Measurement of Renal Viscoelastic Properties with Ultrasound

超声测量肾粘弹特性

• 批准号: 9924519
• 负责人: Matthew William Urban
• 金额: $ 61.33万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-07 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9924519
• 关键词: Achievement; Acoustics; Affect; Allografting; Atrophic; Biopsy; Chronic Kidney Failure; Clinic; Clinical; Creatinine; Data; Diagnosis; Diagnostic; Disease; Doppler Ultrasound; End stage renal failure; Equation; Evaluation; Fibrosis; Foundations; Frequencies; Funding; Glomerular Filtration Rate; Goals; Gold; Graft Rejection; Graft Survival; Grant; Health; Health Care Costs; Hemodialysis; Inflammation; Inflammatory; Kidney; Kidney Diseases; Kidney Failure; Kidney Transplantation; Knowledge; Laboratories; Measurement; Measures; Medical; Medical Imaging; Methods; Modeling; Modulus; Monitor; Motion; Nature; Pathology; Patient Monitoring; Patient-Focused Outcomes; Patients; Physiological; Procedures; Process; Progress Reports; Property; Protocols documentation; Publications; Quality of life; Radiation; Renal function; Research; Research Proposals; Risk; Serum; Statistical Data Interpretation; Stress; Structure; Survival Rate; Techniques; Testing; Therapeutic Intervention; Tissue Differentiation; Tissues; Translating; Translations; Tubular formation; Ultrasonography; Waiting Lists; attenuation; base; clinical practice; clinical translation; cost; diagnosis standard; diagnostic accuracy; elastography; experimental study; imaging approach; imaging modality; improved; insight; interstitial; kidney allograft; kidney biopsy; mechanical properties; non-invasive imaging; patient subsets; programs; public health relevance; screening; soft tissue; standard of care; time use; tool; treatment response; viscoelasticity

ABSTRACT/SUMMARY Background: Chronic kidney disease (CKD) encompasses a long-term decrease in function of the kidneys. CKD can progress to kidney failure or end-stage renal disease (ESRD), which is treated by hemodialysis or kidney transplant. Patient and renal graft survival rates have increased over the past two decades, but long- term survival of grafts is still an issue. Renal biopsy is the gold standard for diagnosis of kidney health, but is an invasive procedure, cannot be used frequently, and can cause complications. Noninvasive indicators of kidney disease including levels of serum creatinine, glomerular filtration rate, and classical medical imaging can provide certain insights into kidney disease state. Elasticity imaging methods can discriminate healthy versus diseased tissue based on different parameters measured in the tissue. We have found in the previous cycle of this grant that certain elastographic parameters are sensitive to different structural or physiological changes in renal allografts. Linear and nonlinear elastic mechanical properties were found to be sensitive to the presence of interstitial fibrosis while viscoelastic parameters were sensitive to inflammatory processes and tubular atrophy. Based on these findings, we propose the use of quantitative, noninvasive methods to perform a comprehensive multi-parametric elastographic evaluation of renal allografts to evaluate health of the transplanted kidney. Methods: Ultrasound shear wave-based methods use acoustic radiation force to “push” the tissue and create shear waves. Ultrasound-based methods are used to detect the propagation of the shear waves through the tissue. The propagation velocity of the shear waves can be modified by several parameters including the elastic, viscoelastic, and nonlinear, mechanical properties in the tissue. We will use shear wave elastography (SWE) to measure elastic properties in the kidney using time-of-flight methods. Viscoelastic properties will be measured using a model-based approach by fitting shear wave velocity dispersion to rheological models or a model-free approach that involves extracting measurements of shear wave velocity and attenuation at various frequencies. Lastly, we will use a method called acoustoelasticity, which combines compression of the renal allograft and SWE measurements to estimate the nonlinear elastic modulus from shear modulus data obtained at various levels of applied stress. The parameters extracted from these measurements will be compared with structural (biopsy) and functional measures of kidney health (serum creatinine, estimated glomerular filtration rate, and Doppler ultrasound results) to elucidate how allograft disease changes these parameters. Establishing these relationships will provide a strong foundation for translating these elastographic measurement methods forward for widespread clinical use for assessment of renal allografts. The noninvasive nature of SWE measurements, available on many clinical ultrasound scanners, make them a strong candidate as a tool for reducing the number of biopsies, and to be used for frequent quantitative assessment and monitoring of patients’ responses to treatment, which will lead to reduced healthcare costs and potentially improved patient outcomes. To accomplish these objectives, we propose the following Specific Aims. Aims: 1) Evaluate the use of SWE to measure elastic mechanical properties for the noninvasive assessment of structural and functional changes in renal allografts. 2) Evaluate the use of SWE to measure viscoelastic mechanical properties to assess renal allograft fibrosis, inflammation, and function. 3) Evaluate the use of acoustoelasticity to measure nonlinear elastic mechanical properties to assess pathology and functional changes in renal allografts.

