analysis could be used as a convenient method for rapid assessment of kidney transplant function.
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Affiliation(s)
- Zhongli Huang
- Department of Urology, Institute of Urology, Organ Transplantation Center, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, 610041, China.,Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Shijian Feng
- Department of Urology, Institute of Urology, Organ Transplantation Center, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, 610041, China.,Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Qiunong Guan
- Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Tao Lin
- Department of Urology, Institute of Urology, Organ Transplantation Center, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, 610041, China
| | - Jianhua Zhao
- Imaging Unit, Integrative Oncology Department, BC Cancer Research Center, 675 W 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - Christopher Y C Nguan
- Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Haishan Zeng
- Imaging Unit, Integrative Oncology Department, BC Cancer Research Center, 675 W 10th Ave, Vancouver, BC, V5Z 1L3, Canada
| | - David Harriman
- Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Hong Li
- Department of Urology, Institute of Urology, Organ Transplantation Center, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, 610041, China.
| | - Caigan Du
- Department of Urologic Sciences, University of British Columbia, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada.
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Improta G, Mazzella V, Vecchione D, Santini S, Triassi M. Fuzzy logic-based clinical decision support system for the evaluation of renal function in post-Transplant Patients. J Eval Clin Pract 2020; 26:1224-1234. [PMID: 31713997 PMCID: PMC7496862 DOI: 10.1111/jep.13302] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In the context of the gradual development of artificial intelligence in health care, the clinical decision support systems (CDSS) play an increasing crucial role in improving the quality of the therapeutic and diagnostic efficiency in health care. The fuzzy logic (FL) provides an effective means for dealing with uncertainties in the health decision-making process; therefore, FL-based CDSS becomes a very powerful tool for data and knowledge management, being able to think like an expert clinician. This work proposes an FL-based CDSS for the evaluation of renal function in posttransplant patients. METHOD Based on the data provided by the Department of Nephrology of the University Hospital Federico II of Naples, a statistical sample is selected according to appropriate inclusion criteria. Four fuzzy inference systems are implemented monitoring the renal function by the level of proteinuria and the glomerular filtration rate (GFR). RESULTS The systems show an accuracy of more than 90% and the outputs are provided through easy to read graphics, so that physicians can intuitively monitor the patient's clinical status, with the objective to improve drugs dosage and reduce medication errors. CONCLUSIONS We propose that the CDSSs for the assessment and follow-up of kidney-transplanted patients built in this study are applicable to clinical practice.
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Affiliation(s)
- Giovanni Improta
- Department of Public Health of the University HospitalUniversity of Naples Federico IINaplesItaly
| | - Valeria Mazzella
- Department of Electronic Engineering and Information Technology, Faculty of EngineeringUniversity of Naples Federico IINaplesItaly
| | - Donatella Vecchione
- Department of Electronic Engineering and Information Technology, Faculty of EngineeringUniversity of Naples Federico IINaplesItaly
| | - Stefania Santini
- Department of Electronic Engineering and Information Technology, Faculty of EngineeringUniversity of Naples Federico IINaplesItaly
| | - Maria Triassi
- Department of Public Health of the University HospitalUniversity of Naples Federico IINaplesItaly
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Dammann E, Groth M, Schild RS, Lemke A, Oh J, Adam G, Herrmann J. B-Flow Sonography vs. Color Doppler Sonography for the Assessment of Vascularity in Pediatric Kidney Transplantation. ROFO-FORTSCHR RONTG 2020; 193:49-60. [PMID: 32516824 DOI: 10.1055/a-1167-8317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare B-flow sonography (BFS) with color Doppler sonography (CDS) for imaging of kidney transplant vascularization in children. PATIENTS AND METHODS All children receiving a kidney transplantation who underwent a protocol-based ultrasound examination (Loqiq 9, GE Medical Systems, Milwaukee, WI, USA) using the BFS and CDS technique with equal settings and probe position between January 2013 and January 2016 were retrospectively assessed (n = 40). The obtained datasets were visually graded according to the following criteria: (I) delineation of the renal vascular tree (Grade 1 - clear demarcation of interlobar, together with arcuate and interlobular vessels; Grade 2 - clear demarcation of interlobar and cortical vessels, but no distinction of interlobular from arcuate vessels; Grade 3 - only clear demarcation of interlobar vessels, Grade 4 - insufficient demarcation) (II) delineation of cortical vessel density in ventral, lateral, and dorsal part of the transplant, (III) smallest vessel-capsule distance, and (IV) maximum cortical vessel count. Comparison between methods was performed using Fisher's exact and paired sample t-tests. RESULTS Applying a curved transducer (C1-6), BFS showed superior delineation of the renal vascular tree (p < 0.001), a lower vessel-capsule distance (p < 0.001), a higher cortical vessel count (p < 0.001), and a higher cortical vessel density in the superficial cortex (p = 0.01) than CDS. In the dorsal and lateral aspects of the transplant, cortical vessel density was lower with BFS (both p < 0.001). Using a linear high-resolution transducer (ML 6-15), no significant differences between the methods were found. CONCLUSION Improved imaging of kidney transplant vascularization can be achieved in children by adding BFS to a standard protocol. The BFS technique is especially beneficial for overall assessment of the renal vascular tree together with the extent of cortical vascularization on curved array images. KEY POINTS · Depiction of vascular tree and ventral cortical vessels is improved by BFS.. · The dorso-lateral cortex was better represented with CDS because of higher penetration.. · Additional monitoring with BFS improves the monitoring of transplant viability.. CITATION FORMAT · Dammann E, Groth M, Schild R et al. B-Flow Sonography vs. Color Doppler Sonography for the Assessment of Vascularity in Pediatric Kidney Transplantation. Fortschr Röntgenstr 2021; 193: 49 - 60.
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Affiliation(s)
- Elena Dammann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Groth
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael-Sebastian Schild
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Lemke
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Preuss S, Rother C, Renders L, Wagenpfeil S, Büttner-Herold M, Slotta-Huspenina J, Holtzmann C, Kuechle C, Heemann U, Stock KF. Sonography of the renal allograft: Correlation between doppler sonographic resistance index (RI) and histopathology. Clin Hemorheol Microcirc 2019; 70:413-422. [PMID: 30562894 DOI: 10.3233/ch-189306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Allograft rejection (AR), chronic allograft injury (CAI) and acute tubular necrosis (ATN) can lead to renal allograft dysfunction after kidney transplantation. Interstitial fibrosis/tubular atrophy (Banff classification 2005) describes chronic allograft injury with no specific etiology, thus explaining the common final endpoint of various (immunologic and non immunologic) etiologies. The aim of this study was to evaluate correlations between the Doppler sonographic RI-values and histopathological changes of renal allografts biopsies during rejection, acute tubular necrosis and chronic allograft injury as well as the influence of donor and recipient features on the intrarenal RI-values. METHODS 102 allograft biopsies and ultrasound reports of 69 patients with kidney transplantation performed at the hospital Klinikum rechts der Isar (Technische Universität München, Germany) between 2009 and 2013 were analyzed retrospectively (41 biopsies of living donors, 61 biopsies of deceased donors). Chronic allograft injury was described using the IFTA (interstitial fibrosis and tubular atrophy) or the ECAI score (extended chronic allograft injury score). The ECAI score was built out of the chronic histological lesions glomerulopathy, interstitial fibrosis, tubular atrophy and fibrous intimal thickening (cg + ci + ct + cv) of the BANFF scoring. RESULTS Intrarenal RI-values were significantly higher in patients with allograft rejection than without rejection (median 0,79 vs. 0,73; inter quartile range: 0,20 vs. 0,13; p = 0,018). The same was found for T-and non-T cell mediated rejection (median 0,78 vs. 0,73; inter quartile range 0,20 vs. 0,13; p = 0,039). There were no significant differences in the RI-values between the subtypes of T-cell mediated rejection (type IA-IIB). Furthermore, there were no significant differences of RI-values regarding antibody-mediated rejection (present vs. not present) or type of rejection (T-cell- vs. antibody mediated rejection). Patients with rejection and simultaneously chronic allograft injury showed significantly higher RI-values than patients with only chronic allograft injury. Analyses using the IFTA or the ECAI score showed comparable results (IFTA p = 0,043; Score p = 0,021). The intrarenal RI-value was neither able to detect chronic allograft injury nor to distinguish between acute tubular necrosis and rejection. The intrarenal RI-value showed a significant correlation with recipient age (p < 0,001) but not with donor features. CONCLUSION In summary, the intrarenal RI-value can indicate a rejection but gives no clear hint to acute tubular necrosis and cannot differentiate from it. Since patients with rejection can have normal RI-values, a biopsy should always be performed in case of suspected rejection. The intrarenal RI-value has no unambiguous validity to determine intrinsic values of the renal allograft, but should rather be understood and interpreted as a systemic parameter influenced by multiple factors.
