Ma Maggie Km, Law Helen Kw, Tse Kin Sun, Chan Kwok Wah, Chan Gary Cw, Yap Desmond Yh, Mok Maggie My, Kwan Lorraine Py, Tang Sydney Cw, Choy Bo Ying, Chan Tak Mao
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
Int J Urol. 2018 May;25(5):450-455. doi: 10.1111/iju.13536. Epub 2018 Feb 14.
To evaluate the use of shear wave elastography in assessment of kidney allograft tubulointerstitial fibrosis.
Shear wave elastography assessment was carried out by two independent operators in kidney transplant recipients who underwent allograft biopsy for clinical indications (i.e. rising creatinine >15% or proteinuria >1 g/day). Allograft biopsies were interpreted by the same pathologist according to the 2013 Banff Classification.
A total of 40 elastography scans were carried out (median creatinine 172.5 μmol/L [interquartile range 133.8-281.8 μmol/L]). Median tissue stiffness at the cortex (22.6 kPa [interquartile range 18.8-25.7 kPa] vs 22.3 kPa [interquartile range 19.0-26.5 kPa], P = 0.70) and medulla (15.0 kPa [interquartile range 13.7-18.0 kPa] vs 15.6 kPa [interquartile range 14.4-18.2 kPa]) showed no significant differences between the two observers. Interobserver agreement was satisfactory (intraclass correlation coefficient of the cortex 0.84, 95% CI 0.70-0.92 and intraclass correlation coefficient of the medulla 0.88, 95% CI 0.78-0.94). The areas under the receiver operating characteristic curves for detection of tubulointerstitial fibrosis were estimated to be 0.75 (95% CI 0.61-0.89), 0.85 (95% CI 0.75-0.95) and 0.65 (95% CI 0.53-0.78) for cortical, medullary tissue stiffness and serum creatinine, respectively.
Shear wave elastography can be used as a non-invasive tool to evaluate kidney allograft fibrosis with reasonable interobserver agreement and superior test performance to serum creatinine in detecting early tubulointerstitial fibrosis.
评估剪切波弹性成像在评估肾移植肾小管间质纤维化中的应用。
由两名独立操作人员对因临床指征（即肌酐升高>15%或蛋白尿>1g/天）而接受移植肾活检的肾移植受者进行剪切波弹性成像评估。移植肾活检由同一位病理学家根据2013年班夫分类法进行解读。
共进行了40次弹性成像扫描（肌酐中位数为172.5μmol/L[四分位间距133.8 - 281.8μmol/L]）。两位观察者之间，皮质的组织硬度中位数（22.6kPa[四分位间距18.8 - 25.7kPa]与22.3kPa[四分位间距19.0 - 26.5kPa]，P = 0.70）和髓质的组织硬度中位数（15.0kPa[四分位间距13.7 - 18.0kPa]与15.6kPa[四分位间距14.4 - 18.2kPa]）无显著差异。观察者间一致性良好（皮质的组内相关系数为0.84，95%CI为0.70 - 0.92；髓质的组内相关系数为0.88，95%CI为0.78 - 0.94）。检测肾小管间质纤维化的受试者工作特征曲线下面积，皮质组织硬度为0.75（95%CI为0.61 - 0.89），髓质组织硬度为0.85（95%CI为0.75 - 0.95），血清肌酐为0.65（95%CI为0.53 - 0.78）。
剪切波弹性成像可作为一种非侵入性工具，用于评估肾移植纤维化，观察者间一致性合理，在检测早期肾小管间质纤维化方面测试性能优于血清肌酐。
