Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow

  • Tara A. Morgan
  • Priyanka Jha
  • Liina Poder
  • Stefanie Weinstein
Invited Article
  • 23 Downloads

Abstract

Ultrasound is routinely used as the first imaging exam for evaluation of renal transplants and can identify most major surgical complications and evaluate vascularity with color Doppler. Ultrasound is limited, however, in the detection of parenchymal disease processes and Doppler evaluation is also prone to technical errors. Multiple new ultrasound applications have been developed and are under ongoing investigation which could add additional diagnostic capability to the routine ultrasound exam with minimal additional time, cost, and patient risk. Contrast-enhanced ultrasound (CEUS) can be used off-label in the transplant kidney, and can assist in detection of infection, trauma, and vascular complications. CEUS also can demonstrate perfusion of the transplant assessed quantitatively with generation of time–intensity curves. Future directions of CEUS include monitoring treatment response and microbubble targeted medication delivery. Elastography is an ultrasound application that can detect changes in tissue elasticity, which is useful to diagnose diffuse parenchymal disease, such as fibrosis, otherwise unrecognizable with ultrasound. Elastography has been successfully applied in other organs including the liver, thyroid, and breast; however, it is still under development for use in the transplant kidney. Unique properties of the transplant kidney including its heterogeneity, anatomic location, and other technical factors present challenges in the development of reference standard measurements. Lastly, B-flow imaging is a flow application derived from B-mode. This application can show the true lumen size of a vessel which is useful to depict vascular anatomy and bypasses some of the pitfalls of color Doppler such as demonstration of slow flow.

Keywords

Ultrasound Elastography Contrast-enhanced ultrasound B-flow 

Notes

Compliance with ethical standards

Funding

None.

Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board waived informed consent for all individual participants included in the study.