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Affiliation(s)
- Stephanie Preuss
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Charlotte Rother
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Lutz Renders
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Stefan Wagenpfeil
- Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (IMBEI), Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland, Germany
| | | | | | - Christopher Holtzmann
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Claudius Kuechle
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Uwe Heemann
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
| | - Konrad Friedrich Stock
- Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, Germany
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Taffel MT, Nikolaidis P, Beland MD, Blaufox MD, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, Heller MT, Khatri G, Preminger GM, Purysko AS, Smith AD, Wang ZJ, Weinfeld RM, Wong-You-Cheong JJ, Remer EM, Lockhart ME. ACR Appropriateness Criteria ® Renal Transplant Dysfunction. J Am Coll Radiol 2018; 14:S272-S281. [PMID: 28473084 DOI: 10.1016/j.jacr.2017.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Myles T Taffel
- Principal Author, George Washington University Hospital, Washington, District of Columbia.
| | - Paul Nikolaidis
- Panel Vice-chair, Northwestern University, Chicago, Illinois
| | | | - M Donald Blaufox
- Albert Einstein College of Medicine, Bronx, New York; Society of Nuclear Medicine and Molecular Imaging
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia; Pennsylvania, American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | | | | | | | | | - Glenn M Preminger
- Duke University Medical Center, Durham, North Carolina; American Urological Association
| | | | - Andrew D Smith
- The University of Mississippi Medical Center, Jackson, Mississippi
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
| | | | | | - Mark E Lockhart
- Panel Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Optimizing Efficiency in the Evaluation of Living Donor Candidates: Best Practices and Implications. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Motoyama D, Ishii Y, Takehara Y, Sugiyama M, Yang W, Nasu H, Ushio T, Hirose Y, Ohishi N, Wakayama T, Kabasawa H, Johnson K, Wieben O, Sakahara H, Ozono S. Four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction (4D PC-VIPR) MR evaluation of the renal arteries in transplant recipients: Preliminary results. J Magn Reson Imaging 2017; 46:595-603. [DOI: 10.1002/jmri.25607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 12/05/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daisuke Motoyama
- Department of Urology; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Yasuo Ishii
- Department of Surgery; Kidney Center, Toranomon Hospital; Tokyo Japan
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging; Nagoya University, Graduate School of Medicine; Nagoya Japan
| | - Masataka Sugiyama
- Department of Diagnostic Radiology & Nuclear Medicine; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Wang Yang
- Department of Diagnostic Radiology & Nuclear Medicine; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Hatsuko Nasu
- Department of Diagnostic Radiology & Nuclear Medicine; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Takasuke Ushio
- Department of Diagnostic Radiology & Nuclear Medicine; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Yuko Hirose
- Department of Diagnostic Radiology & Nuclear Medicine; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Naoki Ohishi
- Department of Radiology; Hamamatsu University Hospital; Shizuoka Japan
| | - Tetsuya Wakayama
- Applied Science Laboratory Asia Pacific, GE Healthcare Japan; Tokyo Japan
| | - Hiroyuki Kabasawa
- Department of Medical Physics and Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Kevin Johnson
- Department of Medical Physics and Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Oliver Wieben
- Department of Medical Physics and Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Harumi Sakahara
- Department of Diagnostic Radiology & Nuclear Medicine; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Seiichiro Ozono
- Department of Urology; Hamamatsu University School of Medicine; Shizuoka Japan
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Lal H, Helavar RV, Gamanagatti S, Jain S, Kumar R. Imaging in renal transplant: Review. INDIAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.1016/j.ijt.2014.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
AIM Ultrasound tissue characterization (USTC) is a precursor of ultrasound virtual histology (USVH), already applied to B-mode images of coronary, carotid, and peripheral arteries, as well as venous thrombosis. Elevated echogenicity has been described for a rejected transplanted kidney. We analyzed data from healthy young adults as reference for further renal USTC. METHODS Ultrasound kidney images of 10 volunteers were analyzed. Pixel brightness in the 0-to-255 range was rescaled to zero for black and 200 for fascia brightness before automatic classification into 14 ranges, including "blood-like" (0-4), "fat-like" (8-26), "hypoechoic muscle-like" (41-60), "hyperechoic muscle-like" (61-76), 4 ranges of "fiber-like" (112-196), "calcium-like" (211-255) and intermediary intervals. Nomenclature was readapted using nonechoic, hypoechoic I to IV, echoic I to IV, hyperechoic I to IV, and saturated echoes to avoid inference to actual kidney tissue. Descriptive and comparative statistics were based on percentages of pixels in specific brightness ranges. SAMPLE POPULATION Eight women and 2 men, 26 ± 4 years (range, 22-34 years) old, were studied. Kidney length was 10.5 ± 0.9 cm (9.0-12.0 cm). Doppler US resistivity index was 0.67 ± 0.03 (0.62-0.71). RESULTS Original fascia brightness converted to 200 value had a mean ± SD of 206 ± 16 (range, 181-236). Kidney grayscale median averaged 37 ± 6 (27-48). Most pixels were hypoechoic II to IV (8-60), averaging 78% ± 6% (66%-87%). Percentages for fat-like, intermediary fat/muscle-like, and hypoechoic muscle-like intervals averaged 25%, 28%, and 25%, respectively. CONCLUSIONS A reference database for USTC/USVH of normal young kidneys was created for future comparisons with transplanted and abnormal kidneys. Normal renal echoes have low brightness. Hyperechoic pixels may represent abnormalities.
