Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis

Abstract

Background: This study aims to observe the dynamic changes of renal artery (RA) disease and cortical blood perfusion (CBP) evaluated by contrast-enhanced ultrasound (CEUS) after percutaneous transluminal renal artery stenting (PTRAS) in patients with severe atherosclerotic renal artery stenosis (ARAS) and to analyze the relationship between CBP and prognosis. Methods: This was a single-center retrospective cohort study. A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included. According to renal glomerular filtration rate (GFR) detected by radionuclide imaging at 12 months after PTRAS, all patients were divided into the poor prognosis group ( n = 21, GFR decreased by ≥20% compared with baseline) and the control group ( n = 77, GFR decreased by < 20% or improved compared with baseline). Renal artery stenosis was diagnosed by digital subtraction angiography, and renal CBP was evaluated by CEUS using TomTec Imaging Systems (Germany) before PTRAS, at 6 months and 12 months after discharge. The receiver operating characteristic (ROC) curve with area under the curve (AUC) was used to analyze the predictive value of CBP parameters, including area under ascending curve (AUC1), area under the descending curve (AUC2), rising time (RT), time to peak intensity (TTP), maximum intensity (IMAX), and mean transit time (MTT) for poor prognosis. Results: Among the 98 patients, there were 52 males (53.1%), aged 55–74 years old, with an average age of 62.1 ± 8.7 years, and an average artery stenosis of 82.3 ± 12.9%. The poor prognosis group was associated with significantly increased incidence of diabetes (76.2% vs . 41.6%), and lower levels of GFR of the stenotic kidney (21.8 mL/min vs . 25.0 mL/min) and total GFR (57.6 mL/min vs . 63.7 mL/min) (all P < 0.05), compared with the control group ( P < 0.05). In addition, the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group (9.5% vs . 0, χ 2 = 9.462, P = 0.002). Compared with the control group, the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2, and extended duration of TTP and MTT ( P < 0.05). At 6 months and 12 months of follow-up, patients in the control group were associated with markedly increased AUC1, AUC2, and IMAX, and shorter duration of RT and MTT ( P < 0.05). The ROC curve showed that the predictive values of AUC1, AUC2, RT, TTP, IMAX, and MTT for poor prognosis were 0.812 (95% CI: 0.698–0.945), 0.752 (95% CI: 0.591–0.957), 0.724 (95% CI: 0.569–0.961), 0.720 (95% CI: 0...

Ultrasound Doppler Flow Parameters Are Independently Associated with Renal Cortex Contrast-Enhanced Multidetector Computed Tomography Perfusion and Kidney Function

“…In recent years, the assessment of renal cortical perfusion has an increasing significance. Ma et al investigated retrospectively 93 patients diagnosed for renal artery stenosis and found that RCP assessed in CEUS is correlated with renal function and the degree of stenosis [ 18 ]. In another work, renal cortex perfusion was the independent factor for renal function decline in 1 year of observation [ 19 ].…”

Quantitative assessment of renal damage in rhesus monkeys with diabetic nephropathy using contrast-enhanced ultrasound

“…Contrast-enhanced ultrasound (CEUS) is a significant advancement in imaging techniques that allows noninvasive quantification of microvascular perfusion in tissues with corresponding quantitative parameters. Some studies (12)(13)(14) showed that CEUS could be used to evaluate renal blood flow perfusion and could identify DN in diabetic patients with kidney damage. However, there are few studies on quantitative CEUS parameters for discriminating DN and evaluating renal function failure.…”