Application Of Shear Wave Elastography In The Study Of Renal Tissue Elasticity In Patients With Diabetic Nephropathy

Objective:Quantitative analyze the elasticity of renal parenchyma in patients with different stages of diabetic nephropathy using the real-time shear wave elastography(SWE)technique and explore the clinical value of SWE in the early diagnosis of diabetic nephropathy.Methods:A total of 178 patients with type 2 diabetes mellitus and 54 healthy controls matched for their age and sex were selected.According to the Mogensen clinical stage,patients with diabetic nephropathy were divided into four groups: 60 cases in group A,43 cases in group B,34 cases in group C,41 cases in group D.Patients in the right lateral position,obtaining the Maximal Longitudinal Axis of Left Renal by Two-dimensional Ultrasound,measuring the size of the left kidney and cortex,medulla and parenchyma thickness.After stabilization of the image,we started SWE to measure the parenchyma young's modulus of the middle of left kidney.At least 3times in the same position,taking the mean of 3 measurements as the final result.The Q-box diameter was set to 10 mm in this research.The system automatically calculates the maximum Young's modulus(Emax),the mean Young's modulus(Emean),the minimum Young's modulus(Emin)(in k Pa)in the Q-Box area.Compare The Young's modulus of renal parenchyma between healthy control group and diabetic nephropathy group.Compare each groups of the renal parenchyma Young's modulus of diabetic nephropathy.Quantitative analysis the changes of renal parenchymal elasticity at different stages of diabetic nephropathy.Results:1.Emean and Emax of renal parenchyma in patients with diabetic nephropathy were significantly higher than those in healthy controls(P <0.05).2.There was no difference in Emean and Emax of renal parenchyma between diabetic nephropathy group A and healthy control group(P> 0.05).3.Emean and Emax of renal parenchyma in diabetic nephropathy group B,C and D(DNIII,IV and V)were larger than those in healthy control group(P <0.05).4.Emax and Emean values of renal parenchyma in diabetic nephropathy group B were significantly different from those in groups C and D(P <0.05),also different from those in groups A and healthy control group.5.The hardness of renal parenchyma in groups A,B,C and D(the group of DM,DNIII,IV,V)gradually increased.Group B(DNIII)were significantly different from the other three groups.6.Spearman correlation analysis showed that there was a positive correlation between Emax and ACR in renal parenchyma(r=0.817,P<0.001);there was a positive correlation between renal Eeman and ACR(r=0.764,P<0.001);there was a positive correlation between renal Emin and ACR(r=0.609,P<0.001).7.Receiver operating characteristic curve analysis showed that:(1)the area under the curve for SWE Emax diagnosis of diabetes complicated by renal injury was0.810,the best cutoff point,sensitivity,and specificity were 6.65 KPa,79%,81.7%,respectively;(2)the area under the curve for SWE Emean diagnosis of diabetes complicated by renal injury was0.785,the best cutoff point,sensitivity,and specificity were3.695 KPa,62.8%,78.3%,respectively.Conclusion:1.Real-time shear wave elastography can quantitatively analyze renal parenchymal elasticity in patients with different stages of diabetic nephropathy.2.Renal parenchyma Emax,Emean gradually increasing trend in different stages of Diabetic nephropathy.3.Stage III of diabetic nephropathy renal parenchymatous Young's modulus value have statistically significant differences with other groups.4.A positive correlation between Young's modulus measured by SWE and ACR in patients with diabetic nephropathy.5.Real-time shear wave ultrasound elastography may help early diagnosis of diabetic nephropathy and may provide a new diagnostic information for the early diagnosis of diabetic nephropathy.