摘要/总结 背景：慢性肾脏病（CKD）包括肾脏功能的长期下降。 CKD 可进展为肾衰竭或终末期肾病 (ESRD)，可通过血液透析或 肾移植。在过去的二十年中，患者和肾移植物的存活率有所提高，但长期 移植物的长期存活仍然是一个问题。肾活检是诊断肾脏健康状况的金标准，但 一种侵入性手术，不能经常使用，并且可能导致并发症。无创指标 肾脏疾病，包括血清肌酐水平、肾小球滤过率和经典医学影像 可以提供对肾脏疾病状态的某些见解。弹性成像方法可以区分健康人 根据组织中测量的不同参数与患病组织进行比较。我们在之前的文章中发现 某些弹性成像参数对不同的结构或生理敏感 同种异体肾移植物的变化。发现线性和非线性弹性机械性能对 间质纤维化的存在，而粘弹性参数对炎症过程敏感， 肾小管萎缩。基于这些发现，我们建议使用定量、非侵入性方法来执行 对同种异体肾移植物进行全面的多参数弹性成像评估，以评估肾移植物的健康状况 移植的肾脏。方法：基于超声剪切波的方法利用声辐射力“推动” 组织并产生剪切波。基于超声波的方法用于检测剪切力的传播 波穿过组织。剪切波的传播速度可以通过几个参数进行修改 包括组织中的弹性、粘弹性和非线性机械特性。我们将使用剪切波 弹性成像 (SWE) 使用飞行时间方法测量肾脏的弹性特性。粘弹性 将使用基于模型的方法通过将剪切波速度色散拟合到 流变模型或涉及提取剪切波速度测量值的无模型方法 以及不同频率下的衰减。最后，我们将使用一种称为声弹性的方法，该方法结合了 同种异体肾移植物的压缩和 SWE 测量以估计非线性弹性模量 在各种施加应力水平下获得的剪切模量数据。从这些中提取的参数 测量结果将与肾脏健康的结构（活检）和功能测量（血清 肌酐、估计肾小球滤过率和多普勒超声结果）来阐明同种异体移植如何 疾病会改变这些参数。建立这些关系将为 将这些弹性成像测量方法广泛应用于临床评估 同种异体肾移植物。 SWE 测量的非侵入性，可用于许多临床超声检查 扫描仪，使它们成为减少活检数量的有力候选工具，并可用于 经常定量评估和监测患者对治疗的反应，这将导致 降低医疗成本并可能改善患者的治疗效果。为了实现这些目标，我们 提出以下具体目标。目标：1) 评估使用 SWE 测量弹性力学 用于对肾同种异体移植物的结构和功能变化进行无创评估的特性。 2）评估 使用 SWE 测量粘弹性机械特性来评估肾同种异体移植物纤维化、炎症、 和功能。 3) 评估使用声弹性来测量非线性弹性机械性能 评估肾同种异体移植物的病理学和功能变化。