Wang Zijie, Yang Haiwei, Suo Chuanjian, Wei Jifu, Tan Ruoyun, Gu Min
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Ultrasound Med. 2017 Sep;36(9):1759-1769. doi: 10.1002/jum.14221. Epub 2017 May 15.
Interstitial fibrosis is the main characteristic of chronic allograft dysfunction, which remains the key factor affecting long-term allograft survival after kidney transplantation. Ultrasound elastography (UE), including real-time elastography, transient elastography, and acoustic radiation force impulse, has been applied widely in breast, thyroid, and liver diseases, especially in the assessment of liver fibrosis. Recently, numerous studies have reported the efficacy of UE methods in evaluating renal allograft fibrosis. This review aims to investigate the clinical applications, limitations, and future roles of UE in current clinical practice in light of changing management paradigms. In current clinical practice, UE methods, especially transient elastographic measurement, appear to be useful for ruling out fibrosis but do not have sufficient accuracy to distinguish between various stages of allograft fibrosis. Moreover, there remain considerable issues to be solved for the application of UE in kidney transplantation. Thus, UE methods cannot replace the crucial role of renal allograft biopsy in the diagnosis and evaluation of allograft fibrosis in kidney transplantation. Perhaps UE methods could be of more importance in the long-term observation and evaluation of allograft fibrosis during follow-up.
间质纤维化是慢性移植肾失功的主要特征，仍是影响肾移植后移植肾长期存活的关键因素。超声弹性成像（UE），包括实时弹性成像、瞬时弹性成像和声辐射力脉冲成像，已广泛应用于乳腺、甲状腺和肝脏疾病，尤其是在肝纤维化评估方面。最近，大量研究报道了UE方法在评估移植肾纤维化中的有效性。本综述旨在根据不断变化的管理模式，探讨UE在当前临床实践中的临床应用、局限性及未来作用。在当前临床实践中，UE方法，尤其是瞬时弹性成像测量，似乎有助于排除纤维化，但在区分移植肾纤维化的不同阶段方面准确性不足。此外，UE在肾移植中的应用仍有相当多问题有待解决。因此，UE方法无法取代移植肾活检在肾移植中对移植肾纤维化诊断和评估的关键作用。或许UE方法在随访期间对移植肾纤维化的长期观察和评估中可能更重要。
