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Renal perfusion in scleroderma patients assessed by microbubble-based contrast-enhanced ultrasound.

Kleinert S, Roll P, Baumgaertner C, Himsel A, Mueller A, Fleck M, Feuchtenberger M, Jenett M, Tony HP - Open Rheumatol J (2012)

Bottom Line: Replenishment was recorded for 8 seconds.Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs.There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate.

View Article: PubMed Central - PubMed

Affiliation: University Hospital of Wuerzburg, Rheumatology/Clinical Immunology, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany.

ABSTRACT

Objectives: Renal damage is common in scleroderma. It can occur acutely or chronically. Renal reserve might already be impaired before it can be detected by laboratory findings. Microbubble-based contrast-enhanced ultrasound has been demonstrated to improve blood perfusion imaging in organs. Therefore, we conducted a study to assess renal perfusion in scleroderma patients utilizing this novel technique.

Materials and methodology: Microbubble-based contrast agent was infused and destroyed by using high mechanical index by Siemens Sequoia (curved array, 4.5 MHz). Replenishment was recorded for 8 seconds. Regions of interests (ROI) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California). Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs.

Results: There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate. However, the other parameters did not reveal significant differences between scleroderma patients and healthy controls.

Conclusion: Renal perfusion of scleroderma patients including the glomerular filtration rate can be assessed using microbubble-based contrast media.

No MeSH data available.


Related in: MedlinePlus

Regions of interest: Red – parenchyma, green –interlobular artery, blue – renal pyramid.
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Figure 1: Regions of interest: Red – parenchyma, green –interlobular artery, blue – renal pyramid.

Mentions: After approval by the local ethics committee, ultrasonographic examinations were conducted in scleroderma patients compared to healthy volunteers as age and sex matched control. Siemens Sequoia (curved array, 4.5 MHz) was used for analysis, and kidneys were documented in B-Mode. The resistance index of the interlobular arteries was measured by color Doppler ultrasound. Measurement of the intrarenal resistance index has been widely established in the evaluation of renovascular changes and is a wide-spread method to get indirect information about the vessel resistance and the perfusion distal of the measuring point. 10 millilitres (ml) of Sonovue ® contrast agent (Altana Pharma) were infused at 90 ml per hour. Sonovue is a suspension of phospholipid stabilized sulphur hexafluoride (SF6) microbubbles. 90% of microbubbles are smaller than 8.0 µm, (mean diameter 2.5 µm) and have a strong echogenicity over the range of frequencies used in medical ultrasound examinations. Ultrasound was performed with the Sequoia CPS programme with a mechanical index of 0.21. After saturation of Sonovue in the kidneys a high mechanical index was used to destroy the contrast medium locally. Replenishment was recorded for 8 seconds. Regions of interests (ROI, Figs. 1-3) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California) using a typical exponential function as estimation [5]. Slope, time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs. Graphical and statistical analyses were performed by Pearson Correlation (two-sided confidence interval 95%) and Mann-Whitney test to compare between control and Scleroderma group using the software GraphPad Prism 3.02. Graphs are displayed with single patients’ results and median, minimum, maximum, and 25th and 75th percentile on the right side. Patients were characterized by autoantibody profile and concomitant medication. Modified Rodnan skin score was assessed. This score increases from 0 to 51 in severity and there is an association between severe skin involvement and burden of organ-based complications.


Renal perfusion in scleroderma patients assessed by microbubble-based contrast-enhanced ultrasound.

Kleinert S, Roll P, Baumgaertner C, Himsel A, Mueller A, Fleck M, Feuchtenberger M, Jenett M, Tony HP - Open Rheumatol J (2012)

Regions of interest: Red – parenchyma, green –interlobular artery, blue – renal pyramid.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3367302&req=5

Figure 1: Regions of interest: Red – parenchyma, green –interlobular artery, blue – renal pyramid.
Mentions: After approval by the local ethics committee, ultrasonographic examinations were conducted in scleroderma patients compared to healthy volunteers as age and sex matched control. Siemens Sequoia (curved array, 4.5 MHz) was used for analysis, and kidneys were documented in B-Mode. The resistance index of the interlobular arteries was measured by color Doppler ultrasound. Measurement of the intrarenal resistance index has been widely established in the evaluation of renovascular changes and is a wide-spread method to get indirect information about the vessel resistance and the perfusion distal of the measuring point. 10 millilitres (ml) of Sonovue ® contrast agent (Altana Pharma) were infused at 90 ml per hour. Sonovue is a suspension of phospholipid stabilized sulphur hexafluoride (SF6) microbubbles. 90% of microbubbles are smaller than 8.0 µm, (mean diameter 2.5 µm) and have a strong echogenicity over the range of frequencies used in medical ultrasound examinations. Ultrasound was performed with the Sequoia CPS programme with a mechanical index of 0.21. After saturation of Sonovue in the kidneys a high mechanical index was used to destroy the contrast medium locally. Replenishment was recorded for 8 seconds. Regions of interests (ROI, Figs. 1-3) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California) using a typical exponential function as estimation [5]. Slope, time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs. Graphical and statistical analyses were performed by Pearson Correlation (two-sided confidence interval 95%) and Mann-Whitney test to compare between control and Scleroderma group using the software GraphPad Prism 3.02. Graphs are displayed with single patients’ results and median, minimum, maximum, and 25th and 75th percentile on the right side. Patients were characterized by autoantibody profile and concomitant medication. Modified Rodnan skin score was assessed. This score increases from 0 to 51 in severity and there is an association between severe skin involvement and burden of organ-based complications.

Bottom Line: Replenishment was recorded for 8 seconds.Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs.There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate.

View Article: PubMed Central - PubMed

Affiliation: University Hospital of Wuerzburg, Rheumatology/Clinical Immunology, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany.

ABSTRACT

Objectives: Renal damage is common in scleroderma. It can occur acutely or chronically. Renal reserve might already be impaired before it can be detected by laboratory findings. Microbubble-based contrast-enhanced ultrasound has been demonstrated to improve blood perfusion imaging in organs. Therefore, we conducted a study to assess renal perfusion in scleroderma patients utilizing this novel technique.

Materials and methodology: Microbubble-based contrast agent was infused and destroyed by using high mechanical index by Siemens Sequoia (curved array, 4.5 MHz). Replenishment was recorded for 8 seconds. Regions of interests (ROI) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California). Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs.

Results: There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate. However, the other parameters did not reveal significant differences between scleroderma patients and healthy controls.

Conclusion: Renal perfusion of scleroderma patients including the glomerular filtration rate can be assessed using microbubble-based contrast media.

No MeSH data available.


Related in: MedlinePlus