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Walmer RW, Ritter VS, Sridharan A, Kasoji SK, Altun E, Lee E, Olinger K, Wagner S, Radhakrishna R, Johnson KA, Rathmell WK, Qaqish B, Dayton PA, Chang EH. The Performance of Flash Replenishment Contrast-Enhanced Ultrasound for the Qualitative Assessment of Kidney Lesions in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:6494. [PMID: 37892632 PMCID: PMC10607866 DOI: 10.3390/jcm12206494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe kidney disease, CT and MRI contrast agents may be contraindicated. Contrast-enhanced ultrasound (CEUS) is a safe alternative for characterizing these lesions, but data on its performance among CKD patients are limited. We performed flash replenishment CEUS in 60 CKD patients (73 lesions). Final analysis included 53 patients (63 lesions). Four readers, blinded to true diagnosis, interpreted each lesion. Reader evaluations were compared to true lesion classifications. Performance metrics were calculated to assess malignant and benign diagnoses. Reader agreement was evaluated using Bowker's symmetry test. Combined reader sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant lesions were 71%, 75%, 45%, and 90%, respectively. Sensitivity (81%) and specificity (83%) were highest in CKD IV/V patients when grouped by CKD stage. Combined reader sensitivity, specificity, PPV, and NPV for diagnosing benign lesions were 70%, 86%, 91%, and 61%, respectively. Again, in CKD IV/V patients, sensitivity (81%), specificity (95%), and PPV (98%) were highest. Inter-reader diagnostic agreement varied from 72% to 90%. In CKD patients, CEUS is a potential low-risk option for screening kidney lesions. CEUS may be particularly beneficial for CKD IV/V patients, where kidney preservation techniques are highly relevant.
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Affiliation(s)
- Rachel W. Walmer
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
| | - Victor S. Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Anush Sridharan
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Sandeep K. Kasoji
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
- Triangle Biotechnology, Durham, NC 27709, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Ellie Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Kristen Olinger
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Sean Wagner
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Roshni Radhakrishna
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA (E.H.C.)
| | - Kennita A. Johnson
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
| | | | - Bahjat Qaqish
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paul A. Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
| | - Emily H. Chang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA (E.H.C.)
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AlHmoud IW, Walmer RW, Kavanagh K, Chang EH, Johnson KA, Bikdash M. Classifying Kidney Disease in a Vervet Model Using Spatially Encoded Contrast-Enhanced Ultrasound Perfusion Parameters. Ultrasound Med Biol 2023; 49:761-772. [PMID: 36463005 DOI: 10.1016/j.ultrasmedbio.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
Early stages of diabetic kidney disease (DKD) are difficult to diagnose in patients with type 2 diabetes. This work was aimed at identifying contrast-enhanced ultrasound (CEUS) perfusion parameters, a microcirculatory biomarker indicative of early DKD progression. CEUS kidney flash-replenishment data were acquired in control, insulin resistant and diabetic vervet monkeys (N = 16). By use of a mono-exponential model, time-intensity curve parameters related to blood volume (A), velocity (β) and flow rate (perfusion index [PI]) were extracted from 10 concentric kidney layers to study spatial perfusion patterns that could serve as strong indicators of disease. Mean squared error (MSE) was used to assess model performance. Features calculated from the perfusion parameters were inputs for the linear regression models to determine which features could distinguish between cohorts. The mono-exponential model performed well, with average MSEs (±standard deviation) of 0.0254 (±0.0210), 0.0321 (±0.0242) and 0.0287 (±0.0130) for the control, insulin resistant and diabetic cohorts, respectively. Perfusion index features, with blood pressure, were the best classifiers between cohorts (p < 0.05). CEUS has the potential to detect early microvascular changes, providing insight into disease-related structural changes in the kidney. The sensitivity of this technique should be explored further by assessing various stages of DKD.
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Affiliation(s)
- Issa W AlHmoud
- Computational Data Science and Engineering, North Carolina A&T State University, Greensboro, North Carolina, USA
| | - Rachel W Walmer
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Kylie Kavanagh
- Department of Pathology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA; College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Emily H Chang
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kennita A Johnson
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA.
| | - Marwan Bikdash
- Computational Data Science and Engineering, North Carolina A&T State University, Greensboro, North Carolina, USA
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Kierski TM, Walmer RW, Tsuruta JK, Yin J, Chérin E, Foster FS, Demore CEM, Newsome IG, Pinton GF, Dayton PA. Acoustic Molecular Imaging Beyond the Diffraction Limit In Vivo. IEEE Open J Ultrason Ferroelectr Freq Control 2022; 2:237-249. [PMID: 38125957 PMCID: PMC10732349 DOI: 10.1109/ojuffc.2022.3212342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Ultrasound molecular imaging (USMI) is a technique used to noninvasively estimate the distribution of molecular markers in vivo by imaging microbubble contrast agents (MCAs) that have been modified to target receptors of interest on the vascular endothelium. USMI is especially relevant for preclinical and clinical cancer research and has been used to predict tumor malignancy and response to treatment. In the last decade, methods that improve the resolution of contrast-enhanced ultrasound by an order of magnitude and allow researchers to noninvasively image individual capillaries have emerged. However, these approaches do not translate directly to molecular imaging. In this work, we demonstrate super-resolution visualization of biomarker expression in vivo using superharmonic ultrasound imaging (SpHI) with dual-frequency transducers, targeted contrast agents, and localization microscopy processing. We validate and optimize the proposed method in vitro using concurrent optical and ultrasound microscopy and a microvessel phantom. With the same technique, we perform a proof-of-concept experiment in vivo in a rat fibrosarcoma model and create maps of biomarker expression co-registered with images of microvasculature. From these images, we measure a resolution of 23 μm, a nearly fivefold improvement in resolution compared to previous diffraction-limited molecular imaging studies.
