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Franke D, Renz DM, Mentzel HJ. [Imaging after kidney transplantation in childhood and adolescence]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:45-53. [PMID: 38180539 DOI: 10.1007/s00117-023-01249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/06/2024]
Abstract
The ultrasound (US) examination is the most important imaging procedure in the clinical care of children with chronic kidney disease, the assessment before kidney transplantation and in the acute and chronic phase after successful kidney transplantation. In trained hands, particularly with experience in Doppler sonography, US ensures that vascular complications, such as occlusions, thrombosis, stenosis as well as non-vascular complications, e.g., urinary tract dilatation, abscesses, hematomas, urine leaks or lymphoceles, are cost-effectively and rapidly diagnosed at any time. For the diagnosis of acute rejection, the US signs in the intraindividual course are only suggestive, but not specific. The gold standard for the diagnosis of acute rejection is a kidney biopsy. In these cases, US serves to exclude other causes. The use of multimodal techniques, various Doppler techniques and microvascular procedures, such as superb microvascular imaging (SMI) or B‑flow and contrast-enhanced ultrasonography (CEUS), optimizes the imaging in the context of transplantations in children. Magnetic resonance imaging with diffusion-weighed imaging (DWI), magnetic resonance angiography (MRA) and magnetic resonance urography (MRU) as well as functional MRU (fMRU) performed with the administration of gadolinium-containing contrast agents, are part of the extended diagnostics and possibly necessary for surgical planning in the early phase after kidney transplantation and for long-term assessment after transplantation. Excretory urography is associated with ionizing radiation and intravenous administration of iodine-containing contrast medium and is obsolete in children. Computed tomography (CT) using age-adapted and weight-adapted dose protocols is an alternative in emergencies if MRI is not available.
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Affiliation(s)
- Doris Franke
- Pädiatrische Sonographie, Klinik für Pädiatrische Nieren‑, Leber- und Stoffwechselerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Diane Miriam Renz
- Arbeitsbereich Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hans-Joachim Mentzel
- Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Deutschland
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2
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Elsingergy MM, Viteri B, Otero HJ, Bhatti T, Morales T, Roberts TPL, Amaral S, Hartung E, Serai SD. Imaging fibrosis in pediatric kidney transplantation: A pilot study. Pediatr Transplant 2023; 27:e14540. [PMID: 37166372 PMCID: PMC10824264 DOI: 10.1111/petr.14540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Noninvasive alternatives to biopsy for assessment of interstitial fibrosis and tubular atrophy (IFTA), the major determinant of kidney transplant failure, remain profoundly limited. Elastography is a noninvasive technique that propagates shear waves across tissues to measure their stiffness. We aimed to test utility of elastography for early detection of IFTA in pediatric kidney allografts. METHODS We compared ultrasound (USE) and MR elastography (MRE) stiffness measurements, performed on pediatric transplant recipients referred for clinically indicated biopsies, and healthy controls. RESULTS Ten transplant recipients (median age 16 years) and eight controls (median age 16.5 years) were enrolled. Three transplant recipients had "stable" allografts and seven had Banff Grade 1 IFTA. Median time from transplantation to biopsy was 12 months. Mean estimated glomerular filtration rate was 61.5 mL/min/1.73m2 by creatinine-cystatin-C CKiD equation at time of biopsy. Mean stiffness, calculated through one-way ANOVA, was higher for IFTA allografts (23.4 kPa USE/5.6 kPa MRE) than stable allografts (13.7 kPa USE/4.4 kPa MRE) and controls (9.1 kPa USE/3.6 kPa MRE). Pearson's coefficient between USE and MRE stiffness values was strong (r = .97). AUC for fibrosis prediction in transplanted kidneys was high for both modalities (0.91 USE and 0.89 MRE), although statistically nonsignificant (p > .05). Stiffness cut-off values for USE and MRE were 13.8 kPa and 4.6 kPa, respectively. Both values yielded a sensitivity of 100% but USE specificity (72%) was slightly higher than MRE (67%). CONCLUSION Elastography shows potential for detection of low-grade IFTA in allografts although a larger sample is imperative for clinical validation.
