Mehmet BEYAZAL, Hatice Beyazal Polat, Fatma BEYAZAL ÇELİKER, Ekrem KARA, Arzu Turan, Mehmet Fatih İnecikli, Tuğba Eldeş

Glomerülonefritli hastalarda böbrek parankiminin gerinim elastografi ile değerlendirilmesi

Amaç: Elastografi doku elastisitesini değerlendiren yeni bir ultrasonografi tekniğidir. Bu çalışmanın amacı, glomerülonefritli hastalarda böbrek parankimini elastografi ile değerlendirmek ve hastaların laboratuvar verileri ile gerinim indeksi arasında ilişkiyi tespit etmektir. Gereç ve Yöntem: Bu çalışmaya glomerülonefritli 26 hasta (13 erkek, 13 kadın, ortalama yaş; 41,67 ± 13,4) ile cinsiyet ve yaş eşleştirilmiş 20 sağlıklı kontrol grubu dahil edildi. Glomerülonefritli hastaların tahmini glomerül filtrasyon hızı (eGFR), serum kreatinin, spot idrar proteini, spot idrar kreatinin, spot idrar protein / kreatinin oranı kaydedildi. Tüm katılımcıların elastografi ile böbrek parankim incelemeleri yapıldı ve gerinim indeksleri ölçüldü. Bulgular: Glomerülonefritli hastalarda sağ ve sol böbrek gerinim indeksleri kontrollerden daha yüksekti (sağ; 3,89 ± 0,82 ve 3,39 ± 0,78 p = 0,038, sol; 3,94 ± 0,69 ve 3,24 ± 0,81 p = 0,003). Hastaların böbrek gerinim indeksleri ile tahmini glomerül filtrasyon hızı, serum kreatinin, spot idrar protein, spot idrar kreatinin, spot idrar protein/kreatinin değerleri ile anlamlı bir korelasyon saptanmadı (p˃ 0,05). Hasta ve kontrol gruplarının gerinim indekslerine dayanan ROC eğrisi analizindeki incelemede glomerülonefrit tanısı için gerinim oranı değerleri cut-off değeri 3,8, duyarlılık %61,5 ve özgüllük %85 idi. Sonuç: Elastogram indeksleri glomerülonefritli hastaları sağlıklı bireylerden ayırmak için kullanılabilir.

Anahtar Kelimeler:

gerinim indeksi, glomerüler hastalık, elastografi, ultrasonografi

The evaluation of renal parenchyma with strain elastography in glomerülonephritis patients

Objective: Elastography is a new ultrasound-based technique able to assess tissue elasticity. The aims of this study were to evaluate the renal parenchyma with elastography in patients with glomerülonephritis and to determine the association between strain index and patients’ laboratory parameters. Material and Method: Twenty-three patients (13 men, 13 women; mean age 41.67 ± 13.4 years) with glomerülonephritis and 20 sex and age-matched healthy controls were enrolled in this study. Estimated glomerüler filtration rate (eGFR), serum creatinine, spot urine protein, spot urine creatinine, spot urine protein/creatinine ratio were recorded in patients with glomerülonephritis. Elastography examinations of renal paranchyma were performed for all participants and the strain ratio values were measured. Results: The right and left strain index values were significantly higher in patients with glomerülonephritis than in controls (right; 3.89±0.82 vs. 3.39±0.78 p=0.038, left; 3.94±0.69 vs. 3.24±0.81 p=0.003, respectively). The strain index scores did not showed any significant correlation with eGFR, serum creatinine, spot urine protein, spot urine creatinine, spot urine protein/creatinine ratio (for all, p˃ 0.05). On ROC curve analysis based on strain ratio values of the patient and control groups, the cut-off value for the diagnosis of glomerülonefritis was 3.8, with a sensitivity of 61.5% and a specificity of 85%. Conclusions: Strain index of elastography can be used to differentiate patients with glomerülonefritis from healthy individuals.

