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Ng KH, Wong JHD, Leong SS. Shear wave elastography in chronic kidney disease - the physics and clinical application. Phys Eng Sci Med 2024; 47:17-29. [PMID: 38078996 DOI: 10.1007/s13246-023-01358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/15/2023] [Indexed: 03/26/2024]
Abstract
Chronic kidney disease is a leading public health problem worldwide. The global prevalence of chronic kidney disease is nearly five hundred million people, with almost one million deaths worldwide. Estimated glomerular filtration rate, imaging such as conventional ultrasound, and histopathological findings are necessary as each technique provides specific information which, when taken together, may help to detect and arrest the development of chronic kidney disease, besides managing its adverse outcomes. However, estimated glomerular filtration rate measurements are hampered by substantial error margins while conventional ultrasound involves subjective assessment. Although histopathological assessment is the best tool for evaluating the severity of the renal pathology, it may lead to renal insufficiency and haemorrhage if complications occurred. Ultrasound shear wave elastography, an emerging imaging that quantifies tissue stiffness non-invasively has gained interest recently. This method applies acoustic force pulses to generate shear wave within the tissue that propagate perpendicular to the main ultrasound beam. By measuring the speed of shear wave propagation, the tissue stiffness is estimated. This paper reviews the literature and presents our combined experience and knowledge in renal shear wave elastography research. It discusses and highlights the confounding factors on shear wave elastography, current and future possibilities in ultrasound renal imaging and is not limited to new sophisticated techniques.
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Affiliation(s)
- Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, UCSI University, Port Dickson, Negeri Sembilan, Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sook Sam Leong
- Centre for Medical Imaging Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia.
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Wu J, Li G, Liu J, Sun W, Liu J, Zou G, Lu H, Zheng M. Utility of shear wave-based ultrasound elastography in chronic kidney disease and related pathological quantitative analysis. Eur Radiol 2023; 33:5625-5633. [PMID: 36847836 DOI: 10.1007/s00330-023-09507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the effects of tissue fibrosis and microvessel density on shear wave-based ultrasound elastography (SWUE) of chronic kidney disease (CKD). In addition, we were looking to see whether SWUE could predict stage of CKD, correlating with the histology on kidney biopsy. METHODS Renal tissue sections from 54 patients diagnosed with suspected CKD were subjected to immunohistochemistry (CD31 and CD34), and the degree of tissue fibrosis was assessed using Masson staining. Before renal puncture, both kidneys were examined using SWUE. Comparative analysis was used to assess the correlation between SWUE and microvessel density, and between SWUE and the degree of fibrosis. RESULTS Fibrosis area according to Masson staining (p < 0.05) and integrated optical density (IOD) (p < 0.05) were positively correlated with CKD stage. The percentage of positive area (PPA) and IOD for CD31 and CD34 were not correlated with CKD stage (p > 0.05). When stage 1 CKD was removed, PPA and IOD for CD34 were negatively correlated with CKD stage (p < 0.05). Masson staining fibrosis area and IOD were not correlated with SWUE (p > 0.05), PPA and IOD for CD31 and CD34 were not correlated with SWUE (p > 0.05) and, finally, no correlation between SWUE and CKD stage was found (p > 0.05). CONCLUSION The diagnostic value of SWUE for CKD staging was very low. The utility of SWUE in CKD was affected by many factors and its diagnostic value was limited. KEY POINTS • There was no correlation between SWUE and the degree of fibrosis, or between SWUE and microvessel density among patients with CKD. • There was no correlation between SWUE and CKD stage and the diagnostic value of SWUE for CKD staging was very low. • The utility of SWUE in CKD is affected by many factors and its value was limited.
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Affiliation(s)
- Jingping Wu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Guanghan Li
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Jian Liu
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Weiliang Sun
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Jiang Liu
- Department of Nephrology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Guming Zou
- Department of Nephrology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Haitao Lu
- Department of Nephrology, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Min Zheng
- Department of Ultrasound Medicine, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
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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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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. The role of shear viscosity as a biomarker for improving chronic kidney disease detection using shear wave elastography: A computational study using a validated finite element model. ULTRASONICS 2023; 133:107046. [PMID: 37247461 DOI: 10.1016/j.ultras.2023.107046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
The application of ultrasound shear wave elastography for detecting chronic kidney disease, namely renal fibrosis, has been widely studied. A good correlation between tissue Young's modulus and the degree of renal impairment has been established. However, the current limitation of this imaging modality pertains to the linear elastic assumption used in quantifying the stiffness of renal tissue in commercial shear wave elastography systems. As such, when underlying medical conditions such as acquired cystic kidney disease, which may potentially influence the viscous component of renal tissue, is present concurrently with renal fibrosis, the accuracy of the imaging modality in detecting chronic kidney disease may be affected. The findings in this study demonstrate that quantifying the stiffness of linear viscoelastic tissue using an approach similar to those implemented in commercial shear wave elastography systems led to percentage errors as high as 87%. The findings presented indicate that use of shear viscosity to detect changes in renal impairment led to a reduction in percentage error to values as low as 0.3%. For cases in which renal tissue was affected by multiple medical conditions, shear viscosity was found to be a good indicator in gauging the reliability of the Young's modulus (quantified through a shear wave dispersion analysis) in detecting chronic kidney disease. The findings show that percentage error in stiffness quantification can be reduced to as low as 0.6%. The present study demonstrates the potential use of renal shear viscosity as a biomarker to improve the detection of chronic kidney disease.