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Affiliation(s)
| | - Bernarda Viteri
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J. Otero
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tricia Bhatti
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tatiana Morales
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy P L Roberts
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Amaral
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erum Hartung
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suraj D. Serai
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Rinaldo C, Grimaldi D, Di Serafino M, Iacobellis F, Verde F, Caruso M, Sabatino V, Orabona GD, Schillirò ML, Vallone G, Cantisani V, Romano L. An update on pyelonephritis: role of contrast enhancement ultrasound (CEUS). J Ultrasound 2023; 26:333-342. [PMID: 36385692 PMCID: PMC10247636 DOI: 10.1007/s40477-022-00733-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Acute pyelonephritis (APN) is a bacterial infection causing inflammation of the kidneys. Diagnosis is usually based on clinical and laboratory findings. Imaging is required if a complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions and to detect underlying causes. CT represents the current imaging modality of choice in clinical practice. CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. CEUS allows us to distinguish small simple nephritic involvement from abscess complications and to follow their evolution over time during antibiotic therapy. The absence of ionizing radiation and the lack of nephrotoxicity make CEUS an ideal tool in the study of pyelonephritis.
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Affiliation(s)
- Chiara Rinaldo
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Dario Grimaldi
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
| | - Marco Di Serafino
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesca Iacobellis
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesco Verde
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Martina Caruso
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Vittorio Sabatino
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | | | - Maria Laura Schillirò
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Gianfranco Vallone
- Department of Life and Health, University of Molise "V. Tiberio", 86100, Campobasso, Italy
| | - Vito Cantisani
- Department of Radiology, Sapienza Rome University, Policlinico Umberto I, 00185, Rome, Italy
| | - Luigia Romano
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
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4
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Cambou L, Millet C, Terrier N, Malvezzi P, Timsit MO, Anglicheau D, Badet L, Morelon E, Prudhomme T, Kamar N, Lejay A, Perrin P, Uro-Coste C, Pereira B, Heng AE, Garrouste C, Guy L. Management and Outcome After Early Renal Transplant Vein Thrombosis: A French Multicentre Observational Study of Real-Life Practice Over 24 Years. Transpl Int 2023; 36:10556. [PMID: 37035106 PMCID: PMC10077970 DOI: 10.3389/ti.2023.10556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023]
Abstract
Early (<14 days) renal transplant vein thrombosis posttransplant (eRVTPT) is a rare but threatening complication. We aimed to assess eRVTPT management and the rate of functional renal transplantation. Of 11,172 adult patients who had undergone transplantation between 01/1997 and 12/2020 at 6 French centres, we identified 176 patients with eRVTPT (1.6%): 16 intraoperative (Group 1, G1) and 160 postoperative (Group 2, G2). All but one patient received surgical management. Patients in group G2 had at least one imaging test for diagnostic confirmation (N = 157, 98%). During the operative management of the G2 group, transplantectomy for graft necrosis was performed immediately in 59.1% of cases. In both groups, either of two techniques was preferred, namely, thrombectomy by renal venotomy or thrombectomy + venous anastomosis repair, with no difference in the functional graft rate (FGR) at hospital discharge (p = NS). The FGR was 62.5% in G1 and 8.1% in G2 (p < 0.001). Numerous complications occurred during the initial hospitalization: 38 patients had a postoperative infection (21.6%), 5 experienced haemorrhagic shock (2.8%), 29 exhibited a haematoma (16.5%), and 97 (55.1%) received a blood transfusion. Five patients died (2.8%). Our study confirms the very poor prognosis of early renal graft venous thrombosis.
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Affiliation(s)
- Ludivine Cambou
- Clermont-Ferrand University Hospital, Department of Urology, Clermont-Ferrand, France
| | - Clémentine Millet
- Clermont-Ferrand University Hospital, Department of Urology, Clermont-Ferrand, France
| | | | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Marc-Olivier Timsit
- Necker Hospital, Assistance Publique-Hôpitaux de Paris, Department of Urology, Paris, France
| | - Dany Anglicheau
- Necker Hospital, Assistance Publique-Hôpitaux de Paris, Department of Nephrology and Kidney Transplantation, Paris, France
| | - Lionel Badet
- Service d’Urologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Morelon
- Service de Néphrologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Prudhomme
- Toulouse University Hospital, Department of Urology, Toulouse, France
| | - Nassim Kamar
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
- Toulouse University Hospital, Department of Nephrology, Toulouse, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Charlotte Uro-Coste
- Clermont-Ferrand University Hospital, Department of Nephrology, 3iHP, Clermont-Ferrand, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
| | - Anne Elisabeth Heng
- Clermont-Ferrand University Hospital, Department of Nephrology, 3iHP, Clermont-Ferrand, France
| | - Cyril Garrouste
- Clermont-Ferrand University Hospital, Department of Nephrology, 3iHP, Clermont-Ferrand, France
- *Correspondence: Cyril Garrouste,
| | - Laurent Guy
- Clermont-Ferrand University Hospital, Department of Urology, Clermont-Ferrand, France
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Stigler J, Tiefenthaler M. Value and limitations of sonography in kidney transplant recipients with special attention to the resistive index - An update. FRONTIERS IN NEPHROLOGY 2022; 2:997839. [PMID: 37675004 PMCID: PMC10479591 DOI: 10.3389/fneph.2022.997839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 09/08/2023]
Abstract
Kidney transplantation has become the standard treatment for end-stage renal disease. Even though the success rates are high, early and late post-transplant complications remain a major clinical problem due to the risk of graft failure. Therefore, it is of highest interest to early diagnose post-transplant complications. Ultrasound with color coded Duplex analysis plays a crucial role in imaging mechanical and vascular complications. In this article, we give an update of the visualizable complications in kidney transplant recipients and discuss the value of resistive index (RI) measurement with its limitations in allograft rejection.