Keywords:

Elastography, ultrasonography, strain index, glomerülar diseases,

PDF

___

Aatif T, Maoujoud O, Montasser DI, Benyahia M, Oualim Z. Glomerülar diseases in the Military Hospital of Morocco: Review of a single centre renal biopsy database on adults. Indian J Nephrol 2012; 22: 257-63.
Xu B, Jiang G, Ye J, He J, Xie W. Research on pediatric glomerülar disease and normal kidney with shear wave based elastography point quantification. Jpn J Radiol 2016; 34: 738-46.
Wang Y, Yao B, Li H, ve ark. Assessment of tumor stiffness with shear wave elastography in a human prostate cancer xenograft implantation model. J Ultrasound Med 2017; 36: 955-63.
Yağcı B, Erdem Toslak I, Çekiç B, ve ark. Differentiation between idiopathic granulomatous mastitis and malignant breast lesions using strain ratio on ultrasonic elastography. Diagn Interv Imaging. 2017; 98: 685-91.
You J, Chen J, Xiang F, ve ark. The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules. J Med Ultrason (2001) 2017 Sep 13. doi: 10.1007/s10396-017-0819-0. [Epub ahead of print]
Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW. Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med. 2010; 29: 551-63.
Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultra-sound elastography in the differential diagnosis of benign andmalignant thyroid nodules. J Ultrasound Med 2009; 28: 861-7.
Tajiri K, Kawai K, Sugiyama T. Strain elastography for assessment of liver fibrosis and prognosis in patients with chronic liver diseases. J Gastroenterol 2017; 52: 724-33.
Gao J, Min R, Hamilton J, ve ark. Corticomedullary strain ratio: a quantitative marker for assessment of renal allograft cortical fibrosis. J Ultrasound Med. 2013; 32: 1769-75.
Gao J, Weitzel W, Rubin JM, ve ark. Renal transplant elasticity ultrasound imaging: correlation between normalized strain and renal cortical fibrosis. Ultrasound Med Biol 2013; 39: 1536-42.
Menzilcioglu MS, Duymus M, Citil S, ve ark. The comparison of resistivity index and strain index values in the ultrasonographic evaluation of chronic kidney disease. Radiol Med 2016; 121: 681-7.
Metin MR, Aydın H, Ünal Ö, ve ark. Differentiation between endometrial carcinoma and atypical endometrial hyperplasia with transvaginal sonographic elastography. Diagn Interv Imaging. 2016; 97: 425-31.
Onur MR, Göya C. Ultrasound elastography: abdominal appli-cations. Turkiye Klinikleri J Radiol Special Topics. 2013; 6: 59-69.
Wang Z, Yang H, Suo C, Wei J, Tan R, Gu M. Application of ultrasound elastography for chronic allograft dysfunction in kidney transplantation. J Ultrasound Med. 2017; 36: 1759-69.
Lim S, Kim SH, Kim Y, ve ark. Coefficient of variance as quality criterion for evaluation of advanced hepatic fibrosis using 2D shear-wave elastography. J Ultrasound Med 2017 Aug 14. doi: 10.1002/jum.14341. [Epub ahead of print]
Zeng J, Huang ZP, Zheng J, Wu T, Zheng RQ. Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases. World J Gastroenterol 2017; 23: 4839-46.
Gersak MM, Lupșor-Platon M, Badea R, Ciurea A, Dudea SM. Strain Elastography (SE) for liver fibrosis estimation - which elastic score to calculate? Med Ultrason 20165; 18: 481-7.
Orlacchio A, Chegai F, Del Giudice C, ve ark. Kidney transplant: usefulness of real-time elastography (RTE) in the diagnosis of graft interstitial fibrosis. Ultrasound Med Biol 2014; 40: 2564-72.
Menzilcioglu MS, Duymus M, Citil S, ve ark. Strain wave elastography for evaluation of renal parenchyma in chronic kidney disease. Br J Radiol 2015; 88: 20140714.