Hu Qiao, Wang Xiao-Yan, He Hong-Guang, Wei Hai-Ming, Kang Li-Ke, Qin Gui-Can
Department of Diagnostic Ultrasound, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Department of Nephrology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
PLoS One. 2014 Dec 29;9(12):e115051. doi: 10.1371/journal.pone.0115051. eCollection 2014.
To investigate the stiffness values obtained by acoustic radiation force impulse (ARFI) quantification in assessing renal histological fibrosis of chronic kidney disease (CKD).
163 patients with CKD and 32 healthy volunteers were enrolled between June 2013 and April 2014. ARFI quantification, given as shear wave velocity (SWV), was performed to measure renal parenchyma stiffness. Diagnostic performance of ARFI imaging and conventional ultrasound (US) were compared with histologic scores at renal biopsy. Intra- and inter-observer reliability of SWV measurement was analyzed.
In CKD patients, SWV measurements correlated significantly with pathological parameters (r = -0.422--0.511, P<0.001), serum creatinine (r = -0.503, P<0.001), and glomerular filtration rate (r = 0.587, P<0.001). The mean SWV in kidneys with severely impaired (histologic score: ≥19 points) was significant lower than that mildly impaired (histologic score: ≤9 points), moderately impaired (histologic score: 10-18 points), and control groups (all P<0.001). Receiver operating characteristic (ROC) curves analyses indicated that the area under the ROC curve for the diagnosis of renal histological fibrosis using ARFI imaging was superior to these conventional US parameters. Using the optimal cut-off value of 2.65 m/s for the diagnosis of mildly impaired kidneys, 2.50 m/s for moderately impaired kidneys, and 2.33 m/s for severely impaired kidneys, the corresponding area under the ROC curves were 0.735, 0.744, and 0.895, respectively. Intra- and intre-observer agreement of SWV measurements were 0.709 (95% CI: 0.390-0.859, P<0.001) and 0.627 (95% CI: 0.233-0.818, P = 0.004), respectively.
ARFI may be an effective tool for evaluating renal histological fibrosis in CKD patients.
探讨通过声辐射力脉冲（ARFI）定量获得的硬度值在评估慢性肾脏病（CKD）肾组织学纤维化中的应用。
2013年6月至2014年4月纳入163例CKD患者和32名健康志愿者。采用ARFI定量技术，以剪切波速度（SWV）来测量肾实质硬度。将ARFI成像和传统超声（US）的诊断性能与肾活检的组织学评分进行比较。分析SWV测量的观察者内和观察者间可靠性。
在CKD患者中，SWV测量值与病理参数（r = -0.422至-0.511，P<0.001）、血清肌酐（r = -0.503，P<0.001）和肾小球滤过率（r = 0.587，P<0.001）显著相关。组织学评分严重受损（≥19分）的肾脏平均SWV显著低于轻度受损（组织学评分：≤9分）、中度受损（组织学评分：10 - 18分）和对照组（均P<0.001）。受试者工作特征（ROC）曲线分析表明，使用ARFI成像诊断肾组织学纤维化的ROC曲线下面积优于这些传统US参数。对于轻度受损肾脏诊断的最佳截断值为2.65 m/s，中度受损肾脏为2.50 m/s，重度受损肾脏为2.33 m/s，相应的ROC曲线下面积分别为0.735、0.744和0.895。SWV测量的观察者内一致性为0.709（95%CI：0.390 - 0.859，P<0.001），观察者间一致性为0.627（95%CI：0.233 - 0.818，P = 0.004）。
ARFI可能是评估CKD患者肾组织学纤维化的有效工具。
