Interobserver reproducibility of contrast-enhanced ultrasound in diabetic nephropathy

2021 ◽  
Author(s):  
Lin Lin ◽  
Yiru Wang ◽  
Lin Yan ◽  
Nan Li ◽  
Xiaoqi Tian ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Mean Transit Time ◽  
Left Kidney ◽  
Intraclass Correlation ◽  
Renal Perfusion ◽  
Peak Time ◽  
Contrast Enhanced Ultrasound ◽  
Interobserver Reproducibility ◽  
Contrast Enhanced ◽  
The Right

Objective: To investigate the interobserver reproducibility of contrast-enhanced ultrasound (CEUS) in patients with diabetic nephropathy. Methods: A total of 40 patients with diabetic nephropathy were enrolled in this retrospective study. We measured peak intensity (PEAK), time-to-peak (TP), area under the curve (AUC) and mean transit time (MTT) of renal CEUS in each patient. Each parameter was performed by two independent observers. The interobserver reproducibility was assessed using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) and Bland–Altman plots by mean difference with 95% limits of agreement (LOAs). Results: The parameters of the left and right kidneys showed moderate or good reliability. The best was the left kidney AUC parameters (ICC,0.945),with a 95% CI of 0.896–0.971.The Bland–Altman plots showed that the mean differences between the right renal parameters (PEAK, TP, AUC and MTT) obtained between the observers 1 and 2 were −6.63%,2.54%,−11.30%,−2.22%, and the 95% LOAs are −30.78 to 17.52%, −30.15 to 35.23%, −43.95 to 21.35%, −44.50 to 40.06%. While the left ones were −2.89%, 0.32%, −8.26%, 1.25% , and the 95% LOAs were −38.50 to 32.72%, −31.98 to 32.62%, −57.89 to 41.37%, −37.21 to 39.71%, respectively. Conclusion: Quantitative CEUS can show good interobserver reproducibility, which is better for the right kidney. It seems necessary to establish standardized techniques for obtaining contrast-enhanced quantitative analysis of renal blood perfusion. Advances in knowledge: Quantitative assessment of renal perfusion by CEUS in patients with diabetic nephropathy provides diagnostic information. Furthermore, renal perfusion assessment in patients with diabetic nephropathy using CEUS has good reproducibility.

scholarly journals Interobserver Variation of the Bolus-and-Burst Method for Pancreatic Perfusion with Dynamic – Contrast-Enhanced Ultrasound

2017 ◽  
Vol 03 (03) ◽  
pp. E99-E106 ◽  
Author(s):  
Marcus Stangeland ◽  
Trond Engjom ◽  
Martin Mezl ◽  
Radovan Jirik ◽  
Odd Gilja ◽  
...  
Keyword(s):  
Blood Volume ◽  
Interobserver Agreement ◽  
Mean Transit Time ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Contrast Enhanced Ultrasound ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Volume Measurements ◽  
Pancreatic Perfusion

Abstract Purpose Dynamic contrast-enhanced ultrasound (DCE-US) can be used for calculating organ perfusion. By combining bolus injection with burst replenishment, the actual mean transit time (MTT) can be estimated. Blood volume (BV) can be obtained by scaling the data to a vessel on the imaging plane. The study aim was to test interobserver agreement for repeated recordings using the same ultrasound scanner and agreement between results on two different scanner systems. Materials and Methods Ten patients under evaluation for exocrine pancreatic failure were included. Each patient was scanned two times on a GE Logiq E9 scanner, by two different observers, and once on a Philips IU22 scanner, after a bolus of 1.5 ml Sonovue. A 60-second recording of contrast enhancement was performed before the burst and the scan continued for another 30 s for reperfusion. We performed data analysis using MATLAB-based DCE-US software. An artery in the same depth as the region of interest (ROI) was used for scaling. The measurements were compared using the intraclass correlation coefficient (ICC) and Bland Altman plots. Results The interobserver agreement on the Logiq E9 for MTT (ICC=0.83, confidence interval (CI) 0.46–0.96) was excellent. There was poor agreement for MTT between the Logiq E9 and the IU22 (ICC=−0.084, CI −0.68–0.58). The interobserver agreement for blood volume measurements was excellent on the Logiq E9 (ICC=0.9286, CI 0.7250–0.98) and between scanners (ICC=0.86, CI=0.50–0.97). Conclusion Interobserver agreement was excellent using the same scanner for both parameters and between scanners for BV, but the comparison between two scanners did not yield acceptable agreement for MTT. This was probably due to incomplete bursting of bubbles in some of the recordings on the IU22.

Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel

2020 ◽  
Vol 76 (2) ◽  
pp. 161-170
Author(s):  
V.I. Huf ◽  
W.A. Wohlgemuth ◽  
W. Uller ◽  
A.P. Piehler ◽  
H. Goessmann ◽  
...  
Keyword(s):  
Mean Transit Time ◽  
Healthy Tissue ◽  
Surrounding Tissue ◽  
Rank Test ◽  
Peak Time ◽  
Venous Malformations ◽  
Contrast Enhanced Ultrasound ◽  
Percutaneous Sclerotherapy ◽  
Contrast Enhanced ◽  
Before And After

INTRODUCTION: Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS: In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 –9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS: In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION: All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.

scholarly journals Impact of region-of-interest size and location on quantitative contrast-enhanced ultrasound of canine splenic perfusion

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Simona Morabito ◽  
Simona Di Pietro ◽  
Luca Cicero ◽  
Annastella Falcone ◽  
Luigi Liotta ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Regional Blood Flow ◽  
Mean Transit Time ◽  
Renal Perfusion ◽  
Contrast Enhanced Ultrasound ◽  
Time Intensity Curve ◽  
Optimal Method ◽  
Software Analysis ◽  
Splenic Parenchyma ◽  
Contrast Enhanced

Abstract Background During contrast enhanced ultrasound (CEUS), the features of the regions of interest (ROI) can affect the value of the perfusion-related parameters obtained from a time intensity curve (TIC). In veterinary medicine, conflicting have been reported on the influence of ROI size and location on renal CEUS. There are some disagreeing evidences regarding the optimal method for selecting ROI in quantitative analysis of renal perfusion using CEUS. The aim of this study was to evaluate the effect of the size and location of ROIs in the spleen of conscious dogs on perfusion variables determined using sulphur hexafluoride contrast-enhanced ultrasounds. Results A prospective observational study on 15 client-owned mixed-breed adult dogs was performed using a system equipped with contrast-tuned imaging technology. Qualitative and quantitative assessments of the spleen enhancement pattern were carried out. Three square ROIs (0.05 cm2) were manually drawn in a row and spaced 1 mm apart, placing adjacent ROIs at three different depths. Three medium rectangular ROIs (0.3 cm2) include the 3 smallest ROIs in each row, indicated by the letters A, B and C, and a single large square ROI (1 cm2) was drawn containing all previous ROIs. Software analysis of time-intensity curves generated within each ROI allowed us to calculate the perfusion-related parameters: peak enhancement, time to peak, regional blood flow, mean transit time and regional blood volume. The coefficient of variation for all blood-related parameters was always lower in the larger ROI than in the other smaller ROIs. ROI A and B, positioned proximally and medially, levels respectively, showed similar coefficients of variation to the largest ROI. The analysis of variance model exhibited a significant effect of location and size of the ROIs in the quantitative analysis of canine spleen perfusion, with a reduction of perfusion-related parameters in the distal ROI. Conclusions The recommendation for a quantitative CEUS examination of a dog’s spleen is to analyze splenic perfusion by drawing a sufficiently large ROI proximal to the ultrasound beam on the splenic parenchyma. This may be of clinical relevance in the diagnosis of splenic diseases.

MO336RENAL CONTRAST-ENHANCED ULTRASOUND (CEUS) TO EVALUATE EARLY AND CHRONIC MODIFICATIONS OF RENAL PERFUSION AND TO PREDICT RENAL DYSFUNCTION AFTER RENAL ISCHEMIA-REPERFUSION IN MICE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Maxime Schleef ◽  
Delphine Baetz ◽  
Christelle Leon ◽  
Bruno Pillot ◽  
Gabriel Bidaux ◽  
...  
Keyword(s):  
Renal Function ◽  
Ischemia Reperfusion ◽  
Renal Perfusion ◽  
Renal Ischemia ◽  
Renal Ultrasound ◽  
Mechanical Index ◽  
Contrast Enhanced Ultrasound ◽  
Serum Urea ◽  
Non Invasive ◽  
Contrast Enhanced

