Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

El-Bandar, Nasrin; Lerchbaumer, Markus Herbert; Peters, Robert W.; Maxeiner, Andreas; Kotsch, Katja; Sattler, Arne; Miller, Kurt; Schlomm, Thorsten; Hamm, Bernd; Budde, Klemens; Liefeldt, Lutz; Fischer, Thomas; Friedersdorff, Frank

doi:10.3390/jcm11030791

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…Whether there is a relationship between CEUS-derived perfusion volume and renal function has not been adequately investigated. A recent study by El-Bandar et al ( 23 ) which used CEUS to quantify perfusion in living donor kidneys suggested, for the first time, that signal intensity of CEUS in normal-weight living donor kidneys may correlate with pre- and post-transplant renal function. In our study, PIKC also showed the strongest negative correlation with eGFR in grafts from donor kidneys with AKI.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors

He,

Wu,

Gong

et al. 2023

Quant Imaging Med Surg

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Background Acute kidney injury (AKI) is frequently found in deceased donors; however, few studies have reported the use of imaging to detect and identify this phenomenon. The purpose of this study was to detect renal microcirculatory perfusion in brain-dead donors using contrast-enhanced ultrasonography (CEUS), investigate the value of CEUS in identifying AKI, and analyze the correlation between CEUS and preimplantation biopsy results and early post-transplant renal function of grafts. Methods This prospective study recruited 94 kidneys from brain-dead donors (AKI =44, non-AKI =50) from August 2020 to November 2022. The inclusion criteria were age ≥18 years and brain death. The exclusion criteria encompassed donors maintained with extracorporeal membrane oxygenation (ECMO) and the presence of irregular kidney anatomy. The mean age of the donors was 45.1±10.4 [standard deviation (SD)] years, and the majority were male (86.2%). CEUS was performed prior to organ procurement, and time-intensity curves (TICs) were constructed. The time to peak (TTP) and peak intensity (PI) of kidney segmental artery (KA), kidney cortex (KC), and kidney medulla (KM) were calculated using TIC analysis. Results Arrival time (AT) of KA (P<0.001) and TTP of kidney cortex (TTPKC) (P<0.001) of the non-AKI group were significantly shorter than those of the AKI group. The PI of the KA (P=0.003), KM (P=0.005), and kidney cortex (PIKC; P<0.001) of the non-AKI group were significantly higher than those of the AKI group. Multivariable logistic regression analysis showed that serum creatinine [odds ratio (OR) =1.06; 95% CI: 1.03–1.1; P<0.001], TTPKC (OR =1.38; 95% CI: 1.03–1.84; P=0.03), and PIKC (OR =0.95; 95% CI: 0.91–1; P=0.046) were the independent factors of AKI. The area under the receiver operating characteristic curve (AUC) for identifying AKI for TTPKC and PIKC was 0.73 and 0.71, respectively. TTPKC showed a weak correlation with interstitial fibrosis (r=0.23; P=0.03), PIKC showed a weak correlation with arterial intimal fibrosis ((r=−0.29; P=0.004) and arteriolar hyalinosis (r=−0.27; P=0.008), and PIKC showed the strongest correlation with eGFR on postoperative day 7 (r=−0.46; P=0.046) in the donor kidneys with AKI. Conclusions CEUS can be used to identify AKI in brain-dead donors. Furthermore, there is a correlation between CEUS-derived parameters and pretransplant biopsy results and early preimplantation renal function of grafts.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors

He,

Wu,

Gong

et al. 2023

Quant Imaging Med Surg

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“…CEUS is an established tool in the assessment of focal lesions, but newer studies have focused on the evaluation of whole-organ perfusion. In a recently published study, El-Bandar and colleagues demonstrated only a minor correlation of CEUS parameter and split renal function assessed on preoperative scintigraph evaluation in living kidney donors [ 13 ]. The study results presented an association of signal intensity parameters on CEUS with kidney function only in normal-weight individuals.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Renal Transplant Perfusion by Contrast-Enhanced Ultrasound after Switch from Calcineurin Inhibitor to Belatacept: A Pilot Study

Osmanodja

Muench

Holderied

et al. 2022

JCM

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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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“…Additionally, they introduce a low incidence of side effects, the most severe of which is anaphylactic reaction, which according to WFUMB/EFSUMB recommendations has an incidence rate of 0.014% (considerably lower than that with iodinated CT-0.035-0.095%-or gadolinium-based MRI contrast agents-6.3%) [45,46]. As they do not contain iodine, they do not interact with thyroid function and can be used when renal function is compromised, and they do not lead to contrast-agent nephropathy [47]. An important feature is that CEUS of the kidney can be performed with a lower dose of contrast agent due to higher perfusion and the more superficial location of the kidney [23].…”

Section: Ceus Vs Other Diagnostic Imaging Methodsmentioning

confidence: 99%

Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions

Zbroja,

Kuczyńska,

Drelich

et al. 2024

JCM

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The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.

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Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

Cited by 9 publications

References 30 publications

Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors

Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors

Assessment of Renal Transplant Perfusion by Contrast-Enhanced Ultrasound after Switch from Calcineurin Inhibitor to Belatacept: A Pilot Study

Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions

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