What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic Kidney Disease (n=391). Intervention: Acoustic radiation force impulse (ARFI) imaging vs. Healthy volunteers. Primary outcome: Diagnostic performance of ARFI for predicting CKD (Area under the ROC curve) (AUC 0.752, 95% CI 0.704 to 0.797, p=<0.001).

July 11, 2013PLoS ONE125 citationsOpen Access

Acoustic Radiation Force Impulse Imaging for Noninvasive Evaluation of Renal Parenchyma Elasticity: Preliminary Findings

Q: What are the key findings of this study?

Acoustic radiation force impulse imaging differentiated chronic kidney disease patients from healthy volunteers with an area under the ROC curve of 0.752 at a cut-off shear wave velocity of 1.88 m/s.

LGLe‐Hang GuoTongji University HXHui‐Xiong XuHuadong Hospital HFHui‐Jun FuTongji University

Key Result

Acoustic radiation force impulse imaging differentiated chronic kidney disease patients from healthy volunteers with an area under the ROC curve of 0.752 at a cut-off shear wave velocity of 1.88 m/s.

Study Design

Type

Cross-Sectional (n=391)

Multicenter

Structured PICO

Does acoustic radiation force impulse (ARFI) imaging accurately detect chronic kidney disease by measuring renal parenchyma elasticity?

Population

391 participants, comprising 327 healthy volunteers and 64 patients with chronic kidney disease, underwent cross-sectional evaluation of renal parenchyma elasticity using acoustic radiation force impulse imaging.

Exposure

Acoustic radiation force impulse (ARFI) imaging to measure shear wave velocity (SWV) of the renal parenchyma.

Comparator

Healthy volunteers compared to CKD patients across different stages (1-5).

Outcome

Diagnostic performance of ARFI for detecting CKD, assessed by receiver operating characteristic (ROC) curve analysis.surrogate

Acoustic radiation force impulse (ARFI) imaging demonstrates moderate diagnostic accuracy for detecting chronic kidney disease, with renal parenchyma showing decreased stiffness in CKD patients compared to healthy volunteers.

Main Result

Effect estimate: AUC 0.752 (95% CI 0.704 to 0.797)

p-value: p=<0.001

Limitations

High standard deviation of shear wave velocity measurements in both healthy volunteers and CKD patients
Relatively small size of the CKD cohort, preventing adjustment for gender and age in the analysis
Lack of evaluation regarding the specific etiologies and pathological changes in the CKD patients
Fixed region of interest dimensions make the technology inapplicable to patients with renal parenchyma thickness less than 1 cm
Sensitivity to movement artifacts and limited detection depth (maximum 8 cm)

Abstract

OBJECTIVE: To evaluate the diagnostic value of acoustic radiation force impulse (ARFI) to test the elasticity of renal parenchyma by measuring the shear wave velocity (SWV) which might be used to detect chronic kidney disease (CKD). METHODS: 327 healthy volunteers and 64 CKD patients were enrolled in the study. The potential influencing factors and measurement reproducibility were evaluated in the healthy volunteers. Correlations between SWV and laboratory tests were analyzed in CKD patients.?Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance of ARFI. RESULTS: The SWV of healthy volunteers correlated significantly to age (r = -0.22, P<0.001, n = 327) and differed significantly between men and women (2.06±0.48 m/s vs. 2.2±0.52 m/s, P = 0.018, n = 327). However, it did not correlate significantly to height, weight, body mass index, waistline, kidney dimension and the depth for SWV measurement (n = 30). Inter- and intraobserver agreement expressed as intraclass coefficient correlation were 0.64 (95% CI: 0.13 to 0.82, P = 0.011) and 0.6 (95% CI: 0.31 to 0.81, P = 0.001) (n = 40). The mean SWV in healthy volunteers was 2.15±0.51 m/s, while was 1.81±0.43 m/s, 1.79±0.29 m/s, 1.81±0.44 m/s, 1.64±0.55 m/s, and 1.36±0.17 m/s for stage 1, 2, 3, 4 and 5 in CKD patients respectively. The SWV was significantly higher for healthy volunteers compared with each stage in CKD patients. ARFI could not predict the different stages of CKD except stage 5. In CKD patients, SWV correlated to e-GFR (r = 0.3, P = 0.018), to urea nitrogen (r = -0.3, P = 0.016), and to creatinine (r = -0.41, P = 0.001). ROC analyses indicated that the area under the ROC curve was 0.752 (95% CI: 0.704 to 0.797) (P<0.001). The cut-off value for predicting CKD was 1.88 m/s (sensitivity 71.87% and specificity 69.69%). CONCLUSION: ARFI may be a potentially useful tool in detecting CKD.

问 AI

Bookmark

View Full Paper