Abstract Background and Aims Renal ischemia-reperfusion can lead to acute kidney injury (AKI), increasing the risk of developing chronic kidney disease (CKD) through inflammation and vascular lesions. Serum urea or creatinine level routinely used as diagnostic indices of renal function are always delayed from the onset of the disease. Therefore, we currently lack reliable markers to early detect AKI, especially in animals. We aimed to show that non-invasive renal contrast-enhanced ultrasound (CEUS) could be a reliable tool to assess early and chronic changes of renal perfusion after renal ischemia-reperfusion. Method Male C57BL6 mice underwent 15 minutes of unilateral renal ischemia by clamping of the left renal vascular pedicle (n = 7), or a sham procedure (n = 3), under inhaled general anesthesia by Sevoflurane. A renal ultrasound was performed on the left ischemic kidney at baseline 1 week before the surgery, then, 20 minutes after reperfusion to assess early modifications of renal perfusion, and 1 month after reperfusion to follow chronic modifications. CEUS was performed in supine position by using a high-resolution ultrasonic imaging system (VEVO 3100 Fujifilm Visualsonics, Toronto, Canada) with a MX550D probe fixed in place with an iron support, ensuring the constant imaging plane throughout acquisition. First, a continuous infusion of microbubbles (VS-11913, Fujifilm Visualsonics, Toronto, Canada) was done through the tail vein, then a high mechanical index burst was given to destroy microbubbles when the contrast enhancement had reached a steady state, and finally, low mechanical-index imaging mode was used until, and 30 sec after the contrast agent concentration reached the plateau. Images were recorded and were analyzed using the “destruction-replenishment” fitting model of the Vevo LAB software (Fujifilm Visualsonics, Toronto, Canada). Renal perfusion was estimated by the total renal Blood Volume (rBV) parameter and was expressed as percentage of the baseline value for each animal. Renal function was also assessed by serum urea concentration 1 month after reperfusion, and the long axis lengths of both the kidneys were measured ex vivo after the mice were euthanized. Results Renal perfusion of the ischemic kidney measured by CEUS was significantly decreased as soon as 20 minutes of reperfusion compared to baseline (median 28,8% of baseline value; interquartiles [20,1 – 69,8%]). 1 month after reperfusion, renal perfusion recovered partially but was still significantly decreased compared to baseline (median 79,9% of baseline value; interquartiles [52,8 – 99,9%]) (Figure A). In sham operated mice, renal perfusion did not differ from baseline at 20 minutes or 1 month (p &gt; 0.05). The renal function, assessed by serum urea, was mildly but significantly impaired 1 month after ischemia-reperfusion compared with sham (median serum urea 9,8 vs. 7,6 mmol/L) (p = 0.02), and this was consistent with the observed kidney atrophy in the ischemic group when compared to the contralateral kidney (median long axis length 7,5 vs 10,8 mm) (p = 0.03). Moreover, the decrease of renal perfusion 20 minutes after reperfusion was significantly correlated with the impairment of renal perfusion 1 month after reperfusion (Pearson r = 0.836, p = 0.005) and with the serum urea level at 1 month (Pearson r = -0.710, p = 0.03) (Figure B-C). Conclusion Renal CEUS was able to detect early impairment of renal perfusion as soon as 20 minutes after 15 minutes of renal ischemia in mice, and perfusion was still decreased 1 month after reperfusion, compared to baseline. This early impairment of perfusion was correlated with the chronic decrease of renal perfusion and renal function 1 month after reperfusion. This was also associated with a significant kidney atrophy. CEUS is an interesting non-invasive tool to assess renal lesions dynamically after ischemia-reperfusion.

Influence of ageing on quantitative contrast-enhanced ultrasound of the kidneys in healthy cats

2018 ◽  
Vol 182 (18) ◽  
pp. 515-515 ◽  
Author(s):  
Emmelie Stock ◽  
Dominique Paepe ◽  
Sylvie Daminet ◽  
Luc Duchateau ◽  
Jimmy H Saunders ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Area Under The Curve ◽  
Renal Perfusion ◽  
Urine Specific Gravity ◽  
Contrast Enhanced Ultrasound ◽  
Non Invasive ◽  
Peak Enhancement ◽  
Contrast Enhanced ◽  
Lower Blood ◽  
Invasive Evaluation