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Affiliation(s)
- William T H Lim
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia.
| | - Ean H Ooi
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia.
| | - Ji J Foo
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Kwan H Ng
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Faculty of Medicine and Health Sciences, UCSI University, Springhill, Negri Sembilan, Malaysia
| | - Jeannie H D Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Centre of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
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Maralescu FM, Bende F, Sporea I, Popescu A, Sirli R, Schiller A, Petrica L, Miutescu B, Borlea A, Popa A, Bodea M, Bob F. Non-Invasive Evaluation of Kidney Elasticity and Viscosity in a Healthy Cohort. Biomedicines 2022; 10:biomedicines10112859. [PMID: 36359379 PMCID: PMC9687569 DOI: 10.3390/biomedicines10112859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: There is currently a lack of published data on kidney elasticity and viscosity. Non-invasive techniques, such as two-dimensional shear-wave elastography (2D-SWE PLUS) and viscosity plane-wave ultrasound (Vi PLUS), have surfaced as new detection methods, which, thanks to efficient processing software, are expected to improve renal stiffness and viscosity measurements. This study aims to be the first one to assess the normal range values in normal renal function subjects and to investigate the factors that impact them. Methods: We conducted a cross-sectional study employing 50 participants (29 women and 21 men) with a mean age of 42.22 ± 13.17, a mean estimated glomerular filtration rate (eGFR) of 97.12 ± 11 mL/min/1.73 m2, a mean kidney length of 10.16 ± 0.66 cm, and a mean body mass index (BMI) of 24.24 ± 3.98. With a C6-1X convex transducer and the Ultra-FastTM software available on the Hologic Aixplorer Mach 30 ultrasound system, we acquired five measurements of renal cortical stiffness and viscosity (achieved from five distinct images in the middle part of the subcapsular cortex) from each kidney. The ten measurements’ median values correlated with the participant’s demographical, biological, and clinical parameters. Results: The mean kidney elasticity was 31.88 ± 2.89 kiloPascal (kPa), and the mean viscosity was 2.44 ± 0.57 Pascal.second (Pa.s) for a mean measurement depth 4.58 ± 1.02 cm. Renal stiffness seemed to be influenced by age (r = −0.7047, p < 0.0001), the measurement depth (r = −0.3776, p = 0.0075), and eGFR (r = 0.6101, p < 0.0001) but not by BMI (r = −0.2150, p = 0.1338), while viscosity appeared to be impacted by age (r = −0.4251, p = 0.0021), eGFR (r = 0.4057, p = 0.0038), the measurement depth (r = −0.4642, p = 0.0008), and BMI (r = −0.3676, p = 0.0086). The results of the one-way ANOVA used to test the differences in the variables among the three age sub-groups are statistically significant for both 2D-SWE PLUS (p < 0.001) and Vi PLUS (p = 0.015). The method found good intra-operator reproducibility for the 2D-SWE PLUS measurements, with an ICC of 0.8365 and a 95% CI of 0.7512 to 0.8990, and for the Vi PLUS measurements, with an ICC of 0.9 and a 95% CI of 0.8515 to 0.9397. Conclusions: Renal stiffness and viscosity screening may become an efficacious, low-cost way to gather supplemental diagnostic data from patients with chronic kidney disease (CKD). The findings demonstrate that these non-invasive methods are highly feasible and not influenced by gender and that their values correlate with renal function and decrease with age progression. Nevertheless, more research is required to ascertain their place in clinical practice.