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Affiliation(s)
| | - Martin Tiefenthaler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Osmanodja B, Muench F, Holderied A, Budde K, Fischer T, Lerchbaumer MH. Assessment of Renal Transplant Perfusion by Contrast-Enhanced Ultrasound after Switch from Calcineurin Inhibitor to Belatacept: A Pilot Study. J Clin Med 2022; 11:jcm11154354. [PMID: 35955971 PMCID: PMC9368965 DOI: 10.3390/jcm11154354] [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: 06/18/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
Calcineurin inhibitors (CNIs) have improved short-term kidney allograft survival but are nephrotoxic and vasoconstrictive. Vasoconstriction is potentially reversible after switching from CNIs to belatacept. The kidney allograft shows optimal requirements for dynamic perfusion imaging using contrast-enhanced ultrasound (CEUS). We performed standardized CEUS in patients after switching from CNIs to belatacept for clinical indication to study the suitability of CEUS, in order to assess the effects of CNI cessation on kidney allograft perfusion. Eleven kidney transplant patients were enrolled from February 2020 until November 2020. Demographic, clinical, and laboratory parameters, as well as perfusion imaging, were assessed at baseline and 6 months after switching immunosuppression. Quantification of perfusion imaging on CEUS was performed using a post-processing software tool on uncompressed DICOM cine loops. After CNI cessation, estimated glomerular filtration rate increased by 4.8 mL/min/1.73 m2 (16%). Despite good quality of fit and comparable regions of interest in baseline and follow-up CEUS examinations, quantification of perfusion imaging showed a slightly improved cortical perfusion without reaching statistical significance after CNI cessation. This is the first study that systematically investigates the suitability of CEUS to detect changes of microvascular perfusion in kidney transplant recipients in vivo. No significant differences could be detected in perfusion measurements before and after CNI cessation.
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Affiliation(s)
- Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
- Correspondence: ; Tel.: +49-30-450-614-368
| | - Frédéric Muench
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
| | - Alexander Holderied
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
| | - Thomas Fischer
- Department of Radiology, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (M.H.L.)
| | - Markus Herbert Lerchbaumer
- Department of Radiology, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (M.H.L.)
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7
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David E, Del Gaudio G, Drudi FM, Dolcetti V, Pacini P, Granata A, Pretagostini R, Garofalo M, Basile A, Bellini MI, D’Andrea V, Scaglione M, Barr R, Cantisani V. Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications. Tomography 2022; 8:1704-1715. [PMID: 35894008 PMCID: PMC9326620 DOI: 10.3390/tomography8040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
Renal transplantation (RT) is the treatment of choice for end-stage renal disease, significantly improving patients’ survival and quality of life. However, approximately 3–23% of patients encounter post-operative complications, and radiology plays a major role for their early detection and treatment or follow-up planning. CT and MRI are excellent imaging modalities to evaluate renal transplant post-operative course; nevertheless, they are both associated with a high cost and low accessibility, as well as some contraindications, making them not feasible for all patients. In particular, gadolinium-based contrast can lead to the rare condition of nephrogenic systemic fibrosis, and iodine-based contrast can lead to contrast-induced nephropathy (CIN). CT also exposes the patients who may require multiple examinations to ionizing radiation. Therefore, considering the overall advantages and disadvantages, contrast-enhanced ultrasound (CEUS) is presently considered an effective first-line imaging modality for post-operative early and long-term follow-up in RT, reducing the need for biopsies and providing adequate guidance for drainage procedures. Hence, this paper aims to review the updated knowledge on CEUS compared with CT and MRI for the evaluation of RT renal transplant complications; advantages, limitations, and possible recommendations are provided.
