Renal Allograft Dysfunction: Evaluation with Shear-wave                    Sonoelastography

Ghonge, Nitin P; Mohan, Mohita; Kashyap, Vikas; Jasuja, Sanjiv

doi:10.1148/radiol.2018170577

Cited by 33 publications

(22 citation statements)

References 14 publications

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“…Furthermore, the patients with allograft dysfunction had a significantly higher stiffness at the cortex as compared to those with stable allograft function (p-value < 0.02). The values of the tissue stiffness at cortex in our study are similar to those reported by Ma et al [23], but the medians are slightly higher as compared to the values reported by Ghonge et al for chronic allograft dysfunction (24.50 kPa ± 4.49 (range, 17.07-32.98 kPa)) [22]. Grenier et al [48] performed a pilot study and quantified the kidney allograft stiffness using supersonic shear imaging (SSI) [49] that use two spatially extended plane shear waves and consequently enlarge the area of available information.…”

Section: Discussionsupporting

confidence: 89%

“…Considering the small number of patients with kidney allograft dysfunction, these results need to be validated on larger cohort. Previous studies have reported significant correlation of kidney allograft stiffness with eGRF (negative), RI (positive) and serum creatinine level (positive) (p-values < 0.05) [22,50,51]. The positive correlation of parenchymal stiffness with serum creatinine level could reflect the link between allograft function and stiffness, but this relation was not proven in our study, nor in the study conducted by Brocchi et al [52].…”

Section: Discussioncontrasting

confidence: 78%

“…Shear wave elastography is considered potentially suitable elastography method for the assessment of fibrosis in kidney recipients, but no examination protocol or reference value had yet established [37]. A small amount of evidence relating to SWE for kidney transplant evaluation exists in the scientific literature, showing higher parenchymal stiffness in kidney allograft as compared to stable function [22,23], association with fibrosis [19], significantly lower stiffness values in overweight or obese patients [37]. We conducted this study to examine the intra-and inter-examinations variability of kidney allografts SWE stiffness as an additional tool in post kidney transplantation evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Early et al summarized personal experience in the SWE evaluation of patients with kidney transplant and listed the following factors that affect the SWE measurements: anisotropy (increased or decreased SWE according to the orientation of medullary pyramids reported to the US beam), urinary pressure (increases SWE, urine pressure determine compression of renal parenchyma), hydronephrosis (increases SWE), vascular occlusions (arterial stenosis decreases SWE by hypoperfusion, venous stenosis increases SWE due to the increased parenchymal pressure), and body mass index (decrease SWE, multifactorial mechanism) [21]. Ghonge et al evaluated the role of SWE in the differentiation of stable renal allograft from acute allograft dysfunction on a sample of 72 patients (stable function in 30 patients, acute dysfunction in 19 patients and chronic dysfunction in 11 patients) and showed significantly higher parenchymal stiffness on patients with chronic allograft dysfunction (stiffness values in stable function < stiffness values in acute allograft dysfunction < stiffness values in Diagnostics 2020, 10, 41 3 of 17 chronic allograft dysfunction (p-value, p < 0.02) [22]. Ma et al reported a median stiffness at the cortex of 22.3 kPa (IQR = (19.0-26.5) kPa) and at the medulla of 15.0 kPa (IQR = (13.7-18.0) kPa) in patients with kidney allograft tubulointerstitial fibrosis and a significant correlation between semiquantitative Banff ci/ct score and cortical (p-value = 0.004) and medullary (p-value < 0.001) tissue stiffness [23].…”

Section: Introductionmentioning

confidence: 98%

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

Bolboacă

Elec

Elec³

et al. 2020

Diagnostics

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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

Bolboacă

Elec

Elec³

et al. 2020

Diagnostics

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“…A more recent prospective study to evaluate the value of SWS for the differentiation of stable allograft function from acute and chronic allograft dysfunction was performed by Ghonge et al The study revealed that SWS can help to differentiate stable allograft function from acute and chronic dysfunction in addition to laboratory and Doppler-based parameters [37].…”

Section: Ultrasoundmentioning

confidence: 99%

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Jehn

Schuette-Nuetgen

Kentrup

et al. 2019

Contrast Media & Molecular Imaging

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To date, allogeneic kidney transplantation remains the best available therapeutic option for patients with end-stage renal disease regarding overall survival and quality of life. Despite the advancements in immunosuppressive drugs and protocols, episodes of acute allograft rejection, a sterile inflammatory process, continue to endanger allograft survival. Since effective treatment for acute rejection episodes is available, instant diagnosis of this potentially reversible graft injury is imperative. Although histological examination by invasive core needle biopsy of the graft remains the gold standard for the diagnosis of ongoing rejection, it is always associated with the risk of causing substantial graft injury as a result of the biopsy procedure itself. At the same time, biopsies are not immediately feasible for a considerable number of patients taking anticoagulants due to the high risk of complications such as bleeding and uneven distribution of pathological changes within the graft. This can result in the wrong diagnosis due to the small size of the tissue sample taken. Therefore, there is a need for a tool that overcomes these problems by being noninvasive and capable of assessing the whole organ at the same time for specific and fast detection of acute allograft rejection. In this article, we review current state-of-the-art approaches for noninvasive diagnostics of acute renal transplant inflammation, i.e., rejection. We especially focus on nonradiation-based methods using magnetic resonance imaging (MRI) and ultrasound.

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Evaluation of the Graft Kidney in the Early Postoperative Period

Goyal

Hemachandran

Kumar

et al. 2020

J of Ultrasound Medicine

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Objectives-To evaluate the various quantitative parameters of Doppler ultrasound, contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) of graft kidneys in the early postoperative period and to explore their utility in the diagnosis of parenchymal causes of graft dysfunction.Methods-In this ethically approved study, consecutive patients who underwent renal transplantation from March 2017 to August 2018 were recruited, and those with urologic or vascular complications and those who denied consent were excluded. All patients underwent ultrasound with Doppler, SWE, CEUS (using sulfur hexafluoride), and renal scintigraphic examinations 3 to 10 days after transplantation. A composite reference standard was used, including the clinical course, renal function test results, urine output, and histopathologic results for graft dysfunction. Cortical SWE values, quantitative CEUS parameters (generated from a time-intensity curve), and their ratios were analyzed to identify graft dysfunction and differentiate acute tubular necrosis (ATN) from acute rejection (AR).Results-Of the 105 patients included, 19 developed graft dysfunction (18.1%; 12 ATN, 5 AR, and 2 drug toxicity) in the early postoperative period. The peak systolic velocity in the interpolar artery showed a significant difference between control and graft dysfunction groups (P < .001) as well as between ATN and AR (P = .019). Resistive indices and SWE did not show significant differences. Ratios of the time to peak showed a significant difference between control and graft dysfunction groups (P < .05). The rise time and fall time of the large subcapsular region of interest and the rise time ratio were significantly different between ATN and AR (P = .03).Conclusions-Contrast-enhanced ultrasound can be used to diagnose parenchymal causes of early graft dysfunction with reasonable diagnostic accuracy.

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Renal Allograft Dysfunction: Evaluation with Shear-wave Sonoelastography

Cited by 33 publications

References 14 publications

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

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

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Evaluation of the Graft Kidney in the Early Postoperative Period

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