Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, Milan, Italy.
Division of Radiology, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy.
J Med Ultrason (2001). 2023 Jul;50(3):381-415. doi: 10.1007/s10396-023-01304-z. Epub 2023 Apr 25.
Ultrasound elastography (USE) is a noninvasive technique for assessing tissue elasticity, and its application in nephrology has aroused growing interest in recent years. The purpose of this article is to systematically review the clinical application of USE in patients with chronic kidney disease (CKD), including native and transplanted kidneys, and quantitatively investigate differences in elasticity values between healthy individuals and CKD patients. Furthermore, we provide a qualitative analysis of the studies included, discussing the potential interplay between renal stiffness, estimated glomerular filtration rate, and fibrosis. In January 2022, a systematic search was carried out on the MEDLINE (PubMed) database, concerning studies on the application of USE in patients with CKD, including patients with transplanted kidneys. The results of the included studies were extracted by two independent researchers and presented mainly through a formal narrative summary. A meta-analysis of nine study parts from six studies was performed. A total of 647 studies were screened for eligibility and, after applying the exclusion and inclusion criteria, 69 studies were included, for a total of 6728 patients. The studies proved very heterogeneous in terms of design and results. The shear wave velocity difference of - 0.82 m/s (95% CI: - 1.72-0.07) between CKD patients and controls was not significant. This result agrees with the qualitative evaluation of included studies that found controversial results for the relationship between renal stiffness and glomerular filtration rate. On the contrary, a clear relationship seems to emerge between USE values and the degree of fibrosis. At present, due to the heterogeneity of results and technical challenges, large-scale application in the monitoring of CKD patients remains controversial.
超声弹性成像（USE）是一种评估组织弹性的非侵入性技术，近年来在肾脏病学中的应用引起了越来越多的关注。本文的目的是系统地回顾 USE 在慢性肾脏病（CKD）患者中的临床应用，包括原发性和移植肾，并定量研究健康个体和 CKD 患者之间的弹性值差异。此外，我们对纳入的研究进行了定性分析，讨论了肾硬度、估计肾小球滤过率和纤维化之间的潜在相互作用。2022 年 1 月，我们对 MEDLINE（PubMed）数据库进行了系统检索，涉及 USE 在 CKD 患者中的应用研究，包括移植肾患者。两名独立研究人员提取了纳入研究的结果，并主要通过正式的叙述性摘要进行呈现。对 6 项研究中的 9 个部分进行了荟萃分析。共筛选出 647 项符合条件的研究，应用排除和纳入标准后，纳入了 69 项研究，共计 6728 例患者。这些研究在设计和结果方面存在很大的异质性。CKD 患者与对照组之间的剪切波速度差异为-0.82m/s（95%CI：-1.72~0.07），差异无统计学意义。这一结果与纳入研究的定性评价一致，纳入研究发现肾硬度与肾小球滤过率之间的关系存在争议。相反，USE 值与纤维化程度之间似乎存在明确的关系。目前，由于结果的异质性和技术挑战，在 CKD 患者的监测中广泛应用仍存在争议。
