Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta‐Analysis

Hwang, Ji-Sun; Kim, Hae Won; Kim, Pyeong Hwa; Suh, Chong Hyun; Yoon, Hyung Ku

doi:10.1002/jum.15654

Cited by 14 publications

(10 citation statements)

References 34 publications

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“…The meta-analysis of Hwang et al 2021 [ 28 ] determined the technical performance of ARFI for evaluating renal parenchymal stiffness. The percentages of technical faults and intrasubject correlation coefficient indicated good agreement in both native and transplanted kidneys, but also that the region of interest location represented a significant factor of heterogeneity in transplanted kidneys.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Renal Allograft Stiffness and Viscosity Using 2D SWE PLUS and Vi PLUS Measures—A Pilot Study

Maralescu

Bende²,

Sporea³

et al. 2022

JCM

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Elastography is a useful noninvasive tool for the assessment of renal transplant recipients. 2D-shear wave elastography (SWE) PLUS and viscosity plane-wave ultrasound (Vi PLUS) have emerged as novel techniques that promise to offer improved renal stiffness and viscosity measures due to improved processing algorithms. Methods: We performed a cross-sectional study of 50 kidney transplanted patients (16 women, 34 men; mean age of 47.5 ± 12.5; mean estimated glomerular filtration rate (eGFR) estimated by Chronic Kidney Disease Epidemiology Collaboration formula: 52.19 ± 22.6 mL/min/1.73 m2; and a mean duration after transplant of 10.09 ± 5 years). For every patient, we obtained five valid measurements of renal stiffness (obtained from five different frames in the cortex of the renal graft), and also tissue viscosity, with a C6-1X convex transducer using the Ultra-Fast™ software available on the Aixplorer Mach 30 ultrasound system (Supersonic Imagine, Aix-en-Provence, France). The median values of elastographic and viscosity measures have been correlated with the patients’ demographic, biological, and clinical parameters. Results: We obtained a cut-off value of renal cortical stiffness of <27.3 kiloPascal(kPa) for detection of eGFR < 60 mL/min/1.73 m2 with 80% sensitivity and 85% specificity (AUC = 0.811, p < 0.0001), a cut-off value of <26.9 kPa for detection of eGFR < 45 mL/min/1.73 m2 with 82.6% sensitivity and 74% specificity (AUC = 0.789, p < 0.0001), and a cut-off value of <23 kPa for detection of eGFR < 30 mL/min/1.73 m2 with 88.8% sensitivity and 75.6% specificity (AUC = 0.852, p < 0.0001). We found a positive correlation coefficient between eGFR and the median measure of renal cortical stiffness (r = 0.5699, p < 0.0001), between eGFR the median measure of viscosity (r = 0.3335, p = 0.0180), between median depth of measures and renal cortical stiffness (r = −0.2795, p = 0.0493), and between median depth of measures and body mass index (BMI) (r = 0.6574, p < 0.0001). Our study showed good intra-operator agreement for both 2D SWE PLUS measures—with an intraclass correlation coefficient (ICC) of 0.9548 and a 95% CI of 0.9315 to 0.9719—and Vi PLUS, with an ICC of 0.8323 and a 95% CI of 0.7457 to 0.8959. The multivariate regression model showed that 2D SWE PLUS values were associated with eGFR, Vi PLUS, and depth of measures. Conclusions: Assessment of renal allograft stiffness and viscosity may prove to be an effective method for identifying patients with chronic allograft injury and could prove to be a low-cost approach to provide additional diagnostic information of kidney transplanted patients.

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Section: Discussionmentioning

confidence: 99%

Assessment of Renal Allograft Stiffness and Viscosity Using 2D SWE PLUS and Vi PLUS Measures—A Pilot Study

Maralescu

Bende²,

Sporea³

et al. 2022

JCM

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“…The performance capability of acoustic radiation force impulse for measuring renal parenchymal stiffness was assessed in a meta-analysis by Hwang et al, 2021 [ 45 ]. The proportions of technical difficulties and intrasubject correlation coefficients agreed well in native and transplanted kidneys, but the placement of the ROI was a major cause of heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Evaluation of Kidney Elasticity and Viscosity in a Healthy Cohort