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Affiliation(s)
- Emanuele David
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Unit of Radiology, Papardo Hospital, 98158 Messina, Italy
- Correspondence: (E.D.); (V.C.)
| | - Giovanni Del Gaudio
- Department of Radiology, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (G.D.G.); (F.M.D.); (V.D.); (P.P.)
| | - Francesco Maria Drudi
- Department of Radiology, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (G.D.G.); (F.M.D.); (V.D.); (P.P.)
| | - Vincenzo Dolcetti
- Department of Radiology, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (G.D.G.); (F.M.D.); (V.D.); (P.P.)
| | - Patrizia Pacini
- Department of Radiology, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (G.D.G.); (F.M.D.); (V.D.); (P.P.)
| | | | - Renzo Pretagostini
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (M.G.)
| | - Manuela Garofalo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (M.G.)
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy;
| | - Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.B.); (V.D.)
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.B.); (V.D.)
| | - Mariano Scaglione
- Department of Surgery, Medicine and Pharmacy, University of Sassari, 07100 Sassari, Italy;
- Department of Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
- Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland SR4 7TP, UK
| | - Richard Barr
- Department of Radiology, Northeastern Ohio Medical University, Youngstown, OH 44272, USA;
| | - Vito Cantisani
- Department of Radiology, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (G.D.G.); (F.M.D.); (V.D.); (P.P.)
- Correspondence: (E.D.); (V.C.)
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Lerchbaumer MH, Fischer T, Uluk D, Friedersdorff F, Hamm B, Spiesecke P. Diagnostic value of contrast-enhanced ultrasound (CEUS) in kidney allografts - 12 years of experience in a tertiary referral center. Clin Hemorheol Microcirc 2022; 82:75-83. [PMID: 35662110 DOI: 10.3233/ch-211357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND B-Mode and Doppler ultrasound are standard diagnostic techniques for early postoperative monitoring and long-term follow-up of kidney transplants. In certain cases, contrast-enhanced ultrasound (CEUS) is used to clarify unclear Doppler findings. OBJECTIVE To investigate the diagnostic performance of CEUS in the workup of renal allograft pathologies. METHODS A systematic search for CEUS examinations of renal transplants conducted in our department between 2008 and 2020 was performed using the following inclusion criteria: i) patient age ≥18 years and ii) confirmation of diagnosis by biopsy and histopathology, imaging follow-up by CEUS, contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or angiography, or intraoperative findings. Exclusion criteria were: i) CEUS performed in the setting of a study and ii) CEUS for other indications than dedicated renal transplant examination. Statistical analysis was performed separately for subgroups with different indications (focal vs non-focal). RESULTS Overall, 78 patients were included in the statistical analysis, which revealed high sensitivity (92.2%, 95% -confidence interval [CI] 81.5-96.9%) and high specificity (88.9%, 95% -CI 71.9-96.1%) of CEUS. CONCLUSIONS The high diagnostic performance demonstrated here and the superficial location of kidney allografts advocate the additional use of CEUS in the follow-up of renal transplant recipients.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Deniz Uluk
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Paul Spiesecke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Memberof Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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9
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Contrast-enhanced ultrasound of the kidneys: principles and potential applications. Abdom Radiol (NY) 2022; 47:1369-1384. [PMID: 35150315 DOI: 10.1007/s00261-022-03438-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is an extension and an enhanced form of ultrasound that allows real-time evaluation of the various structures in different vascular phases. The last decade has witnessed a widespread expansion of CEUS applications beyond the liver. It has shown fair potential in kidneys and its diagnostic efficacy is comparable to CT and MRI. Ultrasound is the well-accepted screening modality for renal pathologies, however, it underperforms in the characterization of the renal masses. CEUS can be beneficial in such cases as it can help in the characterization of such incidental masses in the same sitting. It has an excellent safety profile with no risk of radiation or contract-related nephropathy. It can aid in the correct categorization of renal cysts into one of the Bosniak classes and has proven its worth especially in complex cysts or indeterminate renal masses (especially Bosniak Category IIF and III). Few studies also describe its potential role in solid masses and in differentiating benign from malignant masses. Other areas of interest include infections, infarctions, trauma, follow-up of local ablative procedures, and VUR. Through this review, the readers shall get an insight into the various applications of CEUS in kidneys, with imaging examples.