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Affiliation(s)
- Felix-Mihai Maralescu
- Division of Nephrology, Department of Internal Medicine II, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Felix Bende
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence:
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adalbert Schiller
- Division of Nephrology, Department of Internal Medicine II, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Ligia Petrica
- Division of Nephrology, Department of Internal Medicine II, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Andreea Borlea
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babeș” University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandru Popa
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Madalina Bodea
- Division of Nephrology, Department of Internal Medicine II, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Flaviu Bob
- Division of Nephrology, Department of Internal Medicine II, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Maralescu FM, Bende F, Sporea I, Popescu A, Șirli R, Schiller A, Petrica L, Moga TV, Mare R, Grosu I, Bob F. Assessment of Renal Allograft Stiffness and Viscosity Using 2D SWE PLUS and Vi PLUS Measures-A Pilot Study. J Clin Med 2022; 11:jcm11154370. [PMID: 35955985 PMCID: PMC9369292 DOI: 10.3390/jcm11154370] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Elastography is a useful noninvasive tool for the assessment of renal transplant recipients. 2D-shear wave elastography (SWE) PLUS and viscosity plane-wave ultrasound (Vi PLUS) have emerged as novel techniques that promise to offer improved renal stiffness and viscosity measures due to improved processing algorithms. Methods: We performed a cross-sectional study of 50 kidney transplanted patients (16 women, 34 men; mean age of 47.5 ± 12.5; mean estimated glomerular filtration rate (eGFR) estimated by Chronic Kidney Disease Epidemiology Collaboration formula: 52.19 ± 22.6 mL/min/1.73 m2; and a mean duration after transplant of 10.09 ± 5 years). For every patient, we obtained five valid measurements of renal stiffness (obtained from five different frames in the cortex of the renal graft), and also tissue viscosity, with a C6-1X convex transducer using the Ultra-Fast™ software available on the Aixplorer Mach 30 ultrasound system (Supersonic Imagine, Aix-en-Provence, France). The median values of elastographic and viscosity measures have been correlated with the patients’ demographic, biological, and clinical parameters. Results: We obtained a cut-off value of renal cortical stiffness of <27.3 kiloPascal(kPa) for detection of eGFR < 60 mL/min/1.73 m2 with 80% sensitivity and 85% specificity (AUC = 0.811, p < 0.0001), a cut-off value of <26.9 kPa for detection of eGFR < 45 mL/min/1.73 m2 with 82.6% sensitivity and 74% specificity (AUC = 0.789, p < 0.0001), and a cut-off value of <23 kPa for detection of eGFR < 30 mL/min/1.73 m2 with 88.8% sensitivity and 75.6% specificity (AUC = 0.852, p < 0.0001). We found a positive correlation coefficient between eGFR and the median measure of renal cortical stiffness (r = 0.5699, p < 0.0001), between eGFR the median measure of viscosity (r = 0.3335, p = 0.0180), between median depth of measures and renal cortical stiffness (r = −0.2795, p = 0.0493), and between median depth of measures and body mass index (BMI) (r = 0.6574, p < 0.0001). Our study showed good intra-operator agreement for both 2D SWE PLUS measures—with an intraclass correlation coefficient (ICC) of 0.9548 and a 95% CI of 0.9315 to 0.9719—and Vi PLUS, with an ICC of 0.8323 and a 95% CI of 0.7457 to 0.8959. The multivariate regression model showed that 2D SWE PLUS values were associated with eGFR, Vi PLUS, and depth of measures. Conclusions: Assessment of renal allograft stiffness and viscosity may prove to be an effective method for identifying patients with chronic allograft injury and could prove to be a low-cost approach to provide additional diagnostic information of kidney transplanted patients.
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Affiliation(s)
- Felix-Mihai Maralescu
- Department of Internal Medicine II-Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania; (F.-M.M.); (A.S.); (L.P.); (I.G.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania
| | - Felix Bende
- Department of Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (I.S.); (A.P.); (R.Ș.); (T.V.M.); (R.M.)
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 30041 Timișoara, Romania
- Correspondence:
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (I.S.); (A.P.); (R.Ș.); (T.V.M.); (R.M.)
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 30041 Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (I.S.); (A.P.); (R.Ș.); (T.V.M.); (R.M.)
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 30041 Timișoara, Romania
| | - Roxana Șirli
- Department of Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (I.S.); (A.P.); (R.Ș.); (T.V.M.); (R.M.)
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 30041 Timișoara, Romania
| | - Adalbert Schiller
- Department of Internal Medicine II-Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania; (F.-M.M.); (A.S.); (L.P.); (I.G.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ligia Petrica
- Department of Internal Medicine II-Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania; (F.-M.M.); (A.S.); (L.P.); (I.G.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania
| | - Tudor Voicu Moga
- Department of Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (I.S.); (A.P.); (R.Ș.); (T.V.M.); (R.M.)
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 30041 Timișoara, Romania
| | - Ruxandra Mare
- Department of Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (I.S.); (A.P.); (R.Ș.); (T.V.M.); (R.M.)
- Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes,” University of Medicine and Pharmacy, 30041 Timișoara, Romania
| | - Iulia Grosu
- Department of Internal Medicine II-Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania; (F.-M.M.); (A.S.); (L.P.); (I.G.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania
| | - Flaviu Bob
- Department of Internal Medicine II-Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania; (F.-M.M.); (A.S.); (L.P.); (I.G.); (F.B.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, EftimieMurgu Sq. No. 2, 300041 Timișoara, Romania
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Fluorescence Imaging Using Enzyme-Activatable Probes for Detecting Diabetic Kidney Disease and Glomerular Diseases. Int J Mol Sci 2022; 23:ijms23158150. [PMID: 35897725 PMCID: PMC9332157 DOI: 10.3390/ijms23158150] [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: 07/04/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
A clear identification of the etiology of glomerular disease is essential in patients with diabetes. Renal biopsy is the gold standard for assessing the underlying nephrotic pathology; however, it has the risk for potential complications. Here, we aimed to investigate the feasibility of urinary fluorescence imaging using an enzyme-activatable probe for differentiating diabetic kidney disease and the other glomerular diseases. Hydroxymethyl rhodamine green (HMRG)-based fluorescent probes targeting gamma-glutamyl transpeptidase (GGT) and dipeptidyl-peptidase (DPP) were used. Urinary fluorescence was compared between groups which were classified by their histopathological diagnoses (diabetic kidney disease, glomerulonephritis, and nephrosclerosis) as obtained by ultrasound-guided renal biopsy. Urinary fluorescence was significantly stronger in patients with diabetic kidney disease compared to those with glomerulonephritis/nephrosclerosis after DPP-HMRG, whereas it was stronger in patients with nephrosclerosis than in patients with glomerulonephritis after GGT-HMRG. Subgroup analyses of the fluorescence performed for patients with diabetes showed consistent results. Urinary fluorescence imaging using enzyme-activatable fluorescence probes thus represents a potential noninvasive assessment technique for kidney diseases in patients with diabetes.
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Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: We require an quantitative imaging technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in recent years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic. Methods: The databases of PubMed, Medscape, Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (SWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results, and outcome data were all collected from each study according to a set protocol. Results: We found 37 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of kidney SWS between studies we found increased heterogeneity Q = 513.133; DF = 10; p < 0001, I2 (inconsistency) = 98.12% (95% CI for I2 97.52–98.57%). With a standardized mean difference of −0.216, patients with CKD have a lower kidney SWS than healthy controls. A positive association between kidney SWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, p < 0.001), Q = 73.3, DF = 5, p < 000.1, I2 = 93.18% (95% CI for I2 87.86 to 96.18). The pooled area under the ROC curve for kidney SWS to predict chronic kidney disease was 0.831 (95% CI, p < 0.001), Q = 28.32, DF = 6, p = 0.0001, I2 = 78.8% (95% CI for I2 56.37 to 89.72). In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve (AUC) values are used to compare distinct characteristics (differentiating kidney SWS between mildly and moderately impaired kidneys, between non-diabetic/prediabetic/diabetic patients, or kidney SWS between the CKD and control group), therefore not being suitable for further evaluation. Conclusions: The results show that patients with CKD have a lower kidney SWS than healthy controls. However, the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity. Further research is needed to determine which factors actually influence kidney SWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice.
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Yoǧurtçuoǧlu B, Damar Ç. Renal elastography measurements in children with acute glomerulonephritis. Ultrasonography 2021; 40:575-583. [PMID: 33906284 PMCID: PMC8446499 DOI: 10.14366/usg.20173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/10/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of this study was to compare the acoustic radiation force impulse elastography (ARFI-e) values of the renal cortical parenchyma in children with acute glomerulonephritis (AGN) and healthy children, and to determine a cut-off point for the diagnosis of AGN. METHODS This prospective study included 30 children with biopsy-proven AGN and 30 healthy children. All the children underwent renal ARFI-e measurements. Values were obtained from the upper, middle, and lower zones of the right kidney parenchyma. A total of nine ARFI-e measurements (three from each zone) were made. Statistical analyses were conducted of the mean elastography values (MEVs) of the children in both groups. RESULTS In the patient group, the MEVs measured from the upper, middle and lower zones of the right kidney were 3.42±0.42 m/s, 3.45±0.45 m/s, and 3.39±0.39 m/s (average, 3.42±0.34 m/s), respectively. In the healthy control group, the MEVs measured from the upper, middle, and lower zones of the right kidney were 2.85±0.63 m/s, 2.85±0.68 m/s, and 2.86±0.66 m/s (average, 2.85±0.57 m/s), respectively. The MEVs in all zones were significantly higher in the patient group than in the healthy group (P<0.001). The cut-off values determined to predict AGN in the upper, middle, and lower zones of the kidney were 2.74 m/s (sensitivity, 96.67%; specificity, 46.67%), 2.71 m/s (sensitivity, 96.67%; specificity, 53.33%), and 2.81 m/s (sensitivity, 93.33%; specificity, 56.67%), respectively. CONCLUSION The ARFI-e technique can be considered as a non-invasive, easily applicable, auxiliary method for the early diagnosis of AGN.
