The evaluation of renal parenchyma with strain elastography in glomerülonephritis patients

Yıl 2019, , 114 - 118, 01.06.2019

Mehmet Beyazal , Hatice Beyazal Polat , Fatma Beyazal Çeliker Ekrem Kara , Arzu Turan , Mehmet Fatih İnecikli , Tuğba Eldeş

https://doi.org/10.21601/ortadogutipdergisi.393354

Öz

Objective: Elastography is a new ultrasound-based technique
able to assess tissue elasticity. The aims of this study were to evaluate the renal
parenchyma with elastography in patients with glomerülonephritis and to determine
the association between strain index and patients’ laboratory parameters.

Material and Method: Twenty-three patients (13 men, 13 women; mean
age 41.67 ± 13.4 years) with glomerülonephritis and 20 sex and age-matched healthy
controls were enrolled in this study. Estimated glomerüler filtration rate (eGFR),
serum creatinine, spot urine protein, spot urine creatinine, spot urine protein/creatinine
ratio were recorded in patients with glomerülonephritis. Elastography examinations
of renal paranchyma were performed for all participants and the strain ratio values
were measured.

Results: The right and left strain index values were
significantly higher in patients with glomerülonephritis than in controls (right;
3.89±0.82 vs. 3.39±0.78 p=0.038, left; 3.94±0.69 vs. 3.24±0.81 p=0.003, respectively).
The strain index scores did not showed any significant correlation with eGFR, serum
creatinine, spot urine protein, spot urine creatinine, spot urine protein/creatinine
ratio (for all, p˃ 0.05).
On ROC curve analysis based on strain ratio values of the patient and control groups,
the cut-off value for the diagnosis of glomerülonefritis was 3.8, with a sensitivity
of 61.5% and a specificity of 85%.

Conclusions: Strain index of elastography can be used to
differentiate patients with glomerülonefritis from healthy individuals.

Anahtar Kelimeler

Elastography, ultrasonography, strain index, glomerülar diseases

Glomerülonefritli hastalarda böbrek parankiminin gerinim elastografi ile değerlendirilmesi

Öz

Amaç: Elastografi doku elastisitesini değerlendiren yeni
bir ultrasonografi tekniğidir. Bu çalışmanın amacı, glomerülonefritli hastalarda
böbrek parankimini elastografi ile değerlendirmek ve hastaların laboratuvar verileri
ile gerinim indeksi arasında ilişkiyi tespit etmektir.

Gereç ve Yöntem: Bu çalışmaya glomerülonefritli
26 hasta (13 erkek, 13 kadın, ortalama yaş; 41,67 ± 13,4) ile cinsiyet ve yaş eşleştirilmiş
20 sağlıklı kontrol grubu dahil edildi. Glomerülonefritli hastaların tahmini glomerül
filtrasyon hızı (eGFR), serum kreatinin, spot idrar proteini, spot idrar kreatinin,
spot idrar protein / kreatinin oranı kaydedildi. Tüm katılımcıların elastografi
ile böbrek parankim incelemeleri yapıldı ve gerinim indeksleri ölçüldü.

Bulgular: Glomerülonefritli hastalarda
sağ ve sol böbrek gerinim indeksleri kontrollerden daha yüksekti (sağ; 3,89 ± 0,82
ve 3,39 ± 0,78 p = 0,038, sol; 3,94 ± 0,69 ve 3,24 ± 0,81 p = 0,003). Hastaların
böbrek gerinim indeksleri ile tahmini glomerül filtrasyon hızı, serum kreatinin,
spot idrar protein, spot idrar kreatinin, spot idrar protein/kreatinin değerleri
ile anlamlı bir korelasyon saptanmadı (p˃ 0,05). Hasta ve kontrol gruplarının gerinim indekslerine
dayanan ROC eğrisi analizindeki incelemede glomerülonefrit tanısı için gerinim oranı
değerleri cut-off değeri 3,8, duyarlılık %61,5 ve özgüllük %85 idi.

Sonuç: Elastogram indeksleri glomerülonefritli hastaları
sağlıklı bireylerden ayırmak için kullanılabilir.