et al. 2022

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Introduction: There is currently a lack of published data on kidney elasticity and viscosity. Non-invasive techniques, such as two-dimensional shear-wave elastography (2D-SWE PLUS) and viscosity plane-wave ultrasound (Vi PLUS), have surfaced as new detection methods, which, thanks to efficient processing software, are expected to improve renal stiffness and viscosity measurements. This study aims to be the first one to assess the normal range values in normal renal function subjects and to investigate the factors that impact them. Methods: We conducted a cross-sectional study employing 50 participants (29 women and 21 men) with a mean age of 42.22 ± 13.17, a mean estimated glomerular filtration rate (eGFR) of 97.12 ± 11 mL/min/1.73 m2, a mean kidney length of 10.16 ± 0.66 cm, and a mean body mass index (BMI) of 24.24 ± 3.98. With a C6-1X convex transducer and the Ultra-FastTM software available on the Hologic Aixplorer Mach 30 ultrasound system, we acquired five measurements of renal cortical stiffness and viscosity (achieved from five distinct images in the middle part of the subcapsular cortex) from each kidney. The ten measurements’ median values correlated with the participant’s demographical, biological, and clinical parameters. Results: The mean kidney elasticity was 31.88 ± 2.89 kiloPascal (kPa), and the mean viscosity was 2.44 ± 0.57 Pascal.second (Pa.s) for a mean measurement depth 4.58 ± 1.02cm. Renal stiffness seemed to be influenced by age (r = −0.7047, p < 0.0001), the measurement depth (r = −0.3776, p = 0.0075), and eGFR (r = 0.6101,p < 0.0001) but not by BMI (r = −0.2150, p = 0.1338), while viscosity appeared to be impacted by age (r= −0.4251, p = 0.0021), eGFR (r = 0.4057, p = 0.0038), the measurement depth (r= −0.4642, p = 0.0008), and BMI (r= −0.3676, p = 0.0086). The results of the one-way ANOVA used to test the differences in the variables among the three age sub-groups are statistically significant for both 2D-SWE PLUS (p < 0.001) and Vi PLUS (p = 0.015). The method found good intra-operator reproducibility for the 2D-SWE PLUS measurements, with an ICC of 0.8365 and a 95% CI of 0.7512 to 0.8990, and for the Vi PLUS measurements, with an ICC of 0.9 and a 95% CI of 0.8515 to 0.9397. Conclusions: Renal stiffness and viscosity screening may become an efficacious, low-cost way to gather supplemental diagnostic data from patients with chronic kidney disease (CKD). The findings demonstrate that these non-invasive methods are highly feasible and not influenced by gender and that their values correlate with renal function and decrease with age progression. Nevertheless, more research is required to ascertain their place in clinical practice.

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“…Despite the above-mentioned difficulties in performing renal elastography, if the approach of the kidneys is standardized, it has been proven that the method has good interobserver reproducibility, and thus has the potential to be used in clinical practice [24,25].…”

Section: Methods Descriptionmentioning

confidence: 99%

Renal Elastography for the Assessment of Chronic Kidney Disease

Bob¹

2022

Elastography - Applications in Clinical Medicine

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For the assessment of chronic kidney disease, point shear wave elastography (pSWE) and shear wave speed imaging (2D-SWE) are suitable, but the use of elastography in the assessment of the kidneys is more difficult compared to the use in other organs, because of the complex architecture of the kidneys, characterized by a high anisotropy and also by the limited size of the renal parenchyma, where the measurements are performed. Despite the difficulties of renal elastography, the reproducibility of the method is good. Kidney shear wave speed values are influenced mainly by age and gender, while in chronic kidney disease, renal stiffness is sometimes decreased in more advanced disease and is not influenced mainly by the progression of fibrosis. There are studies proving that a decreased renal blood flow is associated with a decrease in kidney shear wave speed, the fact that could explain why patients with CKD tend to have lower kidney stiffness. Elastography is a real-time imaging method that could be useful in the assessment of the kidneys, but more extensive studies and even some improvements of the processing algorithms of raw data of elastography machines seem to be needed to implement the use in clinical practice.

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Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta‐Analysis

Cited by 14 publications

References 34 publications

Assessment of Renal Allograft Stiffness and Viscosity Using 2D SWE PLUS and Vi PLUS Measures—A Pilot Study

Assessment of Renal Allograft Stiffness and Viscosity Using 2D SWE PLUS and Vi PLUS Measures—A Pilot Study

Non-Invasive Evaluation of Kidney Elasticity and Viscosity in a Healthy Cohort

Renal Elastography for the Assessment of Chronic Kidney Disease

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