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Affiliation(s)
- Thomas M Kierski
- Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Chapel Hill, NC 27599 USA
| | - Rachel W Walmer
- Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Chapel Hill, NC 27599 USA
| | - James K Tsuruta
- Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Chapel Hill, NC 27599 USA
| | - Jianhua Yin
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | | | - F Stuart Foster
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Christine E M Demore
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Isabel G Newsome
- Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Chapel Hill, NC 27599 USA
| | - Gianmarco F Pinton
- Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Chapel Hill, NC 27599 USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Chapel Hill, NC 27599 USA
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Srivastava A, Sridharan A, Walmer RW, Kasoji SK, Burke LM, Dayton PA, Johnson KA, Chang EH. Association of Contrast-Enhanced Ultrasound-Derived Kidney Cortical Microvascular Perfusion with Kidney Function. Kidney360 2022; 3:647-656. [PMID: 35721623 PMCID: PMC9136891 DOI: 10.34067/kid.0005452021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/26/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Individuals with chronic kidney disease (CKD) have decreased kidney cortical microvascular perfusion, which may lead to worsening kidney function over time, but methods to quantify kidney cortical microvascular perfusion are not feasible to incorporate into clinical practice. Contrast-enhanced ultrasound (CEUS) may quantify kidney cortical microvascular perfusion, which requires further investigation in individuals across the spectrum of kidney function. METHODS We performed CEUS on a native kidney of 83 individuals across the spectrum of kidney function and calculated quantitative CEUS-derived kidney cortical microvascular perfusion biomarkers. Participants had a continuous infusion of the microbubble contrast agent (Definity) with a flash-replenishment sequence during their CEUS scan. Lower values of the microbubble velocity (β) and perfusion index (β×A) may represent lower kidney cortical microvascular perfusion. Multivariable linear regression models tested the associations of the microbubble velocity (β) and perfusion index (β×A) with estimated glomerular filtration rate (eGFR). RESULTS Thirty-eight individuals with CKD (mean age±SD 65.2±12.6 years, median [IQR] eGFR 31.5 [18.9-41.5] ml/min per 1.73 m2), 37 individuals with end stage kidney disease (ESKD; age 54.8±12.3 years), and eight healthy volunteers (age 44.1±15.0 years, eGFR 117 [106-120] ml/min per 1.73 m2) underwent CEUS without side effects. Individuals with ESKD had the lowest microbubble velocity (β) and perfusion index (β×A) compared with individuals with CKD and healthy volunteers. The microbubble velocity (β) and perfusion index (β×A) had moderate positive correlations with eGFR (β: rs=0.44, P<0.001; β×A: rs=0.50, P<0.001). After multivariable adjustment, microbubble velocity (β) and perfusion index (β×A) remained significantly associated with eGFR (change in natural log transformed eGFR per 1 unit increase in natural log transformed biomarker: β, 0.38 [95%, CI 0.17 to 0.59]; β×A, 0.79 [95% CI, 0.45 to 1.13]). CONCLUSIONS CEUS-derived kidney cortical microvascular perfusion biomarkers are associated with eGFR. Future studies are needed to determine if CEUS-derived kidney cortical microvascular perfusion biomarkers have prognostic value.
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Affiliation(s)
- Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anush Sridharan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel W. Walmer
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sandeep K. Kasoji
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren M.B. Burke
- Deparatment of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Paul A. Dayton
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kennita A. Johnson
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily H. Chang
- University of North Carolina Kidney Center, Chapel Hill, North Carolina
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Aime S, Amirshaghaghi A, Angel PM, Ardenkjaer-Larsen JH, Atreya R, Awe S, Badea CT, Beekman FJ, Biade S, Borden MA, Brunsing RL, Chandrasekharan P, Chang JB, Chen F, Chen JW, Chen X, Cheng Z, Cheng Z, Cherin E, Clinthorne NH, Cohen J, Colson C, Conolly S, Contag CH, Cutler CS, Dayton PA, Devoogdt N, Dina O, Drake RR, Dubsky S, Ducongé F, Fellows BD, Foster FS, Francis KP, Fung BK, Gambhir SS, Gao R, Giovenzana GB, Goodwill P, Goorden MC, Gorpas D, Grimm J, Groll AN, Hargus S, Harmsen S, He S, Hensley D, Hutton BF, Huynh Q, Iagaru A, Josephson L, Jurisson SS, Keselman P, Kircher MF, Kokate T, Konkle J, Korsen JA, Krasniqi A, Laniyonu A, Levin CS, Lewis MR, Lewis JS, Liu G, Liu Y, Looger LL, Lu K, Lu Y, Lucignani G, Lyons SK, Maina T, Martelli C, Matheson AM, Mempel TR, Meng LJ, Moradi F, Nagle VL, Neurath MF, Nicolson F, Nie L, Ntziachristos V, Orendorff R, Ottobrini L, Ouyang Y, Paez Segala MG, Parraga G, Perez-Liva M, Pratt EC, Rao J, Rath T, Rodriguez E, Rosenthal EL, Ross BD, Saayujya C, Saritas EU, Scott DA, Sheth VR, Slagle C, Tamura R, Tavitian B, Tay ZW, Terreno E, Thakur M, Thompson C, Tian J, Travagin F, Tsourkas A, Tully KM, Usmani SM, VanBrocklin HF, van Keulen S, van Zijl PC, Walmer RW, Wang C, Wang J, Wang LV, Xavier C, Yao J, Yu EY, Zheng X, Zheng B, Zhou XY. Contributors. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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