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12 pages, 3323 KiB

Open AccessArticle

Classification of Chronic Kidney Disease in Sonography Using the GLCM and Artificial Neural Network

by Dong-Hyun Kim and Soo-Young Ye

Diagnostics 2021, 11(5), 864; https://doi.org/10.3390/diagnostics11050864 - 11 May 2021

Cited by 22 | Viewed by 5666

Chronic kidney disease (CKD) can be treated if it is detected early, but as the disease progresses, recovery becomes impossible. Eventually, renal replacement therapy such as transplantation or dialysis is necessary. Ultrasound is a test method with which to diagnose kidney cancer, inflammatory [...] Read more.

Chronic kidney disease (CKD) can be treated if it is detected early, but as the disease progresses, recovery becomes impossible. Eventually, renal replacement therapy such as transplantation or dialysis is necessary. Ultrasound is a test method with which to diagnose kidney cancer, inflammatory disease, nodular disease, chronic kidney disease, etc. It is used to determine the degree of inflammation using information such as the kidney size and internal echo characteristics. The degree of the progression of chronic kidney disease in the current clinical trial is based on the value of the glomerular filtration rate. However, changes in the degree of inflammation and disease can even be observed with ultrasound. In this study, from a total of 741 images, 251 normal kidney images, 328 mild and moderate CKD images, and 162 severe CKD images were tested. In order to diagnose CKD in clinical practice, three ROIs were set: the cortex of the kidney, the boundary between the cortex and medulla, and the medulla, which are areas examined to obtain information from ultrasound images. Parameters were extracted from each ROI using the GLCM algorithm, which is widely used in ultrasound image analysis. When each parameter was extracted from the three areas, a total of 57 GLCM parameters were extracted. Finally, a total of 58 parameters were used by adding information on the size of the kidney, which is important for the diagnosis of chronic kidney disease. The artificial neural network (ANN) was composed of 58 input parameters, 10 hidden layers, and 3 output layers (normal, mild and moderate CKD, and severe CKD). Using the ANN model, the final classification rate was 95.4%, the epoch needed for training was 38 times, and the misclassification rate was 4.6%. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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11 pages, 1455 KiB

Open AccessArticle

Correlation of Kidney Size on Computed Tomography with GFR, Creatinine and HbA1C for an Accurate Diagnosis of Patients with Diabetes and/or Chronic Kidney Disease

by Nashaat Ghaith, Bassem Malaeb, Rasha Itani, Mohammed Alnafea and Achraf Al Faraj

Diagnostics 2021, 11(5), 789; https://doi.org/10.3390/diagnostics11050789 - 27 Apr 2021

Cited by 3 | Viewed by 2423

Abstract

Diabetes is considered one of the major causes of chronic kidney disease (CKD), affecting renal blood vessels and nerves. Diagnosis of CKD by traditional biochemical serum and blood analyses is insufficient and insensitive, thus requiring the development of a more robust technique. This [...] Read more.

Diabetes is considered one of the major causes of chronic kidney disease (CKD), affecting renal blood vessels and nerves. Diagnosis of CKD by traditional biochemical serum and blood analyses is insufficient and insensitive, thus requiring the development of a more robust technique. This novel study aims to propose a new method for the accurate diagnosis of CKD, quantification of kidney damage, and its prognosis by physicians by measuring the kidney volume on computed tomography (CT). In total, 251 patients were enrolled in this retrospective study. They were divided into four groups: control, patients having diabetes, patients having CKD, and patients having both diabetes and CKD. Results showed that kidney volume correlated negatively with both GFR and HbA1C on CT images, in addition to decreasing faster in males than females. Moreover, HbA1C was shown to correlate positively with creatinine and negatively with GFR. Finally, GFR was more robust than creatinine when correlated with age. The association between kidney volume with GFR and HbA1c can be used to accurately anticipate kidney volume in established CKD on CT scan, especially in resource-poor settings. Furthermore, HbA1C can serve as a powerful biomarker for studying renal function in diabetic CKD patients as it correlates with creatinine and GFR. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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12 pages, 3690 KiB

Open AccessArticle

Introduction of the Grayscale Median for Ultrasound Tissue Characterization of the Transplanted Kidney

by Camilo G. Sotomayor, Stan Benjamens, Hildebrand Dijkstra, Derya Yakar, Cyril Moers, Stephan J. L. Bakker and Robert A. Pol

Diagnostics 2021, 11(3), 390; https://doi.org/10.3390/diagnostics11030390 - 25 Feb 2021

Cited by 6 | Viewed by 1851

Abstract

Ultrasound examination is advised for early post-kidney transplant assessment. Grayscale median (GSM) quantification is novel in the kidney transplant field, with no systematic assessment previously reported. In this prospective cohort study, we measured the post-operative GSM in a large cohort of adult kidney [...] Read more.