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Helck A, Wessely M, Notohamiprodjo M, Schönermarck U, Klotz E, Fischereder M, Schön F, Nikolaou K, Clevert DA, Reiser M, Becker C. CT perfusion technique for assessment of early kidney allograft dysfunction: preliminary results. Eur Radiol 2013; 23:2475-81. [DOI: 10.1007/s00330-013-2862-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/12/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
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12
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Kolofousi C, Stefanidis K, Cokkinos DD, Karakitsos D, Antypa E, Piperopoulos P. Ultrasonographic features of kidney transplants and their complications: an imaging review. ISRN RADIOLOGY 2012; 2013:480862. [PMID: 24967275 PMCID: PMC4045518 DOI: 10.5402/2013/480862] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
Renal transplantation is the treatment of choice for managing patients with end-stage kidney disease. Being submitted to a very serious surgical procedure, renal transplant recipients can only benefit from follow-up imaging and monitoring strategies. Ultrasound is considered as the principal imaging test in the evaluation of renal transplants. It is an easily applied bedside examination that can detect possible complications and guide further imaging or intervention. In this imaging review, we present essential information regarding the sonographic features of healthy renal transplants, detailing the surgical technique and how it affects the sonoanatomy. We focus on various complications that occur following renal transplantation and their sonographic features by reviewing pertinent literature sources and our own extensive imaging archives.
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Affiliation(s)
| | | | | | | | - Eleni Antypa
- Radiology Department, Evangelismos Hospital, 10676 Athens, Greece
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13
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Onniboni M, De Filippo M, Averna R, Coco L, Zompatori M, Sverzellati N, Rossi C. Magnetic resonance imaging in the complications of kidney transplantation. Radiol Med 2012; 118:837-50. [PMID: 23090252 DOI: 10.1007/s11547-012-0891-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
Abstract
Kidney transplantation is currently the treatment of choice in most patients with end-stage chronic renal failure owing to the excellent results in terms of both graft and patient survival. However, surgical complications are still very frequent. Although urological (stricture, urinary fistulas, vesico-ureteral reflux) and lymphatic complications (lymphocoele) have a high incidence, they only rarely lead to graft loss. By contrast, vascular complications (stenosis, arterial and venous thrombosis, arterio-venous fistulas, pseudoaneurysms) are relatively rare, but potentially serious and may affect graft survival. Finally, medical complications such as acute tubular necrosis (ATN), rejection and de novo neoplasms may also arise in kidney transplantation. The purpose of this pictorial review is to illustrate the increasingly significant contribution of magnetic resonance angiography (MRA) in the management of complications of kidney transplantation, and emphasise how this method should now be considered a mandatory step in the diagnostic workup of selected cases. Moreover, the application and role in this setting of new magnetic resonance imaging (MRI) techniques, such as diffusion-weighted and blood oxygen level-dependent (BOLD) MRI, are also discussed.
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Affiliation(s)
- M Onniboni
- Scienze Radiologiche, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Padiglione Barbieri, 43100, Parma, Italy.
