Correlation Between Renal Cortical Stiffness and Histological Determinants by Point Shear-Wave Elastography in Patients With Kidney Transplantation

2017 ◽  
Vol 27 (4) ◽  
pp. 346-353 ◽  
Author(s):  
A. L. Croci Chiocchini ◽  
C. Sportoletti ◽  
G. Comai ◽  
S. Brocchi ◽  
I. Capelli ◽  
...  
Keyword(s):  
Shear Wave ◽  
Gold Standard ◽  
Interstitial Fibrosis ◽  
Research Question ◽  
Intraclass Correlation ◽  
Shear Wave Elastography ◽  
Mesangial Matrix ◽  
Tubular Atrophy ◽  
Chronic Allograft Dysfunction ◽  
Allograft Dysfunction

Introduction: Renal allograft biopsy is the gold standard for the detection of histological lesions of chronic allograft dysfunction. The identification of a noninvasive routine test would be desirable. Elastosonography is used to assess tissue stiffness according to viscosity, and no data are available on the use of point quantification shear-wave elastography (ElastPQ) for the evaluation of renal chronic lesions. Research Question: To evaluate the feasibility of ElastPQ to assess cortical allograft stiffness and to determine the correlation of clinical, biological, and pathological factors with the diagnostic accuracy of kidney stiffness values in patients with histological lesions. Design: Forty-two patients underwent kidney transplant biopsy and 10 valid measurements of ElastPQ, blindly performed by 2 operators. The interobserver reproducibility was assessed according to intraclass correlation coefficient. The ElastPQ measurements and the clinical data were compared using the Spearman correlation analysis. Results: 97.6% reliable measurements were obtained using ElastPQ, with an excellent interobserver agreement. The kidney stiffness was significantly higher in the patients with a time since transplantation >12 months and was correlated with chronic lesions (interstitial fibrosis, tubular atrophy transplant glomerulopathy, and mesangial matrix), with the interstitial fibrosis/tubular atrophy, score and with the sum of the scores of the chronic lesions. Mesangial matrix increase is the only independent determinant of kidney stiffness. Discussion: ElastPQ is a noninvasive, reproducible, and sensitive diagnostic tool able to detect moderate/severe chronic lesions. Its routine use during follow-up can identify patients eligible for biopsy, which remains the gold standard exam for detecting chronic allograft dysfunction.

scholarly journals Noninvasive Assessment of Interstitial Fibrosis and Tubular Atrophy in Renal Transplant by Combining Point-Shear Wave Elastography and Estimated Glomerular Filtration Rate

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 18
Author(s):  
Chi Qin ◽  
Hailong Jin ◽  
Haixiang Zhang ◽  
Yun Zhang ◽  
Zhaojie Guan ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Shear Wave ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Interstitial Fibrosis ◽  
Shear Wave Elastography ◽  
Optimal Cutoff ◽  
Tubular Atrophy ◽  
Significant Difference

The purpose of this study was to evaluate the feasibility of the combination of point-shear wave elastography (p-SWE) and estimated glomerular filtration rate (eGFR) for assessing different stages of interstitial fibrosis and tubular atrophy (IF/TA) in patients with chronic renal allograft dysfunction (CAD). From September 2020 to August 2021, 47 patients who underwent renal biopsy and p-SWE examinations were consecutively enrolled in this study. The areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate overall accuracy and to identify the optimal cutoff values for different IF/TA stages. A total of 43 patients were enrolled in this study. The renal cortical stiffness and eGFR showed a significant difference between IF/TA Grade 0–1 and Grade 2–3 (p < 0.001). Additionally, renal stiffness and eGFR were independent predictors for moderate-to-severe IF/TA (Grade ≥ 2) according to multiple logistic regression analysis. The combination of p-SWE and eGFR, with an optimal cutoff value of −1.63, was superior to eGFR alone in assessing moderate-to-severe interstitial fibrosis (AUC, 0.86 vs. 0.72, p = 0.02) or tubular atrophy (AUC, 0.88 vs. 0.74, p = 0.02). There was no difference between p-SWE and eGFR in assessing moderate-to-severe IF/TA (AUC, 0.85 vs. 0.79, p = 0.61). Therefore, combining p-SWE and eGFR is worthy of clinical popularization and application.

scholarly journals Shear Wave Elastography in Evaluating Acute Kidney Allograft Dysfunction: Preliminary Results.