References

  1. 1.
    Hart A, Smith JM, Skeans MA, et al. (2018) OPTN/SRTR 2016 annual data report: kidney. Am J Transplant 18(Suppl 1):18–113CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Erbas B (2017) Peri- and postsurgical evaluations of renal transplant. Semin Nucl Med 47(6):647–659CrossRefPubMedGoogle Scholar
  3. 3.
    Goldberg RJ, Weng FL, Kandula P (2016) Acute and chronic allograft dysfunction in kidney transplant recipients. Med Clin N Am 100(3):487–503CrossRefPubMedGoogle Scholar
  4. 4.
    Correas JM, Anglicheau D, Joly D, et al. (2016) Ultrasound-based imaging methods of the kidney-recent developments. Kidney Int 90(6):1199–1210CrossRefPubMedGoogle Scholar
  5. 5.
    Weinstein S, Jordan E, Goldstein R, et al. (2017) How to set up a contrast-enhanced ultrasound service. Abdom Radiol .  https://doi.org/10.1007/s00261-017-1278-1 Google Scholar
  6. 6.
    Kazmierski B, Deurdulian C, Tchelepi H, et al. (2017) Applications of contrast-enhanced ultrasound in the kidney. Abdom Radiol .  https://doi.org/10.1007/s00261-017-1307-0 Google Scholar
  7. 7.
    Fontanilla T, Minaya J, Cortes C, et al. (2012) Acute complicated pyelonephritis: contrast-enhanced ultrasound. Abdom Imaging 37(4):639–646CrossRefPubMedGoogle Scholar
  8. 8.
    Quaia E, Bertolotto M, Cioffi V, et al. (2008) Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol 191(4):1239–1249CrossRefPubMedGoogle Scholar
  9. 9.
    Wei SP, Xu CL, Zhang Q, et al. (2017) Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses: comparison with contrast-enhanced CT. Abdom Radiol 42(8):2135–2145CrossRefGoogle Scholar
  10. 10.
    King KG, Gulati M, Malhi H, et al. (2015) Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time-intensity curves: how we do it. Abdom Imaging 40(7):2461–2471CrossRefPubMedGoogle Scholar
  11. 11.
    Stenberg B, Wilkinson M, Elliott S, et al. (2017) The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS). Eur Radiol 27(11):4525–4531CrossRefPubMedGoogle Scholar
  12. 12.
    Alvarez Rodriguez S, Hevia Palacios V, Sanz Mayayo E, et al. (2017) The usefulness of contrast-enhanced ultrasound in the assessment of early kidney transplant function and complications. Diagnostics 7(3):53CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Benozzi L, Cappelli G, Granito M, et al. (2009) Contrast-enhanced sonography in early kidney graft dysfunction. Transplant Proc 41(4):1214–1215CrossRefPubMedGoogle Scholar
  14. 14.
    Kihm LP, Hinkel UP, Michael K, et al. (2009) Contrast enhanced sonography shows superior microvascular renal allograft perfusion in patients switched from cyclosporine A to everolimus. Transplantation 88(2):261–265CrossRefPubMedGoogle Scholar
  15. 15.
    Pan FS, Liu M, Luo J, et al. (2017) Transplant renal artery stenosis: evaluation with contrast-enhanced ultrasound. Eur J Radiol 90:42–49CrossRefPubMedGoogle Scholar
  16. 16.
    Grzelak P, Kurnatowska I, Nowicki M, et al. (2013) Detection of transplant renal artery stenosis in the early postoperative period with analysis of parenchymal perfusion with ultrasound contrast agent. Ann Transplant 18:187–194CrossRefPubMedGoogle Scholar
  17. 17.
    Rafailidis V, Fang C, Yusuf GT, et al. (2017) Contrast-enhanced ultrasound (CEUS) of the abdominal vasculature. Abdom Radiol .  https://doi.org/10.1007/s00261-017-1329-7 Google Scholar
  18. 18.
    Chi T, Usawachintachit M, Weinstein S, et al. (2017) Contrast enhanced ultrasound as a radiation-free alternative to fluoroscopic nephrostogram for evaluating ureteral patency. J Urol 198(6):1367–1373CrossRefPubMedGoogle Scholar
  19. 19.
    Shen C, Zhang B, Han WK, et al. (2017) Percutaneous renal access for percutaneous nephrolithotomy guided by contrast enhanced ultrasound: a single-center preliminary experience in China. Beijing Da Xue Xue Bao Yi Xue Ban 49(6):1071–1075PubMedGoogle Scholar
  20. 20.
    Golse N, Santoni S, Karam V, et al. (2017) Is routine intraoperative contrast-enhanced ultrasonography useful during whole liver transplantation. World J Surg .  https://doi.org/10.1007/s00268-017-4295-x PubMedGoogle Scholar
  21. 21.
    Hull TD, Agarwal A, Hoyt K (2017) New ultrasound techniques promise further advances in AKI and CKD. J Am Soc Nephrol 28(12):3452–3460CrossRefPubMedGoogle Scholar
  22. 22.
    Wang Z, Yang H, Suo C, et al. (2017) Application of ultrasound elastography for chronic allograft dysfunction in kidney transplantation. J Ultrasound Med 36(9):1759–1769CrossRefPubMedGoogle Scholar
  23. 23.
    Early H, Aguilera J, McGahan J, et al. (2017) Challenges and considerations when using shear wave elastography to evaluate the transplanted kidney with pictorial review. J Ultrasound Med 36(9):1771–1782CrossRefPubMedGoogle Scholar
  24. 24.
    Nakao T, Ushigome H, Nakamura T, et al. (2015) Evaluation of renal allograft fibrosis by transient elastography (fibro scan). Transplant Proc 47(3):640–643CrossRefPubMedGoogle Scholar
  25. 25.
    Yoo MG, Jung DC, Oh YT, et al. (2017) Usefulness of multiparametric ultrasound for evaluating structural abnormality of transplanted kidney: can we predict histologic abnormality on renal biopsy in advance? AJR Am J Roentgenol 209(3):W139–W144CrossRefPubMedGoogle Scholar
  26. 26.
    Wachsberg RH (2003) B-flow, a non-Doppler technology for flow mapping: early experience in the abdomen. Ultrasound Q 19(3):114–122CrossRefPubMedGoogle Scholar
  27. 27.
    Weskott HP (2000) B-flow—a new method for detecting blood flow. Ultraschall Med 21(2):59–65CrossRefPubMedGoogle Scholar
  28. 28.
    Bucek RA, Reiter M, Koppensteiner I, et al. (2002) B-flow evaluation of carotid arterial stenosis: initial experience. Radiology 225(1):295–299CrossRefPubMedGoogle Scholar
  29. 29.
    Tola M, Yurdakul M, Ozbulbul NI (2012) B-flow imaging for the measurement of residual lumen diameter of renal artery stenosis. J Clin Ultrasound 40(2):85–90CrossRefPubMedGoogle Scholar
  30. 30.
    Wachsberg RH (2007) B-flow imaging of the hepatic vasculature: correlation with color Doppler sonography. AJR Am J Roentgenol 188(6):W522–W533CrossRefPubMedGoogle Scholar
  31. 31.
    Clevert DA, Johnson T, Jung EM, et al. (2007) Color Doppler, power Doppler and B-flow ultrasound in the assessment of ICA stenosis: comparison with 64-MD-CT angiography. Eur Radiol 17(8):2149–2159CrossRefPubMedGoogle Scholar
  32. 32.
    Yurdakul M, Tola M, Cumhur T (2004) B-flow imaging of internal carotid artery stenosis: comparison with power Doppler imaging and digital subtraction angiography. J Clin Ultrasound 32(5):243–248CrossRefPubMedGoogle Scholar
  33. 33.
    Russo E, Cerbone V, Sciano D, et al. (2010) Posttransplant renal monitoring with B-flow ultrasonography. Transplant Proc 42(4):1127–1129CrossRefPubMedGoogle Scholar
  34. 34.
    Clevert DA, Kubisch C, Weckbach S, et al. (2010) B-flow and color Doppler sonography findings in iatrogenic carotid-jugular arteriovenous fistula. Clin Hemorheol Microcirc 44(1):19–25PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA

Personalised recommendations