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Affiliation(s)
- Burak Yoǧurtçuoǧlu
- Department of Radiology, Faculty of Medicine, Gaziantep University, Üniversite Bulvarı, Șehitkamil, Turkey
| | - Çaǧrı Damar
- Department of Radiology, Faculty of Medicine, Gaziantep University, Üniversite Bulvarı, Șehitkamil, Turkey
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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. Shear Wave Elastography: A Review on the Confounding Factors and Their Potential Mitigation in Detecting Chronic Kidney Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2033-2047. [PMID: 33958257 DOI: 10.1016/j.ultrasmedbio.2021.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Early detection of chronic kidney disease is important to prevent progression of irreversible kidney damage, reducing the need for renal transplantation. Shear wave elastography is ideal as a quantitative imaging modality to detect chronic kidney disease because of its non-invasive nature, low cost and portability, making it highly accessible. However, the complexity of the kidney architecture and its tissue properties give rise to various confounding factors that affect the reliability of shear wave elastography in detecting chronic kidney disease, thus limiting its application to clinical trials. The objective of this review is to highlight the confounding factors presented by the complex properties of the kidney, in addition to outlining potential mitigation strategies, along with the prospect of increasing the versatility and reliability of shear wave elastography in detecting chronic kidney disease.
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Affiliation(s)
- William T H Lim
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Ean H Ooi
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.
| | - Ji J Foo
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Kwan H Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeannie H D Wong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Acoustic Radiation Force Impulse Elastography May Predict Acute Rejection in Kidney Transplantation. Transplant Proc 2020; 52:3097-3102. [PMID: 32507711 DOI: 10.1016/j.transproceed.2020.02.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Allograft biopsy that is done as indicated by clinical and laboratory clues about graft rejection provides a definitive diagnosis. Noninvasive methods that may be useful for predicting or diagnosing rejection are important for early diagnosis of possible rejection. PURPOSE The aim of this study is to investigate the relationship between changes in shear wave velocity (SWV) values and renal allograft kidney biopsy findings. MATERIAL AND METHODS Thirty-four end-stage renal failure patients who underwent living donor renal transplantation between January 2015 and July 2015 were enrolled in this prospective cohort study. Implantation, sixth-month protocol, and biopsies that were performed with suspicion of acute rejection were evaluated with renal Doppler ultrasound and elastography findings of recipients' preimplantation donor ultrasonography findings. RESULTS Comparison of renal ultrasound and elastography findings of 2 groups revealed a significant elevation in the resistive index (0.81 vs 0.63, P = .005) and pulsatility index (2.08 vs 1.20, P = .008) values in the rejection group, and no significant difference in the SWV values between the 2 groups. Delta (Δ)-SWV was calculated using the difference between acute rejection values and preimplantation, implantation, and sixth-month values showed a positive correlation between acute rejection (Δ-sixth month, r = 0.498, P = .030), tubulitis (Δ-pretransplant, r = 0.509, P = .037), and inflammation (Δ-pretransplant, r = 0.657, P = .004) scores. However, there were no correlations between Δ-SWV values and glomerulitis and peritubular capillaritis score. CONCLUSION Changes in SWV may predict acute rejection in kidney transplantation patients if the reference measurements were done at a more stable time after the transplantation.
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Akbas M, Koyuncu FM. Evaluation of maternal renal cortical elasticity in pregnancies with early- and late-onset preeclampsia. J Matern Fetal Neonatal Med 2019; 33:1434-1440. [PMID: 31550960 DOI: 10.1080/14767058.2019.1671347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The current study aimed to investigate renal cortical elasticity (RCE) in early- and late-onset preeclampsia patients and compare the results with healthy controls.Materials and methods: The study consisted of 136 pregnant women. Three groups were identified as; the late-onset preeclampsia (LOP) group (n = 40), the early-onset preeclampsia (EOP) group (n = 32) and the control group (n = 64). RCE values were measured by point shear wave elastography (pSWE). Nine measurements were taken for each kidney and the mean of nine measurements was accepted as the mean RCE value for each kidney. The arithmetic mean of left and right RCE values was accepted as the overall RCE value of a subject. Groups were compared in terms of clinical and biochemical parameters, ultrasonography findings and pSWE values.Results: There was a statistically significant difference between groups in terms of overall RCE values (F[2,133] = 17.96, p < .001). Post hoc comparisons indicated that both preeclampsia groups exhibited significantly higher RCE values than the control group. However, overall RCE values were not significantly different between the EOP and LOP groups. Overall RCE values were significantly and positively correlated with systolic blood pressure (r = 0.363, p < .001), diastolic blood pressure (r = 0.347, p < .001), proteinuria (r = 0.343, p < .001), serum creatinine level (r = 0.181, p = .035), serum uric acid level (r = 0.243, p = .004) and blood urea nitrogen (r = 0.27, p = .001).Conclusion: Our study demonstrated that maternal renal cortical stiffness increased in women with preeclampsia. The increased RCE values may be indicative for the severity of preeclampsia due to positive correlations between renal cortical stiffness and systolic - diastolic blood pressure and serum creatinine level.
