The Usefulness of Contrast-Enhanced Ultrasound in the Assessment of Early Kidney Transplant Function and Complications

Rodríguez, Sara Álvarez; Hevia, Vital; Mayayo, E; Santos, V. Gómez Dos; Nicolas, V.; Gallego, María Dolores Sánchez; Álvaro, J. Lorca; Revilla, F.J. Burgos

doi:10.3390/diagnostics7030053

Cited by 25 publications

(9 citation statements)

References 14 publications

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“…However, the resistivity index (RI) is influenced by extra-renal factors and has low sensitivity and low specificity in the identification of acute renal allograft rejection [7]. Contrast-Enhanced Ultrasonography (CEUS) assesses the microvascular perfusion and is used to identify acute vascular complications and renal graft dysfunction [8]. Real-time elastography (RTE), transient elastography (TE), or acoustic radiation force impulse (ARFI) elastography are used to evaluate renal allograft fibrosis [4,5,9].…”

Section: Introductionmentioning

confidence: 99%

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

Bolboacă

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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: Introductionmentioning

confidence: 99%

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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“…Compared to contrasts used in CT or MRI, they are pure intervascular agents that do not extravasate into the vascular system. They are non-nephrotoxic and can be safely tolerated in patients with renal impairment or renal occlusion [ 40 ]. Contrary to CE CT or MRI, in which the acquisition is performed at definite time-points (i.e., snap shots in time), CEUS provides a real-time, high frame rate representation of contrast distribution, with the ability to record the entire contrast examination with dynamic cine-loops.…”

Section: Discussionmentioning

confidence: 99%

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications

et al. 2022

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Renal transplantation (RT) is the treatment of choice for end-stage renal disease, significantly improving patients’ survival and quality of life. However, approximately 3–23% of patients encounter post-operative complications, and radiology plays a major role for their early detection and treatment or follow-up planning. CT and MRI are excellent imaging modalities to evaluate renal transplant post-operative course; nevertheless, they are both associated with a high cost and low accessibility, as well as some contraindications, making them not feasible for all patients. In particular, gadolinium-based contrast can lead to the rare condition of nephrogenic systemic fibrosis, and iodine-based contrast can lead to contrast-induced nephropathy (CIN). CT also exposes the patients who may require multiple examinations to ionizing radiation. Therefore, considering the overall advantages and disadvantages, contrast-enhanced ultrasound (CEUS) is presently considered an effective first-line imaging modality for post-operative early and long-term follow-up in RT, reducing the need for biopsies and providing adequate guidance for drainage procedures. Hence, this paper aims to review the updated knowledge on CEUS compared with CT and MRI for the evaluation of RT renal transplant complications; advantages, limitations, and possible recommendations are provided.

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“…CEUS has also an increasing role in the evaluation of the transplanted kidney. In fact, it can provide information on renal microcirculation and parenchymal flow, thus permitting clinicians to estimate the vascular complications that led to the renal graft dysfunction or acute rejection [38,39].…”

Section: Discussionmentioning

confidence: 99%

Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS

et al. 2019

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Purpose To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam. Methods In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern. Results Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation. Conclusions CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.

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The Usefulness of Contrast-Enhanced Ultrasound in the Assessment of Early Kidney Transplant Function and Complications

Cited by 25 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

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications

Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS

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