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Carmen Roch ◽  
Fernando García ◽  
María Flores ◽  
Ruben González ◽  
Miguel Cepeda ◽  
...  
Keyword(s):  
Shear Wave ◽  
Gold Standard ◽  
Clinical Signs ◽  
Standard Technique ◽  
Shear Wave Elastography ◽  
Tissue Stiffness ◽  
Preliminary Results ◽  
Non Invasive ◽  
Allograft Dysfunction ◽  
Gold Standard Technique

In absence of pharmacological toxicity, allograft dysfunction is usually due to parenchymal inflammation and tubulointerstitial fibrosis, but its clinical signs are often non-specific and tend to appear when advanced damage has been established. We investigated whether Shear Wave Elastography (SWE), a new non-invasive ultrasound (US) based technique that estimates tissue stiffness, could provide early confident diagnosis of acute allograft dysfunction compared to biopsy (gold standard technique).

Liver Elastography in Healthy Children Using Three Different Systems – How Many Measurements Are Necessary?

2020 ◽  
Author(s):  
Anders Batman Mjelle ◽  
Anesa Mulabecirovic ◽  
Roald Flesland Havre ◽  
Edda Jonina Olafsdottir ◽  
Odd Helge Gilja ◽  
...  
Keyword(s):  
Shear Wave ◽  
Transient Elastography ◽  
Intraclass Correlation ◽  
Age Groups ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Healthy Children ◽  
Significant Difference ◽  
Pediatric Liver Disease ◽  
Liver Elastography

Abstract Purpose Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions. Materials and Methods 243 healthy children aged 4–17 years were examined after three hours of fasting. Participants were divided into four age groups: 4–7 years; 8–11 years; 12–14 years and 15–17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8–17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions. Results For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions. Conclusion Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.

scholarly journals Changes in Muscle Hardness from Resting to Mid-Range Lengthened Positions Detected by Shear Wave Elastography (SWE) with a Novel Protocol of Ultrasound Probe Placement

2021 ◽  
Vol 11 (1) ◽  
pp. 452
Author(s):  
Long-Jun Ren ◽  
Connie Lok-Kan Cheng ◽  
Christina Zong-Hao Ma ◽  
Yong-Ping Zheng
Keyword(s):  
Shear Wave ◽  
Intraclass Correlation ◽  
Shear Wave Elastography ◽  
Rectus Femoris ◽  
Healthy Adults ◽  
Physiological Status ◽  
Ultrasound Probe ◽  
Muscle Hardness ◽  
Age Related ◽  
Probe Placement

Muscle hardness and its relationship with different muscle lengths/positions are important for understanding its underlying physiological status, and yet remained unclear. This study aimed to detect the local muscle hardness at different muscle lengths and identify the influence of muscle position on muscle hardness in healthy adults. A total of 26 healthy adults participated in this study. Shear wave elastography (SWE) was used to measure the muscle hardness of the Rectus Femoris (RF), Tibialis Anterior (TA) and Gastrocnemius Medialis (GM). Each muscle was tested at both resting (RST) and mid-range lengthened (MRL) positions. A novel ultrasound probe placing method was introduced, applied, and evaluated in this study. Moderate to excellent intra-/inter-rater reliability (Intraclass Correlation Coefficient, ICC ≥ 0.70) was found for muscle hardness measurements. The muscle hardness significantly increased from the RST to MRL position for all three muscles (p < 0.001). This study found that the muscle hardness increased at its mid-range lengthened position from the resting position. The mid-range lengthened muscle position of TA and GM could also be sensitive enough to reflect the age-related changes in local muscle hardness. This study also highlights the importance of placing the assessed extremities in an appropriate and consistent position when assessing muscle qualities by ultrasonics in clinical practice.

scholarly journals Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study

Diagnostics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 41
Author(s):  
Sorana D. Bolboacă ◽  
Florin Ioan Elec ◽  
Alina Daciana Elec ◽  
Adriana Milena Muntean ◽  
Mihai Adrian Socaciu ◽  
...  
Keyword(s):  
Shear Wave ◽  
Shear Wave Elastography ◽  
Interquartile Range ◽  
P Value ◽  
Single Center ◽  
Tissue Stiffness ◽  
Kidney Allograft ◽  
Stable Function ◽  
Allograft Dysfunction ◽  
Allograft Function

Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients’ characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young’s modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68–31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08–27.68) kPa; p-value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (−0.44, p-value < 0.0001 for allograft cortex and −0.42, p-value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p-value = 0.0021 for allograft cortex and 0.28, p-value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed.

scholarly journals Renal Ultrasound Elastography: A Review of the Previous Reports on Chronic Kidney Diseases

2021 ◽  
Vol 11 (20) ◽  
pp. 9677
Author(s):  
Takuji Iyama ◽  
Takaaki Sugihara ◽  
Tomoaki Takata ◽  
Hajime Isomoto
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Shear Wave ◽  
Malignant Tumors ◽  
Interstitial Fibrosis ◽  
Kidney Diseases ◽  
Shear Wave Elastography ◽  
Ultrasound Elastography ◽  
Renal Ultrasound

The early detection of a kidney injury is essential to protect against the progression of kidney damage owing to the progressive nature of chronic kidney disease. A renal biopsy is the gold standard for the assessment of pathological alterations such as interstitial fibrosis and glomerulosclerosis. However, there are concerns regarding potential complications including bleeding and a reduction in renal function. Ultrasound elastography is an ideal modality for assessing the alterations in various organs and diagnosing malignant tumors. This technique has the potential to help detect early changes in renal function and pathological alterations. However, the careful application and interpretation of this technique in the kidney is required because of its complex hemodynamics and architecture. Shear wave elastography is the most widely investigated technique among ultrasound elastography. This review aims to summarize the previous investigations of the kidney using shear wave elastography, particularly for renal malignancy, kidney transplantation, and chronic kidney disease. Additionally, we have highlighted the influencing factors concerning the practical measurement of renal elasticity.

scholarly journals Reliability Criteria for Liver Stiffness Measurements with Real-Time 2D Shear Wave Elastography in Different Clinical Scenarios of Chronic Liver Disease

2016 ◽  
Vol 38 (06) ◽  
pp. 648-654 ◽  
Author(s):  
Maja Thiele ◽  
Bjørn Madsen ◽  
Bogdan Procopet ◽  
Janne Hansen ◽  
Linda Møller ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Standard Deviation ◽  
Real Time ◽  
Shear Wave ◽  
High Reliability ◽  
Intraclass Correlation ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Diagnostic Study ◽  
Clinical Scenarios

Abstract Purpose Liver stiffness measurement by real-time 2-dimensional shear wave elastography (2D-SWE) lacks universal reliability criteria. We sought to assess whether previously published 2D-SWE reliability criteria for portal hypertension were applicable for the evaluation of liver fibrosis and cirrhosis, and to look for criteria that minimize the risk of misclassification in this setting. Materials and Methods In a biopsy-controlled diagnostic study, we obtained five 2D-SWE measurements of optimal image quality. Correctly classified cases of fibrosis and cirrhosis were compared to misclassified cases. We compared reliability predictors (standard deviation (SD), SD/mean, size of region of interest (ROI) and difference between a single measurement and the patient’s median) with those obtained in a prior study on clinically significant portal hypertension. Results We obtained 678 2D-SWE measurements from 142 patients. Overall, the variability in liver stiffness within single 2D-SWE measurements was low (SD = 1.1 ± 1.5kPa; SD/mean = 12 ± 9 %). Intra-observer analysis showed almost perfect concordance (intraclass correlation coefficient = 0.95; 95 % CI 0.94 – 0.96; average difference from median = 0.4 ± 0.9kPa). For the diagnosis of cirrhosis, a smaller SD (optimally ≤ 1.75 kPa) and larger ROI size (optimally ≥ 18 mm) were associated with higher accuracy. Similarly, within the published cohort of patients assessed for portal hypertension, a low variability of measurements was associated with high reliability. Conclusion A high quality 2D-SWE elastogram ensures low variability and high reliability, regardless of indication. We recommend aiming for a combination of low standard deviation and large ROI.

