Rofo 2020; 192(06): 561-566
DOI: 10.1055/a-1086-5191
Urogenital Tract
© Georg Thieme Verlag KG Stuttgart · New York

The Renal Resistive Index in Allografts: Is Sonographic Assessment Sufficiently Reproducible in a Routine Clinical Setting? – Reproducibility of the Renal Resistive Index

Der renale Widerstandsindex in Nierentransplantaten: Ist die sonografische Bestimmung ausreichend reproduzierbar in der Alltagssituation? – Reproduzierbarkeit des renalen Widerstandsindex
Dorothea Cornelia Theilig
1   Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Germany
,
Hanna Münzfeld
1   Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Germany
,
Timo Alexander Auer
1   Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Germany
,
Felix Feldhaus
1   Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Germany
,
Anne Krüger
2   Division of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany
,
Michael Dürr
2   Division of Nephrology and Internal Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany
,
Dominik Geisel
1   Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Germany
› Author Affiliations
Further Information

Publication History

16 October 2019

13 December 2019

Publication Date:
27 February 2020 (online)

Abstract

Purpose To assess the reproducibility of the renal resistive index (RRI) in a routine clinical setting.

Materials and Methods 22 patients with a kidney allograft and 19 physicians participated in our prospective study. Within 2 hours each patient was examined by 5 different physicians using 2 out of 3 different, randomly allocated ultrasound machines. Each investigator determined the hilar and parenchymal RRI of the allograft. The reproducibility and reproducibility limit of the RRI were assessed as well as Cronbach’s alpha and the intraclass correlation coefficient (ICC). The deviation of the RRI from the mean RRI over the 5 measurements was used as an indicator of reproducibility. The impact of the ultrasound machine, examiner’s level of experience, and kidney function impairment (GFR < 45 ml/min) was assessed with the Kruskal-Wallis test. The bivariate linear correlation of the minimal transplant distance from the body surface with the variance of the parenchymal RRI was analyzed.

Results A reproducibility of 0.045 with a reproducibility limit of 0.124 was found for the parenchymal RRI. The ICC between RRIs was good with 0.852 for the parenchymal RRI and 0.868 for the hilar RRI. The type of ultrasound machine used was found to have a significant impact on the deviation of the parenchymal RRI (Kruskal-Wallis-Test, p = 0.003). Variance in serial parenchymal RRI measurements correlated significantly with the depth of the kidney transplant (p = 0.001).

Conclusion While the RRI is generally sufficiently reproducible, the type of ultrasound machine used and the depth of the kidney transplant within the recipient’s body have a significant impact on reproducibility.

Key Points:

  • The renal resistive index (RRI) in allografts is reproducible.

  • The type of ultrasound machine has an impact on the measured RRI.

  • RRI reproducibility decreases with the depth of the renal allograft in the recipient.

Citation Format

  • Theilig DC, Münzfeld H, Auer TA et al. The Renal Resistive Index in Allografts: Is Sonographic Assessment Sufficiently Reproducible in a Routine Clinical Setting?. Fortschr Röntgenstr 2020; 192: 561 – 566

Zusammenfassung

Ziel Die Überprüfung der Reproduzierbarkeit des renalen Widerstandsindex (RRI) in der Alltagssituation.

Material und Methoden An der prospektiven Studie nahmen 22 Patienten mit Nierentransplantat und 19 Untersucher teil. Jeder Patient wurde innerhalb von 2 Stunden von 5 verschiedenen Untersuchern mit insgesamt 2 von 3 verschiedenen Ultraschallgeräten untersucht, wobei jeweils hilärer und parenchymatöser RRI bestimmt wurden. Die Reproduzierbarkeit, deren Grenzwerte, der Cronbachs Alpha und die Intraklassenkorrelation (ICC) wurden ermittelt. Das Ausmaß der Abweichung vom Mittelwert der 5 Messungen wurde als Indikator für die Reproduzierbarkeit herangezogen. Mittels Kruskal-Wallis-Test wurde der Einfluss von Ultraschallgerät, Erfahrungsgrad des Untersuchers und Nierenfunktionseinschränkung (GFR < 45 ml/min) ermittelt. Die bivariate lineare Korrelation der Abhängigkeit der Varianz der RRI-Messungen von der Tiefe des Nierentransplantats im Patienten wurde eruiert.

Ergebnisse Die statistische Auswertung ergab eine Reproduzierbarkeit des parenchymalen RRI von 0,045 bei einer Grenze von 0,124. Der ICC zwischen den parenchymalen und hilären RRIs lag bei 0,852 bzw. 0,868. Der Kruskal-Wallis-Test zeigte einen signifikanten Unterschied in der Reproduzierbarkeit bei unterschiedlichen Ultraschallgeräten (p = 0,003). Die Korrelation der Varianz der RRIs mit der Tiefe des Nierentransplantats im Patienten war ebenfalls signifikant (p = 0,001).

Schlussfolgerung Die Reproduzierbarkeit des RRI ist prinzipiell auch in der Alltagssituation gegeben, nimmt aber mit der Tiefe des Transplantats im Patienten und durch die Benutzung unterschiedlicher Ultraschallgeräte ab.

Kernaussagen:

  • Der renale Widerstandsindex (RRI) in Nierentransplantaten ist ausreichend reproduzierbar.

  • Der gemessene RRI wird vom verwendeten Ultraschallgerät beeinflusst.