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Affiliation(s)
- Murat Akbas
- Department of Obstetrics and Gynecology, Perinatology Division, Manisa Celal Bayar University, Manisa, Turkey
| | - Faik Mumtaz Koyuncu
- Department of Obstetrics and Gynecology, Perinatology Division, Manisa Celal Bayar University, Manisa, Turkey
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Grossmann M, Tzschätzsch H, Lang ST, Guo J, Bruns A, Dürr M, Hoyer BF, Grittner U, Lerchbaumer M, Nguyen Trong M, Schultz M, Hamm B, Braun J, Sack I, Marticorena Garcia SR. US Time-Harmonic Elastography for the Early Detection of Glomerulonephritis. Radiology 2019; 292:676-684. [DOI: 10.1148/radiol.2019182574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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14
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Kalyoncu Ucar A, Cicek RY, Alis D, Akbas S, Arioz Habibi H, Arslan MU, Eral G, Suleyman A, Caliskan S, Adaletli I. Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:379-385. [PMID: 30027586 DOI: 10.1002/jum.14698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux. METHODS We prospectively evaluated 49 patients with unilateral grade 2 or higher-degree VUR. All patients underwent dimercaptosuccinic acid (DMSA) scintigraphy for evaluation of the renal parenchymal scar. After the DMSA scan, 2 radiologists, who were blinded to clinical data and each other's measurements, evaluated the kidneys of the patients using SWE. The kidneys were divided into 3 parts: upper pole, middle region, and lower pole, and 3 regions of interest were placed to each part. Shear wave velocity (SWV) values were calculated using meters per second as a unit and recorded for each region. Afterward, SWV values were compared to DMSA results. RESULTS There was no significant difference between the observers' mean SWV values of kidneys with VUR without scar formation (mean ± SD, 2.11 ± 0.06 and 2.09 ± 0.05 m/s) and the contralateral normal kidney SVW values (2.11 ± 0.06 and 2.10 ± 0.05 m/s; P = .936 and .724, respectively). We observed a significant difference between the mean SWV values of the kidneys with VUR accompanied by scar formation (2.28 ± 0.10 and 2.27 ± 0.11 m/s) and the mean SWV values of the contralateral normal kidneys (2.09 ± 0.05 and 2.10 ± 0.04 m/s; P < .001 for both observers). CONCLUSIONS Shear wave elastography could detect scar tissue in kidneys; however, the variability of the stiffness due to the kidney's complex structure, and variations in blood perfusion and the glomerular filtration rate of the kidney might limit the use of SWE in current clinical diagnostic algorithms for VUR.
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Affiliation(s)
- Ayse Kalyoncu Ucar
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Deniz Alis
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serkan Akbas
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hatice Arioz Habibi
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mine Usta Arslan
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gokalp Eral
- Biostatistics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ayse Suleyman
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Salim Caliskan
- Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Radulescu D, Peride I, Petcu LC, Niculae A, Checherita IA. Supersonic Shear Wave Ultrasonography for Assessing Tissue Stiffness in Native Kidney. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2556-2568. [PMID: 30154036 DOI: 10.1016/j.ultrasmedbio.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 05/28/2023]
Abstract
Recent years have brought shear wave elastography to the attention of nephrologists as a non-invasive method for detecting kidney fibrosis and, therefore, as a potential tool for reducing the need for kidney biopsy. Few studies are performed on native kidney. We aimed to compare cortical stiffness, assessed by measuring Young's modulus (YM, kPa) with SuperSonic Imaging technology, in patients with various degrees of chronic kidney disease (CKD) compared with healthy individuals. Cortical stiffness was measured by two operators, in different sessions, in 32 patients with CKD stages 3-5 and 20 healthy individuals. Comparison between mean YM values in CKD and those in controls and also between the different stages of CKD was our primary objective. The influence of other possible confounders on YM readings was also investigated and analyzed. Mean YM was significantly greater in CKD patients than in controls. Estimated YM was not able to differentiate the stages of CKD, except stage 5. Intra-subject variability was greater in CKD than in controls. Body mass index was the most important confounder in multiple analyses, in both the CKD and control groups. Our results highlight a positive correlation between increased cortical stiffness and presence of CKD. Further studies are needed to validate this method for implementation in daily clinical practice.
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Affiliation(s)
- Daniela Radulescu
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ileana Peride
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania.
