■微流成像(MFI)是一种新颖的无创超声(US)技术,可描绘肾脏中的微循环血管,同时滤除组织运动并增强血流信号。我们旨在探讨MFI在I-II期膜性肾病(MN)引起的慢性肾脏疾病中检测肾脏微血管灌注的价值。
■从2020年3月至2020年12月,使用MFI对76名参与者进行了前瞻性检查,包括活检证实的MN(n=38)和健康志愿者(n=38)。此外,MN患者被细分为轻度组,一个温和的群体,和根据血管病理学评估结果的严重组。通过ImageProPlus分析所有MFI图像以获得皮质血管指数(VI)。患者基本信息,然后获得每位参与者的相关US参数和实验室结果.最后,在多组间进行单因素分析后,采用二元逻辑回归(前向LR)和有序逻辑回归进行多变量分析.显著性设定为P<0.05。
■与健康对照组相比,MN患者的VI显着降低(0.65±0.09vs.0.35±0.18,P<0.001)。经过多变量分析,我们发现VI[曲线下面积(AUC):0.94;95%置信区间(CI):0.89~0.99]在鉴定MN方面的探索性诊断性能优于血清肌酐(Scr)(AUC:0.87;95%CI:0.79~0.95).我们还观察到MN组之间的参数,包括VI(P=0.006),估计肾小球滤过率(eGFR)(P=0.037),形状(P=0.013),和印象(P=0.007)。此外,在轻度血管损伤组中,VI的探索性诊断性能(AUC:0.79;95%CI:0.64-0.94)优于其他参数,如eGFR(AUC:0.63;95%CI:0.43-0.84)。
■在未使用造影剂的情况下,MFI检测到MN患者(特别是早期血管损伤或肾功能保留的患者)的肾脏微血管灌注异常。结合MFI和B模式US可以提高传统肾脏US的预测性能。
UNASSIGNED: MicroFlow imaging (MFI) is a novel noninvasive ultrasound (US) technique that depicts microcirculatory blood vessels in the kidney while filtering out tissue motion and enhancing blood flow signals. We aimed to investigate the value of MFI for the detection of renal microvascular perfusion in chronic kidney disease caused by stage I-II membranous nephropathy (MN).
UNASSIGNED: Seventy-six participants including biopsy-proven MN (n=38) and healthy volunteers (n=38) were prospectively examined using MFI from March 2020 to December 2020. In addition, patients with MN were subdivided into a mild group, a moderate group, and a severe group based on the results of vascular pathology evaluation. All MFI images were analyzed by Image Pro Plus to obtain a cortical vascular index (VI). Basic patient information, relative US parameters and laboratory results were then acquired for each participant. Finally, after the univariate analysis among multiple groups, binary logistic regression (forward LR) and ordered logistic regression were used for multivariate analysis. Significance was set at P<0.05.
UNASSIGNED: VI was significantly lower in MN patients compared with that of healthy controls (0.65±0.09 vs. 0.35±0.18, P<0.001). After multivariate analysis, we found that the exploratory diagnostic performance of VI [area under the curve (AUC): 0.94; 95% confidence interval (CI): 0.89-0.99] outperformed that of serum creatinine (Scr) (AUC: 0.87; 95% CI: 0.79-0.95) in identifying MN. We also observed considerable differences among MN groups in parameters including VI (P=0.006), estimated glomerular filtration rate (eGFR) (P=0.037), shape (P=0.013), and impression (P=0.007). In addition, in the group with mild vascular damage, the exploratory diagnostic performance of VI (AUC: 0.79; 95% CI: 0.64-0.94) was better than other parameters, such as eGFR (AUC: 0.63; 95% CI: 0.43-0.84).
UNASSIGNED: MFI detected abnormal renal microvascular perfusion in patients with MN (particularly in those with early vascular damage or preserved renal function) without the use of a contrast agent. Combining MFI with B-mode US can improve the predictive performance of traditional kidney US.