Ultrasound examination is advised for early post-kidney transplant assessment. Grayscale median (GSM) quantification is novel in the kidney transplant field, with no systematic assessment previously reported. In this prospective cohort study, we measured the post-operative GSM in a large cohort of adult kidney transplant recipients (KTR) who consecutively underwent Doppler ultrasound directly after transplantation (within 24 h), compared it with GSM in nontransplanted patients, and investigated its association with baseline and follow-up characteristics. B-mode images were used to calculate the GSM in KTR and compared with GSM data in nontransplanted patients, as simulated from summary statistics of the literature using a Mersenne twister algorithm. The association of GSM with baseline and 1-year follow-up characteristics were studied by means of linear regression analyses. In 282 KTR (54 ± 15 years old, 60% male), the median (IQR) GSM was 55 (45–69), ranging from 22 to 124 (coefficient of variation = 7.4%), without differences by type of donation (p = 0.28). GSM in KTR was significantly higher than in nontransplanted patients (p < 0.001), and associated with systolic blood pressure, history of cardiovascular disease, and donor age (std. β = 0.12, −0.20, and 0.13, respectively; p < 0.05 for all). Higher early post-kidney transplant GSM was not associated with 1-year post-kidney transplant function parameters (e.g., measured and estimated glomerular filtration rate). The data provided in this study could be used as first step for further research on the application of early postoperative ultrasound in KTR. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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13 pages, 2700 KiB

Open AccessArticle

Structured Reporting in the Characterization of Renal Cysts by Contrast-Enhanced Ultrasound (CEUS) Using the Bosniak Classification System—Improvement of Report Quality and Interdisciplinary Communication

by Moritz L. Schnitzer, Laura Sabel, Vincent Schwarze, Constantin Marschner, Matthias F. Froelich, Philipp Nuhn, Yannick Falck, Maria-Magdalena Nuhn, Saif Afat, Michael Staehler, Johannes Rückel, Dirk-André Clevert, Johannes Rübenthaler and Thomas Geyer

Diagnostics 2021, 11(2), 313; https://doi.org/10.3390/diagnostics11020313 - 15 Feb 2021

Cited by 2 | Viewed by 2221

Abstract

Background: This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification. Methods: Fifty patients with cystic renal lesions who underwent CEUS were [...] Read more.

Background: This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification. Methods: Fifty patients with cystic renal lesions who underwent CEUS were included in this single-center study. FTR created in clinical routine were compared to SR retrospectively generated by using a structured reporting template. Two experienced urologists evaluated the reports regarding integrity, effort for information extraction, linguistic quality, and overall quality. Results: The required information could easily be extracted by the reviewers in 100% of SR vs. 82% of FTR (p < 0.001). The reviewers trusted the information given by SR significantly more with a mean of 5.99 vs. 5.52 for FTR (p < 0.001). SR significantly improved the linguistic quality (6.0 for SR vs. 5.68 for FTR (p < 0.001)) and the overall report quality (5.98 for SR vs. 5.58 for FTR (p < 0.001)). Conclusions: SR significantly increases the quality of radiologic reports in CEUS examinations of cystic renal lesions compared to conventional FTR and represents a promising approach to facilitate interdisciplinary communication in the future. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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Review

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12 pages, 3196 KiB

Open AccessReview

Role of Contrast-Enhanced Ultrasound (CEUS) in Native Kidney Pathology: Limits and Fields of Action

by Antonio Granata, Irene Campo, Paolo Lentini, Francesco Pesce, Loreto Gesualdo, Antonio Basile, Vito Cantisani, Matthias Zeiler and Michele Bertolotto

Diagnostics 2021, 11(6), 1058; https://doi.org/10.3390/diagnostics11061058 - 08 Jun 2021

Cited by 9 | Viewed by 3402

Abstract

Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) [...] Read more.

Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) in daily clinical practice has significantly reduced the use of contrast enhancement computed tomography (CECT) and contrast enhancement magnetic resonance (CEMR), especially in patients with renal disease. Although there are many situations in which CECT and CEMRI are primarily indicated, their use may be limited by the administration of the contrast medium, which may involve a risk of renal function impairment, especially in the elderly, and in patients with acute kidney injury (AKI) and moderate to severe chronic kidney disease (CKD). In these cases, CEUS can be a valid diagnostic choice. To date, numerous publications have highlighted the role of CEUS in the study of parenchymal micro-vascularization and renal pathology by full integration with second level imaging methods (CECT and CEMRI) both in patients with normal renal function and with diseased kidneys. The aim of this review is to offer an updated overview of the limitations and potential applications of CEUS in native kidney disease. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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10 pages, 465 KiB

Open AccessReview

A Systematic Review on the Correlations between Left Atrial Strain and Cardiovascular Outcomes in Chronic Kidney Disease Patients

by Ana Tanasa, Alexandru Burlacu, Cristina Popa, Mehmet Kanbay, Crischentian Brinza, Liviu Macovei, Radu Crisan-Dabija and Adrian Covic

Diagnostics 2021, 11(4), 671; https://doi.org/10.3390/diagnostics11040671 - 08 Apr 2021

Cited by 4 | Viewed by 2356

Abstract

Left atrial strain (LASr) represents a relatively new but promising technique for left atrial and left ventricle function evaluation. LASr was strongly linked to myocardial fibrosis and endocardial thickness, suggesting the utility of LASr in subclinical cardiac dysfunction detection. As CKD negatively impacts [...] Read more.

Left atrial strain (LASr) represents a relatively new but promising technique for left atrial and left ventricle function evaluation. LASr was strongly linked to myocardial fibrosis and endocardial thickness, suggesting the utility of LASr in subclinical cardiac dysfunction detection. As CKD negatively impacts cardiovascular risk and mortality, underlying structural and functional abnormalities of cardiac remodeling are widely investigated. LASr could be used in LV diastolic dysfunction grading with an excellent discriminatory power. Our objectives were to assess the impact and existing correlations between LASr and cardiovascular outcomes, as reported in clinical trials, including patients with CKD. We searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials for full-text papers. As reported in clinical studies, LASr was associated with adverse cardiovascular outcomes, including cardiovascular death and major adverse cardiovascular events (HR 0.89, 95% CI, 0.84–0.93, p < 0.01), paroxysmal atrial fibrillation (OR 0.847, 95% CI, 0.760–0.944, p = 0.003), reduced exercise capacity (AUC 0.83, 95% CI, 0.78–0.88, p < 0.01), diastolic dysfunction (p < 0.05), and estimated pulmonary capillary wedge pressure (p < 0.001). Despite limitations attributed to LA deformation imaging (image quality, inter-observer variability, software necessity, learning curve), LASr constitutes a promising marker for cardiovascular events prediction and risk evaluation in patients with CKD. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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12 pages, 2861 KiB

Open AccessReview

Pyonephrosis Ultrasound and Computed Tomography Features: A Pictorial Review

by Stefania Tamburrini, Marina Lugarà, Michele Iannuzzi, Edoardo Cesaro, Fiore De Simone, Dario Del Biondo, Roberta Toto, Dora Iulia, Valeria Marrone, Pierluigi Faella, Carlo Liguori and Ines Marano

Diagnostics 2021, 11(2), 331; https://doi.org/10.3390/diagnostics11020331 - 17 Feb 2021

Cited by 11 | Viewed by 6954

Abstract

Urinary tract infections (UTIs) are the most frequent community-acquired and healthcare-associated bacterial infections. UTIs are heterogeneous and range from rather benign, uncomplicated infections to complicated UTIs (cUTIs), pyelonephritis and severe urosepsis, depending mostly on the host response. Ultrasound and computed tomography represent the [...] Read more.