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Hysi E, Kaur H, Young A. Evolving Medical Imaging Techniques for the Assessment of Delayed Graft Function: A Narrative Review. Can J Kidney Health Dis 2021; 8:20543581211048341. [PMID: 34707880 PMCID: PMC8544764 DOI: 10.1177/20543581211048341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/04/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose of review Delayed graft function (DGF) is a significant complication that contributes to poorer graft function and shortened graft survival. In this review, we sought to evaluate the current and emerging role of medical imaging modalities in the assessment of DGF and how it may guide clinical management. Sources of information PubMed, Google Scholar, and ClinicalTrial.gov up until February 2021. Methods This narrative review first examined the pathophysiology of DGF and current clinical management. We then summarized relevant studies that utilized medical imaging to assess posttransplant renal complications, namely, DGF. We focused our attention on noninvasive, evolving imaging modalities with the greatest potential for clinical translation, including contrast-enhanced ultrasound (CEUS) and multiparametric magnetic resonance imaging (MRI). Key findings A kidney biopsy in the setting of DGF can be used to assess the degree of ischemic renal injury and to rule out acute rejection. Biopsies are accompanied by complications and may be limited by sampling bias. Early studies on CEUS and MRI have shown their potential to distinguish between the 2 most common causes of DGF (acute tubular necrosis and acute rejection), but they have generally included only small numbers of patients and have not kept pace with more recent technical advances of these imaging modalities. There remains unharnessed potential with CEUS and MRI, and more robust clinical studies are needed to better evaluate their role in the current era. Limitations The adaptation of emerging approaches for imaging DGF will depend on additional clinical trials to study the feasibility and diagnostic test characteristics of a given modality. This is limited by access to devices, technical competence, and the need for interdisciplinary collaborations to ensure that such studies are well designed to appropriately inform clinical decision-making.
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Affiliation(s)
- Eno Hysi
- Division of Nephrology, St. Michael's Hospital, Unity Health Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, ON, Canada
| | - Harmandeep Kaur
- Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, ON, Canada
| | - Ann Young
- Division of Nephrology, St. Michael's Hospital, Unity Health Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
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Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications. AJR Am J Roentgenol 2021; 217:1217-1231. [PMID: 33908269 DOI: 10.2214/ajr.21.25713] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) utilization is expanding rapidly, particularly in children, in whom the modality offers important advantages of dynamic evaluation of the vasculature, portability, lack of ionizing radiation, and lack of need for sedation. Accumulating data establish an excellent safety profile of ultrasound contrast agents in children. Although only FDA-approved for IV use in children for characterizing focal liver lesions and for use during echocardiography, growing off-label applications are expanding the diagnostic potential of ultrasound. Focal liver lesion evaluation is the most common use of CEUS, and the American College of Radiology Pediatric LI-RADS Working Group recommends including CEUS for evaluation of a newly discovered focal liver lesion in many circumstances. Data also support the role of CEUS in hemodynamically stable children with blunt abdominal trauma, and CEUS is becoming a potential alternative to CT in this setting. Additional potential applications that require further study include evaluation of pathology in the lung, spleen, brain, pancreas, bowel, kidney, female pelvis, and scrotum. This review explores the implementation of CEUS in children, describing basic principles of ultrasound contrast agents and CEUS technique and summarizing current and potential IV diagnostic applications based on pediatric-specific supporting evidence.
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Improved Method of Contrast-enhanced Ultrasound examination of the Kidneys in Patients with Type 2 Diabetes Mellitus. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim of the research. Тo evaluate the diagnostic efficacy of the contrast-enhanced ultrasound examination of kidneys in patients with type 2 diabetes mellitus with a dose of 0.5 ml of contrast agent administered.Materials and methods. We examined 12 patients with a verified diagnosis of type 2 diabetes. The age of the examined patients was 31–59 years, the mean age was 49 ± 1.3 years. All patients underwent complex diagnostics, including ultrasound examination of the kidneys in B-mode with further renal vessels color Doppler imaging to assess vessels hemodynamics. A contrast-enhanced ultrasound examination of the kidneys was carried out using Sonovue contrast agent at the doses of 2.5 ml (according to the European Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound) and 0.5 ml (an improved technique of contrast agent intravenous bolus administration).Results. The improved technique (0.5 ml of contrast agent intravenous bolus administration) in comparison with the European Recommendations technique (2.5 ml of contrast agent intravenous bolus administration) used in patients with type 2 diabetes showed no or minor differences in the qualitative and quantitative indicators of contrast-enhanced ultrasound examination which did not affect the interpretation of the results.Conclusion. The improved contrast-enhanced ultrasound examination technique using 0.5 ml of a contrast agent showed its possibilities in diagnosing diabetic nephropathy in patients with type 2 diabetes, and also revealed the potential of an economically beneficial distribution of a contrast agent without losing the quality and information content of the study.
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