Tomoelastography for Longitudinal Monitoring of Viscoelasticity Changes in the Liver and in Renal Allografts after Direct-Acting Antiviral Treatment in 15 Kidney Transplant Recipients with Chronic HCV Infection

Abstract

Besides the liver, hepatitis C virus (HCV) infection also affects kidney allografts. The aim of this study was to longitudinally evaluate viscoelasticity changes in the liver and in kidney allografts in kidney transplant recipients (KTRs) with HCV infection after treatment with direct-acting antiviral agents (DAAs). Fifteen KTRs with HCV infection were treated with DAAs (daclatasvir and sofosbuvir) for 3 months and monitored at baseline, end of treatment (EOT), and 3 (FU1) and 12 (FU2) months after EOT. Shear-wave speed (SWS) and loss angle of the complex shear modulus (φ), reflecting stiffness and fluidity, respectively, were reconstructed from multifrequency magnetic resonance elastography data with tomoelastography post-processing. After virus elimination by DAAs, hepatic stiffness and fluidity decreased, while kidney allograft stiffness and fluidity increased compared with baseline (hepatic stiffness change at FU1: −0.14 m/s, p < 0.01, and at FU2: −0.11 m/s, p < 0.05; fluidity at FU1: −0.05 rad, p = 0.04 and unchanged at FU2: p = 0.20; kidney allograft stiffness change at FU1: +0.27 m/s, p = 0.01, and at FU2: +0.30 m/s, p < 0.01; fluidity at FU1 and FU2: +0.06 rad, p = 0.02). These results suggest the restoration of mechanically sensitive structures and functions in both organs. Tomoelastography can be used to monitor the therapeutic results of HCV treatment non-invasively on the basis of hepatic and renal viscoelastic parameters.

Magnetic resonance elastography resolving all gross anatomical segments of the kidney during controlled hydration

“… i) High resolution MRE within a feasible breath-hold time was performed with fractional motion encoding ( Rump et al, 2007 ). From the existing literature, no study achieved a smaller voxel volume, and only one method/group, using multifrequency MRE (tomoelastography with weighted shear wave calculations), published seven papers using the same resolution with a voxel volume of 16 mm³ ( Streitberger et al, 2014 ; Marticorena Garcia et al, 2016 ; Marticorena Garcia et al, 2018a ; Marticorena Garcia et al, 2018b ; Lang et al, 2019 ; Marticorena Garcia et al, 2019 ; Marticorena Garcia et al, 2021 ), of which only one study deployed breath-hold acquisition similar to that used in this study ( Marticorena Garcia et al, 2016 ). Our rationale to acquire high-resolution data, even with the drawback of reduced SNR, is that the structures within the kidney are relatively small.…”

“… ii) To our knowledge, this is the first study to use a rotating eccentric mass to induce acoustic waves into the kidney ( Runge et al, 2018 ; Manduca et al, 2021 ). So far, only pneumatic ( Bensamoun et al, 2011 ; Rouvière et al, 2011 ; Lee et al, 2012 ; Low et al, 2015 ; Marticorena Garcia et al, 2016 ; Dittmann et al, 2017 ; Kirpalani et al, 2017 ; Marticorena Garcia et al, 2018a ; Marticorena Garcia et al, 2018b ; Kline et al, 2018 ; Gandhi et al, 2019 ; Lang et al, 2019 ; Marticorena Garcia et al, 2019 ; Brown et al, 2020 ; Gandhi et al, 2020 ; Han et al, 2020 ; Kennedy et al, 2020 ; Marticorena Garcia et al, 2021 ; Zhang et al, 2021 ; Dillman et al, 2022 ; Güven et al, 2022 ; Shatil et al, 2022 ; Chen et al, 2023a ; Chen et al, 2023b ; Elsingergy et al, 2023 ), or piezoelectric drivers ( Streitberger et al, 2014 ) were used. Only one study reported the total shear displacement from 8–35 μm at 45 and 76 Hz (pneumatic system) ( Rouvière et al, 2011 ).…”

