International Journal of General Medicine (Dec 2020)
Contrast-Enhanced Ultrasound Assessment of Renal Parenchymal Perfusion in Patients with Atherosclerotic Renal Artery Stenosis to Predict Renal Function Improvement After Revascularization
Abstract
Xiuyan Wang,1 Shuo Wang,1 Yan-ping Pang,1 Tian Jiang,1 Chen Yu,2 Yuan Li,1 Baomin Shi3 1Department of Ultrasonography, Tongji Hospital of Tongji University, Shanghai, People’s Republic of China; 2Department of Nephrology, Tongji Hospital of Tongji University, Shanghai, People’s Republic of China; 3Department of General Surgery, Tongji Hospital of Tongji University, Shanghai, People’s Republic of ChinaCorrespondence: Baomin ShiDepartment of General Surgery, Tongji Hospital of Tongji University, No. 389, Xincun Road, Putuo District, Shanghai 200065, People’s Republic of ChinaTel + 86-15002199639Email [email protected] LiDepartment of Ultrasonography, Tongji Hospital of Tongji University, No. 389 Xincun Road, Putuo District, Shanghai 200065, People’s Republic of ChinaTel + 86- 13918249006Email [email protected]: Identifying patients with atherosclerotic renal artery stenosis (ARAS) who will be improved in renal function after percutaneous transluminal renal artery stenting (PTRAS) is crucial since most patients show no worthwhile benefit of PTRAS. Although the assessment of renal parenchymal perfusion is useful for the identification, few studies predict the renal functional improvement by evaluating the characteristics of renal perfusion.Objective: The aim of this study was to assess the renal parenchymal perfusion in ARAS patients with contrast-enhanced ultrasonography (CEUS) and predict the benefits of renal function after PTRAS utilizing time-intensity curve (TIC) parameters.Methods: Thirty-eight kidneys in 30 ARAS patients received PTRAS in this study. They were divided into moderate stenosis group (n=25) and severe stenosis group (n=13) and mild dysfunction group (n=14) and moderate dysfunction group (n=24) according to the degree of renal stenosis and radioisotope glomerular filtration rate (rGFR). The baseline assessment of renal function and renal parenchymal perfusion were performed for all patients. rGFR was repeated to evaluate the renal outcome at 4 months after PTRAS. The outcome of PTRAS was classified as improved, stable, or deteriorated compared to the baseline. Time-intensity curve (TIC) parameters obtained from CEUS were analyzed to evaluate the predictive accuracy.Results: TIC parameters (AUC and PI) were positively correlated with renal function (r=0.617, 0.663; P< 0.05) but weakly and negatively correlated with the stenosis (r=− 0.360, − 0.435; P< 0.05). Baseline rGFR was not accurate in predicting improved renal function after PTRAS (0.670). The accuracy of the combined prediction model of baseline AUC and PI (0.889) was higher than the individual indicators (baseline AUC: 0.855 and PI: 0.782).Conclusion: CEUS could accurately assess renal parenchymal perfusion and identify ARAS patients with potential benefit after PTRAS. The combination of TIC parameters (AUC and PI) is valuable in the prediction of improved renal function after PTRAS.Keywords: atherosclerotic renal artery stenosis, percutaneous transluminal renal artery stenting, renal parenchymal perfusion, contrast-enhanced ultrasonography, time-intensity curve, radioisotope glomerular filtration rate