Usefulness of Contrast-enhanced Ultrasound in the Evaluation of Chronic Kidney Disease

Abstract

Background: Contrast-enhanced ultrasound (CEUS) can provide more improved images of renal blood flow and much more information of both macro- and microcirculation of the kidney as compared to Doppler US. Objective: To investigate the usefulness of CEUS by analyzing differences in perfusion-related parameters among the three chronic kidney disease (CKD) subgroups and the control group. Methods: Thirty-eight patients with CKD and 21 controls who were age-matched (20-49 years) were included. Included CKD patients were stratified into three groups according to their eGFR: group I, eGFR >= 60 ml/min/1.73 m(2) (GFR category I and II); group H, 30 ml/min/1.73 m(2) <= eGFR < 60 ml/min/1.73 m(2) (GFR category III); and group III, eGFR < 30 ml/min/1.73 m(2) (GFR category IV and V). Comparisons with the controls (eGFR > 90 ml/min/1.73 m(2)) were performed. Real-time and dynamic renal cortex imaging was performed using CEUS. Time-intensity curves and several bolus model quantitative perfusion parameters were created using the VueBox e quantification software. We compared the parameters among the CKD subgroups and between the CKD and control groups. Results: Eight patients were included in group I, 12 patients in group II, and 18 patients in group III. Significant differences were noted in the wash-in and wash-out rates between the CKD and control groups (p = 0.027 and p = 0.018, respectively), but not between those of the CKD subgroups. There were no significant differences of other perfusion parameters among the CKD subgroups and between the CKD and control groups. Conclusion: A few perfusion related CEUS parameters (WiR and WoR) can be used as markers of renal microvascular perfusion relating renal function. CEUS can effectively and quantitatively exhibit the renal microvascular perfusion in patients with CKD as well as normal control participants.