Early Heather M, Cheang Ellen C, Aguilera Jorge M, Hirschbein Jonah S W, Fananapazir Ghaneh, Wilson Machelle D, McGahan John P
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA.
J Ultrasound Med. 2018 Jun;37(6):1455-1465. doi: 10.1002/jum.14487. Epub 2017 Nov 16.
To evaluate the utility of ultrasound-based shear wave elastography (SWE) as a noninvasive method to accurately detect and potentially stage the severity of renal allograft fibrosis and assess its user reproducibility.
In this Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 70 renal transplant recipients underwent an SWE evaluation of their allograft followed directly by biopsy. Two radiologists performed separate SWE measurement acquisitions and the mean, median, and standard deviation of 10 SWE measurements, obtained separately within the cortex and the medulla, were automatically computed. Each patient's SWE results were subsequently compared to their histologic fibrosis scores. The Fisher exact test and univariate logistic regression models were fit to test for associations between the presence of fibrosis (yes/no) as well as categorical SWE results based on the fibrosis severity, ranging from F0 (no fibrosis) to F3 (severe fibrosis), correlating with histologic scores according to the 2007 Banff classification system. Interobserver and intraobserver correlations were also examined.
Our median medulla SWE values reached statistical significance (P = .04) in association with fibrosis. Furthermore, for every unit increase in the median medulla SWE measurement, the odds of fibrosis increased by approximately 20%. No statistical significance was found for mean cortical, median cortical, or mean medullary SWE values (P = .32, .37, and .06, respectively) in association with fibrosis.
The use of SWE for assessing renal allograft fibrosis is challenging but promising. Further investigation with a larger sample size remains to validate our initial results and establish clinical relevance.
评估基于超声的剪切波弹性成像（SWE）作为一种无创方法，准确检测肾移植纤维化严重程度并进行潜在分期，以及评估其使用者可重复性的效用。
在这项经机构审查委员会批准、符合《健康保险流通与责任法案》的前瞻性研究中，70例肾移植受者接受了对其移植肾的SWE评估，随后直接进行活检。两名放射科医生分别进行SWE测量采集，并自动计算在皮质和髓质内分别获得的10次SWE测量的平均值、中位数和标准差。随后将每位患者的SWE结果与其组织学纤维化评分进行比较。采用Fisher精确检验和单变量逻辑回归模型，以检验纤维化存在与否以及基于纤维化严重程度的分类SWE结果（范围从F0（无纤维化）到F3（严重纤维化））与根据2007年Banff分类系统的组织学评分之间的关联。还检查了观察者间和观察者内的相关性。
我们的髓质SWE中位数与纤维化相关，差异有统计学意义（P = 0.04）。此外，髓质SWE中位数测量每增加一个单位，纤维化的几率增加约20%。皮质平均、皮质中位数或髓质平均SWE值与纤维化相关均未发现统计学意义（P分别为0.32、0.37和0.06）。
使用SWE评估肾移植纤维化具有挑战性但前景光明。需要更大样本量的进一步研究来验证我们的初步结果并确立临床相关性。
