Quantitative assessment of renal perfusion in children with UPJO by contrast enhanced ultrasound: A pilot study

  • Author Footnotes
    1 Shuofan Chen and Defu Lin contributed equally to this work.
    Shuofan Chen
    Footnotes
    1 Shuofan Chen and Defu Lin contributed equally to this work.
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Author Footnotes
    1 Shuofan Chen and Defu Lin contributed equally to this work.
    Defu Lin
    Footnotes
    1 Shuofan Chen and Defu Lin contributed equally to this work.
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Pei Liu
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Qinglin Liu
    Affiliations
    Department of u ltrasound, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Minglei Li
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Wenwen Han
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Xiaoman Wang
    Affiliations
    Department of u ltrasound, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Weiping Zhang
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Hongcheng Song
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Zhenwu Li
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Ning Sun
    Correspondence
    Correspondence to: Ning Sun, No.56 Nanlishilu Rd, West District, Beijing, China, Tel.: +86 10 15901103362; fax: +86 10 63551726.
    Affiliations
    Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing 100045, China
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  • Author Footnotes
    1 Shuofan Chen and Defu Lin contributed equally to this work.
Published:November 19, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.11.004

      Summary

      Background

      Contrast-enhanced ultrasound (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of a parenchymal organ.

      Objective

      To prospectively and quantitatively analyse the role of CEUS in evaluating renal perfusion for assessing renal function in children with ureteropelvic junction obstruction (UPJO).

      Methods

      The study protocol was approved by the local ethics committee, and written informed consent was obtained from the patients’ parents or guardians. Ultrasonography, CEUS, and radioisotope renography were performed for 51 children (42 boys, 9 girls; mean age, 6.75 ± 4.14 years) with unilateral UPJO. The slope of the ascending curve (A), time to peak (TTP), peak intensity (PI), and area under the curve (AUC) were recorded during CEUS; quantitative data were calculated by QLab system (semiautomated border tracking, Philips Healthcare) software. Sensitivity and specificity values were determined for CEUS with respect to radioisotope renography.

      Results

      CEUS was used to evaluate 102 kidneys in 51 patients, for which the perfusion time–intensity curve (TIC) was determined. The TIC of renal cortical perfusion in all groups showed an asymmetrical single–peak curve, which could be clearly distinguished between the experimental group and the control group. Compared with the control group, the experimental group showed a markedly prolonged TTP but a significantly decreased A (P < 0.05). There was no significant correlation between the AUC, PI and differential renal function (DRF), but the correlation coefficient between TTP, A and DRF remained significant (p < 0.001).The receiver operating characteristic (ROC) curves drawn to differentiate DRF using the TTP value yielded an area under the ROC curve (AUROC) of 0.86. For a quantitative assessment of DRF less than 40% by CEUS, the sensitivity and specificity values were 92.86% and 76.14%, respectively.

      Discussion

      Unlike in previous studies, no significant difference in the AUC or PI was found between the control group and the experimental group in this study (P > 0.05). Renal blood perfusion could not be evaluated overall by CEUS. Parenchymal thinning may be considered a limitation to CEUS.

      Conclusions

      Summary TableDiagnostic performance of TTP and A values.
      Parameter AUROC P Sensitivity (%) Specificity (%) Cut-off
      TTP (s) 0.86 <0.001 92.86 76.14 23.459
      A (dB/s) 0.85 <0.001 86.36 78.57 0.920

      Keywords

      Abbreviations:

      A (the slope of the ascending curve), ANH (antenatal hydronephrosis), ANOVA (one -way analysis of variance), AUC (area under the curve), AUROC (an area under the ROC curve), BVF (blood volume fraction), CEUS (contrast-enhanced ultrasonography), CKD (chronic kidney disease), DKD (diabetic kidney disease), DMSA (dimercapto succinic acid), DRF (differential renal function), EFSUMB:European Federation of Societies for Ultrasound in Medicine and Biology (GFR), glomerular filtration rate (IVP), intravenous pyelography (NBF), nutrient blood flow (PI), peak intensity (QLab: Philips advanced ultrasound quantification software), RFI (renal function impairment), SPECT/CT (single-photon emission computed tomography/computed tomography), TTP (time to peak), TIC (time–intensity curve), UPJO (ureteropelvic junction obstruction), US (ultrasonography)
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