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AIUM practice guideline for the performance of an ultrasound examination in the practice of urology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:133-144. [PMID: 22215782 DOI: 10.7863/jum.2012.31.1.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Helck A, Bamberg F, Sommer W, Wessely M, Becker C, Clevert D, Notohamiprodjo M, Reiser M, Nikolaou K. Optimized contrast volume for dynamic CT angiography in renal transplant patients using a multiphase CT protocol. Eur J Radiol 2011; 80:692-8. [DOI: 10.1016/j.ejrad.2010.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/06/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
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Laberge JM. Interventional management of renal transplant arteriovenous fistula. Semin Intervent Radiol 2011; 21:239-46. [PMID: 21331135 DOI: 10.1055/s-2004-861558] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Percutaneous needle biopsy has become an indispensable tool for the evaluation and management of patients with renal allograft dysfunction. But this invasive procedure is not without risk. Vascular injury in the form of arteriovenous fistula, pseudoaneurysm, or arteriocalyceal fistula may result in symptoms that require percutaneous endovascular intervention. In this article, the occurrence, detection, and treatment of biopsy-related renal transplant injury are described.
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Affiliation(s)
- Jeanne M Laberge
- Department of Radiology, Division of Interventional Radiology, University of California, San Francisco
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Ismaeel MM, Abdel-Hamid A. Role of high resolution contrast-enhanced magnetic resonance angiography (HR CeMRA) in management of arterial complications of the renal transplant. Eur J Radiol 2011; 79:e122-7. [PMID: 21601400 DOI: 10.1016/j.ejrad.2011.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/11/2011] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Transplant renal artery (RA) stenosis (TRAS) is the most frequent posttransplantation vascular complication. Contrast enhanced magnetic resonance (CeMRA) angiography has been established as the preferred imaging technique for the evaluation of TRAS because it does not require the use of iodinated contrast material and does not expose the patient to ionizing radiation. Digital subtraction angiography (DSA) is the gold standard in the evaluation of arterial tree of the renal allograft. AIM OF THE WORK This study was carried out to assess the accuracy of CeMRA in the detection of arterial complications after renal transplantation. PATIENTS AND METHODS Thirty renal transplant patients with suspected arterial complications in which both CeMRA and DSA were performed were included in the study. The HR CeMRA shows 93.7% sensitivity, 80% specificity, 88.2% positive predictive value, 88.9% negative predictive value and 88.5% accuracy. CONCLUSION HR CeMRA is an accurate reliable tool in the assessment of arterial complications after renal transplantation. It may replace DSA as a diagnostic modality with reservation of interventional techniques for endovascular treatment of suitable cases.
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Elsayes KM, Menias CO, Willatt J, Azar S, Harvin HJ, Platt JF. Imaging of Renal Transplant: Utility and Spectrum of Diagnostic Findings. Curr Probl Diagn Radiol 2011; 40:127-39. [DOI: 10.1067/j.cpradiol.2010.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Gao J, Hentel K, Zhu Q, Ma T, Shih G, Mennitt K, Min R. Doppler angle correction in the measurement of intrarenal parameters. Int J Nephrol Renovasc Dis 2011; 4:49-55. [PMID: 21694949 PMCID: PMC3108792 DOI: 10.2147/ijnrd.s17811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Indexed: 01/02/2023] Open
Abstract
Background: The aim of this study was to assess differences in intrarenal artery Doppler parameters measured without and with Doppler angle correction. Methods: We retrospectively reviewed color duplex sonography in 30 normally functioning kidneys (20 native kidneys in 10 subjects and 10 transplanted kidneys in 10 subjects) performed between January 26, 2010 and July 26, 2010. There were 10 age-matched men and 10 age-matched women (mean 39.8 ± 12.2, range 21–60 years) in this study. Depending on whether the Doppler angle was corrected in the spectral Doppler measurement, Doppler parameters including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) measured at the interlobar artery of the kidney were divided into two groups, ie, initial Doppler parameters measured without Doppler angle correction (Group 1) and remeasured Doppler parameters with Doppler angle correction (Group 2). Values for PSV, EDV, and RI measured without Doppler angle correction were compared with those measured with Doppler angle correction, and were analyzed statistically with a paired-samples t-test. Results: There were statistical differences in PSV and EDV at the interlobar artery in the upper, mid, and lower poles of the kidney between Group 1 and Group 2 (all P < 0.001). PSV and EDV in Group 1 were significantly lower than in Group 2. RI in Group 1 was the same as that in Group 2 in the upper, mid, and lower poles of the kidneys. Conclusion: Doppler angle correction plays an important role in the accurate measurement of intrarenal blood flow velocity. The true flow velocity converted from the maximum Doppler velocity shift is produced only when the Doppler angle is 0°, so that the emission sound beam is parallel to the direction of blood flow at the sampled artery. Therefore, the Doppler angle correction should be routinely applied and displayed on renal color duplex sonography.