The degenerative effects of ageing on the kidneys have been extensively studied in humans. However, only recently interest has been focused on renal ageing in veterinary medicine. Contrast-enhanced ultrasound allows non-invasive evaluation of renal perfusion in conscious cats. Renal perfusion parameters were obtained in 43 healthy cats aged 1–16 years old, and the cats were divided in four age categories: 1–3 years, 3–6 years, 6–10 years and over 10 years. Routine renal parameters as serum creatinine, serum urea, urine-specific gravity, urinary protein:creatinine ratio and systolic blood pressure were also measured. No significant differences in any of the perfusion parameters were observed among the different age categories. A trend towards a lower peak enhancement and wash-in area under the curve with increasing age, suggestive for a lower blood volume, was detected when comparing the cats over 10 years old with the cats of 1–3 years old. Additionally, no significant age-effect was observed for the serum and urine parameters, whereas a higher blood pressure was observed in healthy cats over 10 years old.

scholarly journals Endothelin mediates renal vascular memory of a transient rise in perfusion pressure due to NOS inhibition

1999 ◽  
Vol 276 (4) ◽  
pp. F629-F634 ◽  
Author(s):  
Xin-Zhou Zhang ◽  
Chris Baylis
Keyword(s):  
Perfusion Pressure ◽  
Left Kidney ◽  
Renal Perfusion ◽  
Transient Increase ◽  
Transient Rise ◽  
Group 3 ◽  
Group 2 ◽  
The Right ◽  
Renal Vascular ◽  
Renal Responses

We investigated the renal responses to NO synthase (NOS) inhibition with N-monomethyl-l-arginine (l-NMA; 30 mg/kg) in anesthetized rats in which renal perfusion pressure (RPP) to the left kidney was mechanically adjusted. Acutel-NMA increased blood pressure (BP, ∼20%) and renal vascular resistance (RVR) rose (∼50%) in the right kidneys that were always exposed to high RPP. In group 1, the left kidney was exposed to a transient increase (5 min) in RPP which was then normalized, and the rise in RVR was similar to the right kidney. In group 2 the left kidney was never exposed to high RPP, and the rise in RVR was attenuated relative to the right kidney. In group 3, rats were pretreated with the endothelin (ET) receptor antagonist Bosentan, immediately before exposure of the left kidney to a transient increase in RPP, and the rise in RVR was also attenuated relative to the right kidney. NOS inhibition resulted in a natriuresis and diuresis in the right kidneys, and ∼50% of the natriuresis persisted in the left kidney of group 2, in the absence of any rise in RPP. ET antagonism completely prevented the natriuresis and diuresis in response to acutel-NMA in both left and right kidneys. These data suggest that transient exposure to high RPP by NOS inhibition prevents an appropriate vasodilatory response when RPP is lowered, due to the intrarenal action of ET.

scholarly journals Assessment of sorafenib induced changes in tumor perfusion of uveal melanoma metastases with dynamic contrast-enhanced ultrasound (DCE-US)

2021 ◽  
Author(s):  
Dane Wildner ◽  
Lucie Heinzerling ◽  
Max E. Scheulen ◽  
Eckhart Kaempgen ◽  
Gerold Schuler ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Uveal Melanoma ◽  
Mean Transit Time ◽  
Prospective Trial ◽  
Early Response ◽  
Response To Treatment ◽  
Contrast Enhanced Ultrasound ◽  
Dynamic Contrast Enhanced ◽  
Sorafenib Therapy ◽  
Contrast Enhanced

Abstract Purpose Dynamic contrast-enhanced ultrasound (DCE-US) was used to monitor early response to sorafenib therapy in patients with liver metastases from uveal melanoma. Methods In total, 21 patients with liver metastases were recruited within a prospective trial and underwent daily sorafenib therapy. DCE-US of a target lesion was performed before initiation of treatment, on day 15 and 56. Two independent blinded investigators performed software analysis for DCE-US parameters and inter-observer-correlation was calculated. Response to treatment was evaluated on day 56. DCE-US parameters were correlated with clinical response and RECIST1.1 criteria. Results Inter-observer-correlation (r) of DCE-US parameters [time-to-peak (TTP), mean-transit-time (MTT), peak intensity (PI), regional blood volume (RBV), regional blood flow (RBF)] at baseline, day 15, and day 56 was highly significant (r-range 0.73–0.97, all p < 0.001). Out of 17 evaluable patients, 12 patients survived day 56 (clinical responders, cRE), whereas, five patients died before day 56 and were classified as non-responders (cNR). TTP values significantly increased in the cRE group 15 days after initiation of treatment for investigator 1 (p = 0.034) and at day 56 for both investigators (p = 0.028/0.028). MTT had increased significantly in the cRE group on day 56 (p = 0.037/0.022). In the cNR group changes for TTP and MTT remained insignificant. Thus, increase of the DCE-US parameters TTP and MTT are associated with response to treatment and prognosis. Conclusion An increase of TTP and MTT at frequent intervals could serve as a surrogate marker for early response evaluation to anti-angiogenic treatment of metastatic uveal melanoma.

