Evaluating Renal Transplant Status Using Viscoelastic Response (VisR) Ultrasound.
Evaluating Renal Transplant Status Using Viscoelastic Response (VisR) Ultrasound.
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DOI：
10.1016/j.ultrasmedbio.2018.03.016
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发表时间：
2018-08
影响因子：
2.9
通讯作者：
Gallippi CM
中科院分区：
文献类型：
--
作者：
Hossain MM;Selzo MR;Hinson RM;Baggesen LM;Detwiler RK;Chong WK;Burke LM;Caughey MC;Fisher MW;Whitehead SB;Gallippi CM
慢性肾病最理想且最经济有效的方法是通过肾移植来治疗，但移植物存活是一个重大挑战。虽然及时治疗可以避免不可逆的移植物损伤，但当标准临床指标未能检测到早期移植物功能障碍时，干预就会被延迟。用于描绘移植物健康状况的更敏感和更具体的参数可能是肾实质的粘弹性特性，可以通过粘弹性响应（VisR）超声（一种基于声辐射力（ARF）的新型成像方法）进行无创检查。本研究的目的是评估 VisR 成像在体内描绘经组织学证实的肾移植病理的性能。 VisR 成像在有（n = 19）和没有（n = 25）肾同种异体移植活检临床指征的患者中进行。 VisR 结果指标（τ、相对弹性 (RE) 和相对粘度 (RV)）的中值是在五个感兴趣区域 (ROI) 中计算的，这些感兴趣区域是在实质（外部、中心和内部）和骨盆（外部和内部）中手动描绘的。计算所有可能的 ROI 组合的给定 VisR 指标的比率，并使用两样本 Wilcoxon 检验对按诊断类别细分的活检患者与非活检对照同种异体移植物之间的相应比率进行统计比较 (p < 0.05)。虽然 τ 比率非特异性区分具有血管疾病、肾小管/间质疤痕、慢性同种异体移植肾病和肾小球肾炎的同种异体移植物与非活检对照同种异体移植物，但 RE 仅区分具有血管疾病和肾小管/间质疤痕的同种异体移植物，而 RV 仅区分血管疾病。这些结果表明，可以使用非侵入性 VisR RE 和 RV 指标来识别具有疤痕和血管疾病的同种异体移植物。
Chronic kidney disease is most desirably and cost-effectively treated by renal transplantation, but graft survival is a major challenge. While irreversible graft damage can be averted by timely treatment, intervention is delayed when early graft dysfunction goes undetected by standard clinical metrics. A more sensitive and specific parameter for delineating graft health could be the viscoelastic properties of the renal parenchyma, which are interrogated noninvasively by Viscoelastic Response (VisR) ultrasound - a new acoustic radiation force (ARF)-based imaging method. Assessing the performance of VisR imaging for delineating histologically confirmed renal transplant pathologies, in vivo, is the purpose of this study. VisR imaging was performed in patients with (n = 19) and without (n=25) clinical indication for renal allograft biopsy. The median values of VisR outcome metrics (τ, relative elasticity (RE), and relative viscosity (RV)) were calculated in five regions of interest (ROIs) that were manually delineated in the parenchyma (outer, center, and inner) and in the pelvis (outer and inner). The ratios of a given VisR metric for all possible ROI combinations were calculated and the corresponding ratios were statistically compared between biopsied patients subdivided by diagnostic categories versus non-biopsied, control allografts using the two-sample Wilcoxon test (p < 0.05). While τ ratios nonspecifically differentiated allografts with vascular disease, tubular/interstitial scarring, chronic allograft nephropathy, and glomerulonephritis from non-biopsied control allografts, RE only distinguished allografts with vascular disease and tubular/interstitial scarring, and RV distinguished only vascular disease. These results suggest that allografts with scarring and vascular disease can be identified using noninvasive VisR RE and RV metrics.
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