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Affiliation(s)
- Jing Gao
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, NY, USA
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Immediate renal Doppler ultrasonography findings (<24 h) and its association with graft survival. World J Urol 2011; 29:547-53. [DOI: 10.1007/s00345-011-0666-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/21/2011] [Indexed: 10/18/2022] Open
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Donadio C, Abdelkawy H, Grassi G. Echographic Renal Dimensions Can Predict Glomerular Filtration Rate of Potential Living Kidney Donors. Transplant Proc 2010; 42:1035-9. [DOI: 10.1016/j.transproceed.2010.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gosmanova EO, Wu S, O'Neill WC. Application of ultrasound in nephrology practice. Adv Chronic Kidney Dis 2009; 16:396-404. [PMID: 19695508 DOI: 10.1053/j.ackd.2009.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography plays critical roles in many aspects of nephrology practice. Applications include the evaluation of the kidneys and urinary tract, guidance for the percutaneous kidney biopsy and temporary hemodialysis access placement, and vascular ultrasound of upper extremities related to the permanent hemodialysis access. The simplicity of technique and the limited spectrum of pathological changes coupled with portability, low cost, and safety make sonography the modality of choice for kidney and vascular imaging. This review summarizes the indications for kidney and vascular ultrasound and describes the most commonly encountered findings. Although many ultrasound findings are nonspecific, their diagnostic use is greatly enhanced by knowledge of the clinical presentation. Therefore, it is essential for nephrologists to possess skills in performing and interpreting ultrasound studies in order to improve the care of patients with kidney diseases.
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Aschwanden M, Mayr M, Imfeld S, Steiger J, Jaeger KA, Thalhammer C. Rapid adaptation of the intrarenal resistance index after living donor kidney transplantation. Nephrol Dial Transplant 2009; 24:1331-4. [PMID: 19188340 DOI: 10.1093/ndt/gfp016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited data exist concerning changes of renal perfusion directly after kidney transplantation. Colour-coded duplex sonography is the accepted method to assess kidney perfusion after transplantation. A widely used, although unspecific, Doppler parameter is the intrarenal resistance index (RI). The aim of this study was to clarify the influence of different patient- and procedure-related factors on RI before and immediately after living kidney transplantation. METHODS In a prospective study, 80 living kidney transplantation donor-recipient pairs were included. RI was measured in the donor 1 to 3 days before nephrectomy and in the recipient during the first hour after transplantation to examine the influence of age, heart rate, duration of cold and warm ischaemia time and immunosuppressive medications. RESULTS Mean RI did not differ between donors and recipients. RI correlated with age, both in donors (r = 0.58, P < 0.001) and recipients (r = 0.39, P < 0.001). In recipients, 10 or more years younger than their donors (n = 24), an average decrease of 0.05 in RI compared to the donors' value was observed (P = 0.01). Heart rate, cold and warm ischaemia time and immunosuppressive medications had no influence on the recipient RI. In patients with delayed graft function, a significant increase in RI within 14 days was observed. However, the initial RI was not predictive of graft function. CONCLUSIONS The transplanted kidney seems to be able to adjust its RI within a short time despite several potential harmful factors that can occur during the transplantation.