Urinary tract infections (UTIs) are the most frequent community-acquired and healthcare-associated bacterial infections. UTIs are heterogeneous and range from rather benign, uncomplicated infections to complicated UTIs (cUTIs), pyelonephritis and severe urosepsis, depending mostly on the host response. Ultrasound and computed tomography represent the imaging processes of choice in the diagnosis and staging of the pathology in emergency settings. The aim of this study is to describe the common ultrasound (US) and computed tomography (CT) features of pyonephrosis. US can make the diagnosis, demonstrating echogenic debris, fluid/fluid levels, and air in the collecting system. Although the diagnosis appears to be easily made with US, CT is necessary in non-diagnostic US examinations to confirm the diagnosis, to demonstrate the cause and moreover to stage the pathology, defining extrarenal complications. In emergency settings, US and CT are differently used in the diagnosis and staging of pyonephrosis. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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14 pages, 4446 KiB

Open AccessReview

From Nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review

by Antonio Granata, Giulio Distefano, Alessio Sturiale, Michele Figuera, Pietro Valerio Foti, Stefano Palmucci and Antonio Basile

Diagnostics 2021, 11(1), 101; https://doi.org/10.3390/diagnostics11010101 - 11 Jan 2021

Cited by 30 | Viewed by 11150

Abstract

Left renal vein (LRV) entrapment, also known as nutcracker phenomenon if it is asymptomatic, is characterized by abnormality of outflow from the LRV into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial [...] Read more.

Left renal vein (LRV) entrapment, also known as nutcracker phenomenon if it is asymptomatic, is characterized by abnormality of outflow from the LRV into the inferior vena cava (IVC) due to extrinsic LRV compression, often accompanied by demonstrable lateral (hilar) dilatation and medial (mesoaortic) stenosis. Nutcracker syndrome, on the other hand, includes a well-defined set of symptoms, and the severity of these clinical manifestations is related to the severity of anatomic and hemodynamic findings. With the aim of providing practical guidance for nephrologists and radiologists, we performed a review of the literature through the PubMed database, and we commented on the definition, the main clinical features, and imaging pattern of this syndrome; we also researched the main therapeutic approaches validated in the literature. Finally, from the electronic database of our institute, we have selected some characteristic cases and we have commented on the imaging pattern of this disease. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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10 pages, 1275 KiB

Open AccessReview

Kidney Transplantation and Diagnostic Imaging: The Early Days and Future Advancements of Transplant Surgery

by Stan Benjamens, Cyril Moers, Riemer H.J.A. Slart and Robert A. Pol

Diagnostics 2021, 11(1), 47; https://doi.org/10.3390/diagnostics11010047 - 30 Dec 2020

Cited by 6 | Viewed by 2447

Abstract

The first steps for modern organ transplantation were taken by Emerich Ullmann (Vienne, Austria) in 1902, with a dog-to-dog kidney transplant, and ultimate success was achieved by Joseph Murray in 1954, with the Boston twin brothers. In the same time period, the ground-breaking [...] Read more.

The first steps for modern organ transplantation were taken by Emerich Ullmann (Vienne, Austria) in 1902, with a dog-to-dog kidney transplant, and ultimate success was achieved by Joseph Murray in 1954, with the Boston twin brothers. In the same time period, the ground-breaking work of Wilhelm C. Röntgen (1895) and Maria Sklodowska-Curie (1903), on X-rays and radioactivity, enabled the introduction of diagnostic imaging. In the years thereafter, kidney transplantation and diagnostic imaging followed a synergistic path for their development, with key discoveries in transplant rejection pathways, immunosuppressive therapies, and the integration of diagnostic imaging in transplant programs. The first image of a transplanted kidney, a urogram with intravenous contrast, was shown to the public in 1956, and the first recommendations for transplantation diagnostic imaging were published in 1958. Transplant surgeons were eager to use innovative diagnostic modalities, with renal scintigraphy in the 1960s, as well as ultrasound and computed tomography in the 1970s. The use of innovative diagnostic modalities has had a great impact on the reduction of post-operative complications in kidney transplantation, making it one of the key factors for successful transplantation. For the new generation of transplant surgeons, the historical alignment between transplant surgery and diagnostic imaging can be a motivator for future innovations. Full article

(This article belongs to the Special Issue Imaging in Kidney Disease)

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