“…Since then, MRE methods have been improved and have shed light on the potential to assess (patho-) physiological renal processes ( Morrell et al, 2017 ). According to a Pubmed search, 20 October 2023, we could identify 26 studies on the human kidney (excluding animal, ex-vivo and tumor studies) ( Bensamoun et al, 2011 ; Rouvière et al, 2011 ; Lee et al, 2012 ; Streitberger et al, 2014 ; Low et al, 2015 ; Marticorena Garcia et al, 2016 ; Dittmann et al, 2017 ; Kirpalani et al, 2017 ; Marticorena Garcia et al, 2018a ; Marticorena Garcia et al, 2018b ; Kline et al, 2018 ; Gandhi et al, 2019 ; Lang et al, 2019 ; Marticorena Garcia et al, 2019 ; Brown et al, 2020 ; Gandhi et al, 2020 ; Han et al, 2020 ; Kennedy et al, 2020 ; Marticorena Garcia et al, 2021 ; Zhang et al, 2021 ; Dillman et al, 2022 ; Güven et al, 2022 ; Shatil et al, 2022 ; Chen et al, 2023a ; Chen et al, 2023b ; Elsingergy et al, 2023 ). So far, only pneumatic ( Bensamoun et al, 2011 ; Rouvière et al, 2011 ; Lee et al, 2012 ; Low et al, 2015 ; Marticorena Garcia et al, 2016 ; Dittmann et al, 2017 ; Kirpalani et al, 2017 ; Marticorena Garcia et al, 2018a ; Marticorena Garcia et al, 2018b ; Kline et al, 2018 ; Gandhi et al, 2019 ; Lang et al, 2019 ; Marticorena Garcia et al, 2019 ; Brown et al, 2020 ; Gandhi et al, 2020 ; Han et al, 2020 ; Kennedy et al, 2020 ; Marticorena Garcia et al, 2021 ; Zhang et al, 2021 ; Dillman et al, 2022 ; Güven et al, 2022 ; Shatil et al, 2022 ; Chen et al, 2023a ; Chen et al, 2023b ...…”

“…According to a Pubmed search, 20 October 2023, we could identify 26 studies on the human kidney (excluding animal, ex-vivo and tumor studies) ( Bensamoun et al, 2011 ; Rouvière et al, 2011 ; Lee et al, 2012 ; Streitberger et al, 2014 ; Low et al, 2015 ; Marticorena Garcia et al, 2016 ; Dittmann et al, 2017 ; Kirpalani et al, 2017 ; Marticorena Garcia et al, 2018a ; Marticorena Garcia et al, 2018b ; Kline et al, 2018 ; Gandhi et al, 2019 ; Lang et al, 2019 ; Marticorena Garcia et al, 2019 ; Brown et al, 2020 ; Gandhi et al, 2020 ; Han et al, 2020 ; Kennedy et al, 2020 ; Marticorena Garcia et al, 2021 ; Zhang et al, 2021 ; Dillman et al, 2022 ; Güven et al, 2022 ; Shatil et al, 2022 ; Chen et al, 2023a ; Chen et al, 2023b ; Elsingergy et al, 2023 ). So far, only pneumatic ( Bensamoun et al, 2011 ; Rouvière et al, 2011 ; Lee et al, 2012 ; Low et al, 2015 ; Marticorena Garcia et al, 2016 ; Dittmann et al, 2017 ; Kirpalani et al, 2017 ; Marticorena Garcia et al, 2018a ; Marticorena Garcia et al, 2018b ; Kline et al, 2018 ; Gandhi et al, 2019 ; Lang et al, 2019 ; Marticorena Garcia et al, 2019 ; Brown et al, 2020 ; Gandhi et al, 2020 ; Han et al, 2020 ; Kennedy et al, 2020 ; Marticorena Garcia et al, 2021 ; Zhang et al, 2021 ; Dillman et al, 2022 ; Güven et al, 2022 ; Shatil et al, 2022 ; Chen et al, 2023a ; Chen et al, 2023b ; Elsingergy et al, 2023 ), or piezoelectric drivers ( Streitberger et al, 2014 ) were use...…”

Noninvasive Liver Fibrosis Staging: Comparison of MR Elastography with Extracellular Volume Fraction Analysis Using Contrast-Enhanced CT

“…Previous studies have reported the usefulness of imaging examinations such as computed tomography (CT) and magnetic resonance (MR) imaging for noninvasively evaluating liver fibrosis [ 1 , 2 , 3 , 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Hepatic extracellular volume fraction (fECV) analysis with contrast-enhanced CT is another noninvasive method for evaluating liver fibrosis.…”