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Quantitative ultrasound for non-invasive evaluation of subclinical rejection in renal transplantation

 Deok-Gie Kim  ;  Jun Young Lee  ;  Jhii-Hyun Ahn  ;  Taesic Lee  ;  Minseob Eom  ;  Hyun Seok Cho  ;  Jihye Ku 
 EUROPEAN RADIOLOGY, Vol.33(4) : 2367-2377, 2023-04 
Journal Title
Issue Date
Contrast Media ; Elasticity Imaging Techniques* ; Graft Rejection / diagnostic imaging ; Humans ; Kidney / diagnostic imaging ; Kidney / pathology ; Kidney Transplantation* ; Transplantation, Homologous ; Ultrasonography / methods
Color Doppler ultrasonography ; Contrast agent ; Graft rejection ; Kidney transplantation ; Ultrasonography
Objectives: This study aimed to investigate the predictive efficacy of shear-wave elastography, superb microvascular imaging (SMI), and CEUS for allograft rejection in kidney transplants without graft dysfunction.

Methods: From January 2021 to November 2021, 72 consecutive patients who underwent both allograft biopsy and ultrasound were evaluated. Blood test results were obtained within a week of the ultrasound examinations, which were performed before the protocol biopsy. Resistive index (RI), tissue viscoelasticity, vascular index, and quantitative CEUS parameters were measured. Patients were divided based on biopsy results into the rejection and non-rejection groups.

Results: Among the 72 patients, 21 patients had pathological characteristics of acute rejection. RI of allograft was significantly higher in the rejection group (p = 0.007), compared to the non-rejection group. There were no significant between-group differences in vascular indices of SMI, mean elasticity, and mean viscosity. Meanwhile, among the parameters obtained by the time-intensity curve on CEUS, the cortical and medullary ratios of average contrast signal intensity, peak enhancement, wash-in area AUC, wash-in perfusion index, wash-out AUC, and wash-in and wash-out AUC were significantly different between the two groups (p < 0.05). In the receiver operating characteristic curve analysis for predicting allograft rejection, the AUC was 0.853 for the combination of six CEUS parameters, RI, and blood urea nitrogen.

Conclusions: Among non-invasive quantitative ultrasound measurements, CEUS parameters are the most useful for diagnosing subclinical allograft rejection. Furthermore, the combination of CEUS parameters, RI, and blood urea nitrogen may be helpful for the early detection of renal allograft rejection.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Deok Gie(김덕기)
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