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Affiliation(s)
- Markus Aschwanden
- Department of Angiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Yoo YM, Sikdar S, Karadayi K, Kolokythas O, Kim Y. Adaptive clutter rejection for 3D color Doppler imaging: preliminary clinical study. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1221-1231. [PMID: 18455291 DOI: 10.1016/j.ultrasmedbio.2008.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 12/11/2007] [Accepted: 01/28/2008] [Indexed: 05/26/2023]
Abstract
In three-dimensional (3D) ultrasound color Doppler imaging (CDI), effective rejection of flash artifacts caused by tissue motion (clutter) is important for improving sensitivity in visualizing blood flow in vessels. Since clutter characteristics can vary significantly during volume acquisition, a clutter rejection technique that can adapt to the underlying clutter conditions is desirable for 3D CDI. We have previously developed an adaptive clutter rejection (ACR) method, in which an optimum filter is dynamically selected from a set of predesigned clutter filters based on the measured clutter characteristics. In this article, we evaluated the ACR method with 3D in vivo data acquired from 37 kidney transplant patients clinically indicated for a duplex ultrasound examination. We compared ACR against a conventional clutter rejection method, down-mixing (DM), using a commonly-used flow signal-to-clutter ratio (SCR) and a new metric called fractional residual clutter area (FRCA). The ACR method was more effective in removing the flash artifacts while providing higher sensitivity in detecting blood flow in the arcuate arteries and veins in the parenchyma of transplanted kidneys. ACR provided 3.4 dB improvement in SCR over the DM method (11.4 +/- 1.6 dB versus 8.0 +/- 2.0 dB, p < 0.001) and had lower average FRCA values compared with the DM method (0.006 +/- 0.003 versus 0.036 +/- 0.022, p < 0.001) for all study subjects. These results indicate that the new ACR method is useful for removing nonstationary tissue motion while improving the image quality for visualizing 3D vascular structure in 3D CDI.
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Affiliation(s)
- Yang Mo Yoo
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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27
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AIUM practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:319-326. [PMID: 18204029 DOI: 10.7863/jum.2008.27.2.319] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Paleologo G, Abdelkawy H, Barsotti M, Basha A, Bernabini G, Bianchi A, Caprio F, Emad A, Grassi G, Nerucci B, Tregnaghi C, Rizzo G, Donadio C. Kidney dimensions at sonography are correlated with glomerular filtration rate in renal transplant recipients and in kidney donors. Transplant Proc 2007; 39:1779-81. [PMID: 17692610 DOI: 10.1016/j.transproceed.2007.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). For practical reasons, renal function is often evaluated from serum creatinine (S Cr) or cystatin C (S Cys), and GFR is predicted from SCr. Ultrasound scanning of the kidneys is used only to evaluate renal morphology. The aim of this study was to evaluate the relationship between sonographic renal dimensions and GFR in renal transplant recipients and in kidney donors. GFR (urinary clearance of (99m)Tc-DTPA), S Cr, and S Cys were measured in 33 donors (28 females [F], 5 males [M]; SCr, 0.81-1.90 mg/dL) and 30 recipients (8 F, 22 M; SCr, 0.96-2.42 mg/dL). GFR was also predicted using the Cockcroft and Gault (CG) formula and with the simplified Modification of Diet in Renal Disease (MDRD) formula. Length, width, and depth of kidneys and renal sinus were measured using renal sonography. Among sonographic measurements, kidney length showed the best correlation with GFR. A closer correlation with GFR was found in donors (r = 0.639; P < .00007) than in recipients (r = 0.511; P < .005). In either case, the correlation of kidney length with GFR was greater than that of S Cr or S Cys, and similar to that of CG or MDRD GFR. Accuracy of kidney length as an indicator of GFR impairment was not statistically different from laboratory tests. Only in donors did CG show better accuracy. In conclusion, renal dimensions at sonography closely correlated with GFR. Thus, renal sonography can give information also on the function of the renal graft and of the remaining kidney of living donors.
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Affiliation(s)
- G Paleologo
- Nefrologia con Trapianti, Azienda Ospedaliero-Universitaria, Pisa, Italy
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Gao J, Ng A, Shih G, Goldstein M, Kapur S, Wang J, Min RJ. Intrarenal color duplex ultrasonography: a window to vascular complications of renal transplants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1403-18. [PMID: 17901143 DOI: 10.7863/jum.2007.26.10.1403] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE We analyze and discuss the importance of intrarenal color duplex ultrasonography (CDUS) in the diagnosis and differential diagnosis of vascular complications in renal transplants. METHODS We retrospectively reviewed results of CDUS, especially intrarenal CDUS, in 102 consecutive inpatients with vascular complications of renal transplants from January 1, 2000, to December 31, 2006. Correlations between CDUS and magnetic resonance angiography, digital subtraction angiography, surgical findings, and clinical diagnoses were studied. RESULTS Abnormal findings on intrarenal CDUS clearly represent vascular complications primarily located at the main renal vessels and intrarenal vessels. In our study, there were 5 cases of false-negative intrarenal arteriovenous fistulas, 1 case of false-positive transplant renal vein thrombosis, and 2 cases of false-negative transplant renal artery stenosis. The accuracy of detecting vascular complications of renal transplants with CDUS was 92% (94/102). CONCLUSIONS Intrarenal CDUS is a noninvasive, accurate diagnostic tool that can be administrated portably and is easily repeatable, thereby making it not only a highly valuable imaging technique but also the method of choice in screening and diagnosing vascular complications of renal transplants.
