Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis

Maralescu, Felix-Mihai; Chiodan, Milena; Sircuta, Alexandru; Schiller, Adalbert; Petrică, Ligia; Bob, Flaviu

doi:10.3390/app12052359

Cited by 10 publications

(5 citation statements)

References 53 publications

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“…A recent meta-analysis of renal elastography investigations demonstrated that patients with a lower eGFR had lower kidney stiffness on average. However, even though renal elastography appears to be a promising method for monitoring CKD progression, studies up to date reveal great heterogeneity [ 32 ]. As intrarenal blood flow decreases as fibrosis progresses, alterations in renal perfusion may influence renal stiffness and explain some inconsistencies in results.…”

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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“…A decrease in renal stiffness with the progression of CKD has also been shown in other kidney elastography studies [ 10 , 13 , 28 , 29 , 30 , 31 , 32 , 33 ], but there have also been some studies that revealed an increase in stiffness as the disease progressed [ 11 , 34 , 35 , 36 , 37 ]. Despite the fact that renal elastography seems to be a viable technique for tracking the progression of CKD, existing research has revealed substantial differences among such techniques [ 38 ]. The high degree of anisotropy of the kidney [ 39 ] or modifications in renal blood flow may have an impact on renal stiffness and justify the discrepancies in the outcomes.…”

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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“…Thus more comprehensive studies on DMSA scans should be conducted in the future, especially including follow-up scintigraphy, to provide further details on this topic. Another recent meta-analysis study on patients with CRF reported that renal SWV was generally lower in different elastography studies and that the results of various studies differed significantly [16]. Similar to a previous meta-analysis [4], it was suggested that renal elastography could not be considered a solid element of routine monitoring because it required technical improvements.…”

Section: Discussionmentioning

confidence: 79%

Comparison of shear wave elastography and dimercaptosuccinic acid renal cortical scintigraphy in pediatric patients

Salan

Menzilcioğlu

Güler

et al. 2023

Nuclear Medicine Communications

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Background Although it causes low-dose radiation exposure, dimercaptosuccinic acid (DMSA) renal cortical scintigraphy is the gold standard examination method in the noninvasive diagnosis of renal scar tissue (RST). Shear wave elastography (SWE) has recently come to the fore as a technique for measuring kidney stiffness in the examination of RST. The present study aims to compare DMSA and SWE tests to evaluate whether SWE can be used instead of DMSA as a test that does not cause radiation exposure in pediatric patients. Methods In this prospective study, sonographic elastography was performed on pediatric patients with DMSA images. In the SWE examination, measurements were made from each kidney’s upper, middle and lower parts. DMSA and elastography data were compared for the diagnosis of RST. Results A total of 64 patients were included in the present study. There were 68.8% female (n = 44) and 31.2% (n = 20) male patients. There were 45 pediatric patients [Female 30 (66.7%), male 15 (33.3%)] in group 1 (pathological group) and 19 pediatric patients [Female 14 (73.7%), male 5 (26.3%)] in the control group. When DMSA data and SWE values were compared, it was found that elastography did not show a statistically significant performance in predicting renal scarring Conclusion In the existing literature, various studies reported different values for the diagnosis of renal stiffness using SWE. Similar to some previous studies, the present study observed no significant correlations between DMSA and SWE. Thus, DMSA preserves its major role and effectiveness as an important predictor of RST in pediatric patients.

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Are the Currently Available Elastography Methods Useful in the Assessment of Chronic Kidney Disease? A Systematic Review and a Meta-Analysis

Cited by 10 publications

References 53 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

Comparison of shear wave elastography and dimercaptosuccinic acid renal cortical scintigraphy in pediatric patients

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