scholarly journals Volumetric Contrast-Enhanced Ultrasound Imaging of Renal Perfusion

2014 ◽  
Vol 33 (8) ◽  
pp. 1427-1437 ◽  
Author(s):  
Marshall Mahoney ◽  
Anna Sorace ◽  
Jason Warram ◽  
Sharon Samuel ◽  
Kenneth Hoyt
Keyword(s):  
Ultrasound Imaging ◽  
Renal Perfusion ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

scholarly journals Количественный анализ трансректального ультразвукового исследования с контрастным усилением в диагностике рака предстательной железы (индексы): предварительные результаты

2020 ◽  
pp. 12-25
Keyword(s):  
Prostate Cancer ◽  
Quantitative Analysis ◽  
Transit Time ◽  
Rise Time ◽  
Mean Transit Time ◽  
Contrast Enhanced Ultrasound ◽  
Time To Peak ◽  
Quantitative Parameters ◽  
Peak Intensity ◽  
Contrast Enhanced

Цель исследования - выявление наиболее информативных относительных количественных показателей (индексов) ТРУЗИ с КУ в диагностике РПЖ с использованием результатов прицельной биопсии под контролем ТРУЗИ. Материал и методы исследования: обследовано 75 пациентов с подозрением на рак предстательной железы по данным пальцевого ректального исследования и (или) повышением уровня общего простатспецифического антигена сыворотки крови. При этом обязательным условием было наличие гипоэхогенных очагов в периферической зоне предстательной железы. Всем пациентам проводилась системная и прицельная биопсия. Прицельная биопсия осуществлялась из гипоэхогенных очагов - зон интереса, которые были предварительно выбраны для количественного анализа контрастного усиления. В соответствии с морфологическими данными были выделены две группы очагов: 30 очагов в группе “РПЖ” (основная группа) и 45 очагов в группе “не РПЖ” (группа сравнения). ТРУЗИ выполнялись на аппарате Epiq 5 (Philips, Нидерланды) внутриполостным микроконвексным датчиком 4-10 МГц. Использовался ультразвуковой контрастный препарат Соновью (Bracco Swiss S.A., Швейцария). При анализе кривой “время-интенсивность” оценивались следующие безразмерностные индексы, представляющие собой отношение соответствующих абсолютных параметров в зоне интереса и эталонной зоне: индекс WIR (wash-in rate), индекс TTP (time to peak), индекс PI (peak intensity), индекс MTT (mean transit time), индекс TPH (time from peak to one half) и индекс RT (rise time). Результаты исследования: достоверные различия между группами получены по индексам WIR (P 0,0001), PI (P 0,0001), TTP (P = 0,0008) и RT (P = 0,0248). Тест “индекс PI > 1,174 - рак предстательной железы” характеризуется чувствительностью 83,3%, специфичностью 88,9%, предсказательной ценностью положительного теста 83,3%, предсказательной ценностью отрицательного теста 88,9%, AUC 0,910. Тест “индекс WIR > 1,432 - рак предстательной железы” характеризуется чувствительностью 76,7%, специфичностью 82,2%, предсказательной ценностью положительного теста 74,2%, предсказательной ценностью отрицательного теста 84,1%, AUC 0,808. Тест “индекс TTP ≤ 0,936 - рак предстательной железы” характеризуется чувствительностью 73,3%, специфичностью 66,7%, предсказательной ценностью положительного теста 59,5%, предсказательной ценностью отрицательного теста 78,9%, AUC 0,729. Определяется достоверная корреляция умеренной силы между суммой Глисона и индексом PI (rS = 0,394, P = 0,0311). Выводы: использование относительных параметров (индексов) количественного анализа трансректального ультразвукового исследования с контрастным усилением может привести к повышению эффективности прицельных биопсий. Индексы отличаются большей информативностью, чем абсолютные параметры. Ключевые слова: ультразвуковое исследование с контрастным усилением, количественный анализ, количественные относительные параметры, индексы, перфузия, предстательная железа, рак предстательной железы, contrast-enhanced ultrasound (CEUS), quantitative analysis, relative quantitative parameters, indices, perfusion, prostate, prostate cancer

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