Anahtar Kelimeler

gerinim indeksi, glomerüler hastalık, elastografi, ultrasonografi

Kaynakça

• Aatif T, Maoujoud O, Montasser DI, Benyahia M, Oualim Z. Glomerülar diseases in the Military Hospital of Morocco: Review of a single centre renal biopsy database on adults. Indian J Nephrol 2012; 22: 257-63.
• Xu B, Jiang G, Ye J, He J, Xie W. Research on pediatric glomerülar disease and normal kidney with shear wave based elastography point quantification. Jpn J Radiol 2016; 34: 738-46.
• Wang Y, Yao B, Li H, ve ark. Assessment of tumor stiffness with shear wave elastography in a human prostate cancer xenograft implantation model. J Ultrasound Med 2017; 36: 955-63.
• Yağcı B, Erdem Toslak I, Çekiç B, ve ark. Differentiation between idiopathic granulomatous mastitis and malignant breast lesions using strain ratio on ultrasonic elastography. Diagn Interv Imaging. 2017; 98: 685-91.
• You J, Chen J, Xiang F, ve ark. The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules. J Med Ultrason (2001) 2017 Sep 13. doi: 10.1007/s10396-017-0819-0. [Epub ahead of print]
• Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW. Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med. 2010; 29: 551-63.
• Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultra-sound elastography in the differential diagnosis of benign andmalignant thyroid nodules. J Ultrasound Med 2009; 28: 861-7.
• Tajiri K, Kawai K, Sugiyama T. Strain elastography for assessment of liver fibrosis and prognosis in patients with chronic liver diseases. J Gastroenterol 2017; 52: 724-33.
• Gao J, Min R, Hamilton J, ve ark. Corticomedullary strain ratio: a quantitative marker for assessment of renal allograft cortical fibrosis. J Ultrasound Med. 2013; 32: 1769-75.
• Gao J, Weitzel W, Rubin JM, ve ark. Renal transplant elasticity ultrasound imaging: correlation between normalized strain and renal cortical fibrosis. Ultrasound Med Biol 2013; 39: 1536-42.
• Menzilcioglu MS, Duymus M, Citil S, ve ark. The comparison of resistivity index and strain index values in the ultrasonographic evaluation of chronic kidney disease. Radiol Med 2016; 121: 681-7.
• Metin MR, Aydın H, Ünal Ö, ve ark. Differentiation between endometrial carcinoma and atypical endometrial hyperplasia with transvaginal sonographic elastography. Diagn Interv Imaging. 2016; 97: 425-31.
• Onur MR, Göya C. Ultrasound elastography: abdominal appli-cations. Turkiye Klinikleri J Radiol Special Topics. 2013; 6: 59-69.
• Wang Z, Yang H, Suo C, Wei J, Tan R, Gu M. Application of ultrasound elastography for chronic allograft dysfunction in kidney transplantation. J Ultrasound Med. 2017; 36: 1759-69.
• Lim S, Kim SH, Kim Y, ve ark. Coefficient of variance as quality criterion for evaluation of advanced hepatic fibrosis using 2D shear-wave elastography. J Ultrasound Med 2017 Aug 14. doi: 10.1002/jum.14341. [Epub ahead of print]
• Zeng J, Huang ZP, Zheng J, Wu T, Zheng RQ. Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases. World J Gastroenterol 2017; 23: 4839-46.
• Gersak MM, Lupșor-Platon M, Badea R, Ciurea A, Dudea SM. Strain Elastography (SE) for liver fibrosis estimation - which elastic score to calculate? Med Ultrason 20165; 18: 481-7.
• Orlacchio A, Chegai F, Del Giudice C, ve ark. Kidney transplant: usefulness of real-time elastography (RTE) in the diagnosis of graft interstitial fibrosis. Ultrasound Med Biol 2014; 40: 2564-72.
• Menzilcioglu MS, Duymus M, Citil S, ve ark. Strain wave elastography for evaluation of renal parenchyma in chronic kidney disease. Br J Radiol 2015; 88: 20140714.