Full-Field-of-View Time-Harmonic Elastography of the Native Kidney

Garcia, Stephan Rodrigo Marticorena; Großmann, Markus; Lang, S.; Trong, Manh Nguyen; Schultz, Michael K.; Guo, Jing; Hamm, Bernd; Braun, Jürgen; Sack, Ingolf; Tzschätzsch, Heiko

doi:10.1016/j.ultrasmedbio.2018.01.007

Cited by 17 publications

(7 citation statements)

References 31 publications

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“…Along this line, other potential confounders of elastography methods such as inflammation, cholestasis, hepatic congestion, and steatosis need to be addressed in future studies in order to develop robust quality criteria. Despite these possible confounders, THE had an excellent test–retest reliability, confirming previous results . A similarly good test–retest reliability was reported for the LiMAx test, rendering the combination of the two tests, THE and LiMAx, suitable for diagnostic purposes.…”

Section: Discussionsupporting

confidence: 85%

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Heucke

Wuensch

Mohr

et al. 2019

J of Gastro and Hepatol

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Background and Aim Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure–function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13C‐methacetin Liver MAximum capacity (LiMAx) test and tissue‐structure related stiffness by 2D time‐harmonic elastography for the assessment of liver disease progression. Methods LiMAx test and time‐harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. Results LiMAx values correlated negatively with liver stiffness (r = −0.747), aminotransferase to platelet ratio index (r = −0.604), and fibrosis 4 (r = −0.573). Median (interquartile range) LiMAx values decreased with fibrosis progression from 395 μg/kg/h (371–460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126–309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52–1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54–1.67 m/s]) to severe fibrosis (1.85 m/s [1.76–1.92 m/s]). Conclusion Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

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Section: Discussionsupporting

confidence: 85%

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Heucke

Wuensch

Mohr

et al. 2019

J of Gastro and Hepatol

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“…For the kidney, on the other hand, the 95% LOA was as large as − 43.5~66.9% despite an excellent interoperator ICC. This discrepancy between the 95% LOA and interoperator ICC in the kidney is thought to be due to the inhomogeneity of the renal parenchyma consisting of the cortex and medulla [30]. Reproducibility depends on both the magnitude of measurement error as well as the true heterogeneity in the population from which measurements are made [31].…”

Section: Discussionmentioning

confidence: 99%

Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers

et al. 2019

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PurposeThis study was conducted in order to assess the intra- and interoperator reproducibility of shear-wave speed (SWS) measurement on elasticity phantoms and healthy volunteers using ultrasound-based point shear-wave elastography.Materials and methodsThis study was approved by the institutional review board. Two operators measured the SWS of five elasticity phantoms and seven organs (thyroid, lymph node, muscle, spleen, kidney, pancreas, and liver) of 30 healthy volunteers with 1.0–4.5 MHz convex (4C1) and 4.0–9.0 MHz linear (9L4) transducers. The phantom measurements were repeated ten times, while the volunteer measurements were performed five times each. Intra- and interoperator reproducibility was assessed. Interoperator reproducibility was also evaluated with the 95% Bland–Altman limits of agreement (LOA).ResultsIn phantoms, all intraclass correlation coefficients (ICCs) were above 0.90 and the 95% LOA between the two operators were less than ± 18%. In volunteers, intraoperator ICCs were > 0.75 for all regions except the pancreas. Interoperator ICC was above 0.75 for the right lobe of the liver (depth 4 cm) and the kidney, but the 95% LOA was less than ± 25% only for the liver.ConclusionAlthough excellent in phantoms, interoperator reproducibility was insufficient for all regions in the volunteers other than the right hepatic lobe at a depth of 4 cm. Clinicians should be aware of the 95% LOA when using SWS in patients.Key Points • Our phantom study indicated a high reproducibility for shear-wave speed (SWS) measurements with point shear-wave elastography (pSWE). • In volunteers, intraoperator reproducibility was generally high, but the interoperator reproducibility was not high enough except for the right hepatic lobe at 4 cm depth. • To evaluate interoperator reproducibility, the 95% limits of agreement (LOA) between operators should be considered in addition to the intraclass correlation coefficient (ICC). Electronic supplementary materialThe online version of this article (10.1007/s00330-019-06195-8) contains supplementary material, which is available to authorized users.

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“…Ultrasound elastography, which provides measurement on tissue stiffness, may be of use in the future to aid in diagnosing pathology of native kidney disease [14]. Elastography research and clinical applications are increasing and we may be seeing its use more in the POCUS arena soon as well.…”

Section: Discussionmentioning

confidence: 99%

“…Elastography research and clinical applications are increasing and we may be seeing its use more in the POCUS arena soon as well. Additionally, contrast enhanced ultrasound may detect small abnormalities in renal parenchyma with comparable sensitivity and specificity to CT scan without the risk of radiation exposure [14]. This may be especially useful in patients with poor renal function such as our patient who are at risk for further nephropathy.…”

Section: Discussionmentioning

confidence: 99%

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Brown

Petersen

Kinas

et al. 2019

Case Reports in Emergency Medicine

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Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and “peeing air.” CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the left kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reflective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner. Often this illness presents similarly to simple, acute pyelonephritis or undifferentiated sepsis. Therefore, POCUS allows for real time consideration of this condition while in the emergency department and thus prompter time to treatment.

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Full-Field-of-View Time-Harmonic Elastography of the Native Kidney

Cited by 17 publications

References 31 publications

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

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