scholarly journals A novel biomarker of chronic allograft dysfunction in renal transplant recipients (serum calreticulin and CD47)

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Rasha Ibrahim Abdel Razek Gawish ◽  
Hayam Abdel Meguid El Aggan ◽  
Sabah Abdel Hady Mahmoud ◽  
Sara Ahmed Mohamed Mortada
Keyword(s):  
Renal Function ◽  
Renal Transplantation ◽  
Interstitial Fibrosis ◽  
Graft Function ◽  
High Sensitivity ◽  
Enzyme Linked Immunosorbent Assay ◽  
Renal Transplant Recipients ◽  
Chronic Allograft Dysfunction ◽  
Allograft Dysfunction ◽  
Potential Biomarker

Abstract Background Chronic allograft dysfunction (CAD) is considered the leading cause of late allograft loss. The cluster of differentiation 47 (CD47) and calreticulin (CRT) are involved in many and diverse cellular processes. The present study was designed to study the role of the pro-phagocytic CRT and anti-phagocytic CD47 signals in patients with renal transplantation in relation to graft function. Thirty renal transplantation recipients (RTR) for more than 6 months [15 with stable renal function and 15 with chronic allograft dysfunction (CAD)] and 15 healthy controls were enrolled in the study. Quantification of CRT, CD47, and high-sensitivity C-reactive protein (hsCRP) levels in serum was done using standardized enzyme-linked immunosorbent assay (ELISA) kits. Measurement of renal function and urinary alkaline phosphatase (U.ALP) was done. Renal interstitial fibrosis (IF) was graded in renal biopsies of CAD. Results Serum CRT and urinary ALP levels were statistically significant higher (P < 0.001) while serum CD47 level was statistically significant lower (P < 0.001) in patients with CAD than patients with stable graft function and controls. There was statistically insignificant difference between controls and patients with stable graft function. Serum CRT and serum CD47 levels were positively correlated with each other and with worsening renal and tubular function, serum hsCRP in RTR and with degree of renal IF in patients with CAD (P < 0.05). Conclusions The activation and dysregulation of CRT and CD47 could play a role in the development of CAD and could be a potential biomarker for renal allograft dysfunction.

scholarly journals Interconversion of elasticity measurements between two-dimensional shear wave elastography and transient elastography

2018 ◽  
Vol 20 (2) ◽  
pp. 127 ◽  
Author(s):  
Yeun-Yoon Kim ◽  
Myung-Joon Kim ◽  
Hyun Joo Shin ◽  
Haesung Yoon ◽  
Ha Yan Kim ◽  
...  
Keyword(s):  
Biliary Atresia ◽  
Shear Wave ◽  
Transient Elastography ◽  
Intraclass Correlation ◽  
Shear Wave Elastography ◽  
Two Dimensional ◽  
Regression Analyses ◽  
Supersonic Shear Imaging ◽  
Probe Selection ◽  
Elasticity Measurements

Aims: To enable comparison and interconversion of elasticity measurements between two-dimensional (2D) shear wave elastography (SWE) and transient elastography (TE).Materials and methods: Elasticities of three phantoms were measured by 2D SWE (supersonic shear imaging) using four probes and TE using two probes. We performed regression analyses to evaluate correlation between the measurements and phantom elasticities, and make converting equations. In pediatric biliary atresia patients who had stiffness measurements by both 2D SWE and TE within 1-year interval, TE measurements were retrospectively converted into correlating 2D SWE values. We compared the calculated values with 2D SWE measurements by intraclass correlation coefficient.Results: Measurements in phantoms varied according to elastography method and probe selection. However, the measurement by both 2D SWE (R2, 0.974-0.985; p<0.001) and TE (R2, 0.996-0.999; p<0.001) showedsignificant linear correlation with phantom elasticity in all probe settings. From 67 biliary atresia patients (age, 2 months-20 years), agreements between the measured and calculated values were excellent in all 88 examinations within 1-year interval(ρ=0.828; p<0.001) and in 63 examinations within 2-month interval (ρ=0.863, p<0.001). Conclusions: The equations enabledinterconversion of elasticity values among different probes of 2D SWE and TE and provided reliable estimation of elasticityvalues for different probe settings in biliary atresia patients.

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