| | - Lucian Cristian Petcu
- Department of Biostatistics and Biophysics, Faculty of Dental Medicine, "Ovidius" University Constanta, Constanta, Romania
| | - Andrei Niculae
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ionel Alexandru Checherita
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
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16
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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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Marticorena Garcia SR, Grossmann M, Lang ST, Nguyen Trong M, Schultz M, Guo J, Hamm B, Braun J, Sack I, Tzschätzsch H. Full-Field-of-View Time-Harmonic Elastography of the Native Kidney. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:949-954. [PMID: 29478787 DOI: 10.1016/j.ultrasmedbio.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/07/2018] [Accepted: 01/12/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to analyze full-field-of-view maps of renal shear wave speed (SWS) measured by time-harmonic elastography (THE) in healthy volunteers in terms of reproducibility, regional variation and physiologic effects. The kidneys of 37 healthy volunteers were investigated by multifrequency THE. The complete renal parenchyma, as well as cortex and medulla, was analyzed. A subgroup was investigated to test reproducibility (n = 3). Significant differences between SWS in cortex, medulla and full parenchyma were observed (2.10 ± 0.17, 1.35 ± 0.11 and 1.71 ± 0.16 m/s, all p values < 0.001) with mean intra-volunteer standard deviations of repeated measurements of 0.04 m/s (1.6%), 0.06 m/s (4.0%) and 0.08 m/s (4.5%), respectively. No effects of kidney anatomy, age, body mass index, blood pressure and heart rate on SWS were observed. THE allows generation of full-field-of-view SWS maps of native kidneys with high reproducibility.
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Affiliation(s)
- Stephan Rodrigo Marticorena Garcia
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus Grossmann
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sophia Theresa Lang
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Jing Guo
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Hewadikaram DK, Bandara M, Pattivedana AN, Jayaweera HHE, Jayananda KM, Madhavi WAM, Pallewatte A, Jayasumana C, Siribaddana S, Wansapura JP. A novel ultrasound technique to detect early chronic kidney disease. F1000Res 2018; 7:448. [PMID: 30906523 DOI: 10.12688/f1000research.14221.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) of unknown etiology is recognized as a major public health challenge and a leading cause of morbidity and mortality in the dry zone in Sri Lanka. CKD is asymptomatic and are diagnosed only in late stages. Evidence points to strong correlation between progression of CKD and kidney fibrosis. Several biochemical markers of renal fibrosis have been associated with progression of CKD. However, no marker is able to predict CKD consistently and accurately before being detected with traditional clinical tests (serum creatinine, and cystatin C, urine albumin or protein, and ultrasound scanning). In this paper, we hypothesize that fibrosis in the kidney, and therefore the severity of the disease, is reflected in the frequency spectrum of the scattered ultrasound from the kidney. We present a design of a simple ultrasound system, and a set of clinical and laboratory studies to identify spectral characteristics of the scattered ultrasound wave from the kidney that correlates with CKD. We believe that spectral parameters identified in these studies can be used to detect and stratify CKD at an earlier stage than what is possible with current markers of CKD.
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19
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Hewadikaram DK, Bandara M, Pattivedana AN, Jayaweera HHE, Jayananda KM, Madhavi WAM, Pallewatte A, Jayasumana C, Siribaddana S, Wansapura JP. A novel ultrasound technique to detect early chronic kidney disease. F1000Res 2018; 7:448. [PMID: 30906523 PMCID: PMC6415322 DOI: 10.12688/f1000research.14221.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) of unknown etiology is recognized as a major public health challenge and a leading cause of morbidity and mortality in the dry zone in Sri Lanka. CKD is asymptomatic and are diagnosed only in late stages. Evidence points to strong correlation between progression of CKD and kidney fibrosis. Several biochemical markers of renal fibrosis have been associated with progression of CKD. However, no marker is able to predict CKD consistently and accurately before being detected with traditional clinical tests (serum creatinine, and cystatin C, urine albumin or protein, and ultrasound scanning). In this paper, we hypothesize that fibrosis in the kidney, and therefore the severity of the disease, is reflected in the frequency spectrum of the scattered ultrasound from the kidney. We present a design of a simple ultrasound system, and a set of clinical and laboratory studies to identify spectral characteristics of the scattered ultrasound wave from the kidney that correlates with CKD. We believe that spectral parameters identified in these studies can be used to detect and stratify CKD at an earlier stage than what is possible with current markers of CKD.
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20
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Iyama T, Takata T, Koda M, Fukuda S, Hoi S, Mae Y, Fukui T, Munemura C, Isomoto H. Renal shear wave elastography for the assessment of nephron hypertrophy: a cross-sectional study in chronic kidney disease. J Med Ultrason (2001) 2018; 45:571-576. [PMID: 29411183 DOI: 10.1007/s10396-018-0866-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the association of renal elasticity to microscopic findings of nephron hypertrophy and nephrosclerosis. METHODS Patients who underwent renal biopsy were enrolled. Renal elasticity was measured by acoustic radiation force impulse, and nephron size (glomerular volume, non-sclerotic glomerular density, and mean profile tubular area) and nephrosclerosis (globally sclerotic glomeruli and interstitial fibrosis) were estimated. Nephron hypertrophy was indicated by larger glomerular volume, larger tubular area, and lower non-sclerotic glomerular density. Nephrosclerosis was indicated by a higher percentage of globally sclerotic glomeruli and higher severity of fibrosis. RESULTS Renal elasticity was negatively correlated with glomerular volume (r = - 0.480, P = 0.024) and mean tubular area (r = - 0.469, P = 0.028), but it was not correlated with non-sclerotic glomerular density (r = 0.205, P = 0.359), percentage of globally sclerotic glomeruli (r = 0.057, P = 0.800), and severity of fibrosis (r = 0.014, P = 0.950). In a multiple linear regression analysis, glomerular volume and mean tubular area were independently associated with renal elasticity (std β = - 0.454, P = 0.015 and std β = - 0.577, P = 0.007, respectively). CONCLUSION Renal elasticity was correlated with microstructural findings of nephron hypertrophy. Measuring renal elasticity could help in detecting kidney disease.