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Affiliation(s)
- Jing Gao
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, Starr 8A 27, New York, NY 10021, USA.
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Browne RFJ, Tuite DJ. Imaging of the renal transplant: comparison of MRI with duplex sonography. ACTA ACUST UNITED AC 2007; 31:461-82. [PMID: 16447085 DOI: 10.1007/s00261-005-0394-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Renal transplantation is an established treatment for patients with end-stage renal disease. Many causes of graft dysfunction are treatable, making prompt detection and diagnosis of complications essential. Sensitive, noninvasive imaging procedures, which do not use iodinated contrast media, are therefore highly desirable to evaluate graft function. Duplex sonography (US) has traditionally been the initial investigation of graft dysfunction. US offers many advantages, particularly during the postoperative period, when it can be performed portably regardless of renal function and can guide percutaneous procedures. However, US lacks specificity in assessing hydronephrosis, cannot differentiate parenchymal causes of dysfunction, and may have difficulty assessing transplant vessels. Recently comprehensive magnetic resonance imaging (MRI) protocols including MR urography, gadolinium-enhanced MR angiography, and MR renography have evolved as a "one-stop" diagnostic technique in the evaluation of the entire graft and peritransplant region. Multiplanar capabilities enable MRI to identify the site of urinary obstruction and assess renal vessels in their entirety. The evolving technique of MR renography may also differentiate parenchymal causes of dysfunction. By combining these three components into a single examination, further information may be obtained regarding the graft when compared with US and other conventional studies, with improved patient convenience, less morbidity, and a potential cost saving.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin, 24, Ireland.
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Beier UH, John E, Lumpaopong A, Co JG, Jelnin V, Benedetti E, Testa G, Bottke R, Sharon BI, Ruiz CE. Electron-beam CT as a diagnostic modality in pediatric nephrology and renal transplant surgery. Pediatr Nephrol 2006; 21:677-82. [PMID: 16520947 DOI: 10.1007/s00467-006-0045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 10/26/2005] [Accepted: 11/22/2005] [Indexed: 11/27/2022]
Abstract
Electron-beam computed tomography is an imaging technology with a variety of medical applications, primarily in cardiology due to its sub-second acquisition time enabling visualization of a beating heart. Recently, this technique has also been introduced into other fields because of lower radiation exposure compared to traditional computed tomography, as well as the strengths of post-procedural three-dimensional visualization. This report evaluates electron-beam computed tomography as a diagnostic modality in pediatric nephrology patients. Seven patients reflecting typical clinical scenarios in pediatric nephrology were reviewed with regard to the value of electron-beam computed tomography and its contribution to the diagnostic workup. Electron-beam computed tomography is noninvasive and allows three-dimensional post-processing, enabling highly accurate images while requiring less radiation and acquisition time. It is very useful for clinical questions that require a detailed description of vascular and renal anatomy.
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Affiliation(s)
- Ulf H Beier
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Room 1438 CSB, Chicago, IL 60612-7324, USA.
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Coley BD. Pediatric applications of abdominal vascular Doppler: Part II. Pediatr Radiol 2004; 34:772-86. [PMID: 15300339 DOI: 10.1007/s00247-004-1227-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2004] [Revised: 04/19/2004] [Accepted: 05/03/2004] [Indexed: 10/26/2022]
Abstract
Ultrasound is a remarkably powerful and versatile modality for pediatric imaging, without requiring exposure to radiation or sedatives. By providing information on blood flow, Doppler sonography can reveal details about normal physiology and disease processes not discernable from gray-scale anatomic images alone. In part I, the basics of hemodynamics and effects on the Doppler waveform were discussed, along with clinical applications in hepatic disease. In part II, the application of Doppler in renal disease and in conditions affecting the deep abdominal vessels are discussed. The role of ultrasound contrast agents in pediatric Doppler imaging is briefly reviewed.
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Affiliation(s)
- Brian D Coley
- Department of Radiology, Columbus Children's Hospital, 700 Children's Dr, Columbus, OH 43205, USA.
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