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Affiliation(s)
- Takuji Iyama
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Tomoaki Takata
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan.
| | - Masahiko Koda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Satoko Fukuda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Shotaro Hoi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Yukari Mae
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Takeaki Fukui
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Chishio Munemura
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
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Zhang Y, Mao DF, Zhang MW, Fan XX. Clinical value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension. World J Gastroenterol 2017; 23:8044-8052. [PMID: 29259380 PMCID: PMC5725299 DOI: 10.3748/wjg.v23.i45.8044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension, and assess the value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension.
METHODS All 67 patients with liver cirrhosis diagnosed as portal hypertension by hepatic venous pressure gradient in our hospital from June 2014 to December 2014 were enrolled into this study. The baseline information of these patients was recorded. Furthermore, 67 patients were followed-up at 20 mo after treatment, and liver and spleen shear wave velocity were measured by acoustic radiation force impulse at the 1st week, 3rd month and 9th month after treatment. Patients with favorable prognosis were assigned into the favorable prognosis group, while patients with unfavorable prognosis were assigned into the unfavorable prognosis group. The variation and difference in liver and spleen shear wave velocity in these two groups were analyzed by repeated measurement analysis of variance. Meanwhile, in order to evaluate the effect of liver and spleen shear wave velocity on the prognosis of patients with portal hypertension, Cox’s proportional hazard regression model analysis was applied. The ability of those factors in predicting the prognosis of patients with portal hypertension was calculated through receiver operating characteristic (ROC) curves.
RESULTS The liver and spleen shear wave velocity in the favorable prognosis group revealed a clear decline, while those in the unfavorable prognosis group revealed an increasing tendency at different time points. Furthermore, liver and spleen shear wave velocity was higher in the unfavorable prognosis group, compared with the favorable prognosis group; the differences were statistically significant (P < 0.05). The prognosis of patients with portal hypertension was significantly affected by spleen hardness at the 3rd month after treatment [relative risk (RR) = 3.481]. At the 9th month after treatment, the prognosis was affected by liver hardness (RR = 5.241) and spleen hardness (RR = 7.829). The differences between these two groups were statistically significant (P < 0.05). The ROC analysis revealed that the area under the curve (AUC) of spleen hardness at the 3rd month after treatment was 0.644, while the AUCs of liver and spleen hardness at the 9th month were 0.579 and 0.776, respectively. These might predict the prognosis of patients with portal hypertension.
CONCLUSION Spleen hardness at the 3rd month and liver and spleen shear wave velocity at the 9th month may be used to assess the prognosis of patients with portal hypertension. This is hoped to be used as an indicator of predicting the prognosis of patients with portal hypertension.
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Affiliation(s)
- Yan Zhang
- Department of Interventional Therapy, Second Hospital of Ningbo Municipality, Ningbo 315010, Zhejiang Province, China
| | - Da-Feng Mao
- Department of Interventional Therapy, Second Hospital of Ningbo Municipality, Ningbo 315010, Zhejiang Province, China
| | - Mei-Wu Zhang
- Department of Interventional Therapy, Second Hospital of Ningbo Municipality, Ningbo 315010, Zhejiang Province, China
| | - Xiao-Xiang Fan
- Department of Interventional Therapy, Second Hospital of Ningbo Municipality, Ningbo 315010, Zhejiang Province, China
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Wang L. Applications of acoustic radiation force impulse quantification in chronic kidney disease: a review. Ultrasonography 2016; 35:302-8. [PMID: 27599890 PMCID: PMC5040133 DOI: 10.14366/usg.16026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022] Open
Abstract
Acoustic radiation force impulse (ARFI) imaging is an emerging technique with great promise in the field of elastography. Previous studies have validated ARFI quantification as a method of estimating fibrosis in chronic liver disease. Similarly, fibrosis is the principal process underlying the progression of chronic kidney disease, which is the major cause of renal failure. However, the quantification of tissue stiffness using ARFI imaging is more complex in the kidney than in the liver. Moreover, not all previous studies are comparable because they employed different procedures. Therefore, subsequent studies are warranted, both in animal models and in clinical patients, in order to better understand the histopathological mechanisms associated with renal elasticity and to further improve this imaging method by developing a standardized guidelines for its implementation.
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Affiliation(s)
- Liang Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
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