  • Die Reproduzierbarkeit des RRI nimmt mit der Transplantattiefe im Empfänger ab.

 
  • References

  • 1 Rifkin MD, Needleman L, Pasto ME. et al. Evaluation of renal transplant rejection by duplex Doppler examination: value of the resistive index. Am J Roentgenol 1987; 148: 759-762 . doi:10.2214/ajr.148.4.759
  • 2 Rigsby CM, Taylor KJ, Weltin G. et al. Renal allografts in acute rejection: evaluation using duplex sonography. Radiology 1986; 158: 375-378 . doi:10.1148/radiology.158.2.3510443
  • 3 Don S, Kopecky KK, Filo RS. et al. Duplex Doppler US of renal allografts: causes of elevated resistive index. Radiology 1989; 171: 709-712 . doi:10.1148/radiology.171.3.2655003
  • 4 Platt JF, Ellis JH, Rubin JM. Intrarenal arterial Doppler sonography in the detection of renal vein thrombosis of the native kidney. Am J Roentgenol 1994; 162: 1367-1370 . doi:10.2214/ajr.162.6.8192001
  • 5 Reuther G, Wanjura D, Bauer H. Acute renal vein thrombosis in renal allografts: detection with duplex Doppler US. Radiology 1989; 170: 557-558 . doi:10.1148/radiology.170.2.2643150
  • 6 Gottlieb RH, Lieberman JL, Pabico RC. et al. Diagnosis of renal artery stenosis in transplanted kidneys: value of Doppler waveform analysis of the intrarenal arteries. Am J Roentgenol 1995; 165: 1441-1446 . doi:10.2214/ajr.165.6.7484582
  • 7 Bellos I, Perrea DN, Kontzoglou K. Renal resistive index as a predictive factor of delayed graft function: A meta-analysis. Transplant Rev (Orlando) 2019; 33: 145-153 . doi:10.1016/j.trre.2019.03.003
  • 8 Naesens M, Heylen L, Lerut E. et al. Intrarenal resistive index after renal transplantation. N Engl J Med 2013; 369: 1797-1806 . doi:10.1056/NEJMoa1301064
  • 9 Rifkin MD, Pasto ME, Goldberg BB. Duplex Doppler examination in renal disease: evaluation of vascular involvement. Ultrasound Med Biol 1985; 11: 341-346
  • 10 Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: where do we stand?. Am J Roentgenol 2003; 180: 885-892 . doi:10.2214/ajr.180.4.1800885
  • 11 Kim SH, Kim WH, Choi BI. et al. Duplex Doppler US in patients with medical renal disease: resistive index vs serum creatinine level. Clin Radiol 1992; 45: 85-87
  • 12 Petersen LJ, Petersen JR, Ladefoged SD. et al. The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure. Nephrol Dial Transplant 1995; 10: 2060-2064
  • 13 Rigsby CM, Burns PN, Weltin GG. et al. Doppler signal quantitation in renal allografts: comparison in normal and rejecting transplants, with pathologic correlation. Radiology 1987; 162: 39-42 . doi:10.1148/radiology.162.1.3538151
  • 14 Platt JF, Ellis JH, Rubin JM. et al. Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings. Am J Roentgenol 1990; 154: 1223-1227 . doi:10.2214/ajr.154.6.2110732
  • 15 Bellos I, Pergialiotis V, Kontzoglou K. Renal resistive index as predictor of acute kidney injury after major surgery: A systematic review and meta-analysis. J Crit Care 2019; 50: 36-43 . doi:10.1016/j.jcrc.2018.11.001
  • 16 Di Nicolo P, Granata A. Renal intraparenchymal resistive index: the ultrasonographic answer to many clinical questions. J Nephrol 2018; DOI: 10.1007/s40620-018-00567-x.
  • 17 Di Nicolo P, Granata A. Renal Resistive Index: not only kidney. Clin Exp Nephrol 2017; 21: 359-366 . doi:10.1007/s10157-016-1323-3
  • 18 Pozniak MA, Zagzebski JA, Scanlan KA. Spectral and color Doppler artifacts. Radiographics 1992; 12: 35-44 . doi:10.1148/radiographics.12.1.1734480
  • 19 Rubens DJ, Bhatt S, Nedelka S. et al. Doppler artifacts and pitfalls. Radiol Clin North Am 2006; 44: 805-835 . doi:10.1016/j.rcl.2006.10.014
  • 20 Terslev L, Diamantopoulos AP, Dohn UM. et al. Settings and artefacts relevant for Doppler ultrasound in large vessel vasculitis. Arthritis Res Ther 2017; 19: 167 . doi:10.1186/s13075-017-1374-1
  • 21 Strouthidis NG, White ET, Owen VM. et al. Factors affecting the test-retest variability of Heidelberg retina tomograph and Heidelberg retina tomograph II measurements. Br J Ophthalmol 2005; 89: 1427-1432 . doi:10.1136/bjo.2005.067298
  • 22 London NJ, Aldoori MI, Lodge VG. et al. Reproducibility of Doppler ultrasound measurement of resistance index in renal allografts. Br J Radiol 1993; 66: 510-513 . doi:10.1259/0007-1285-66-786-510
  • 23 Imuta N, Kinoshita N, Etani H. et al. The reproducibility of color Doppler duplex sonography in the measurement of renal arterial blood velocity. Ultrasound Med Biol 1997; 23: 813-819
  • 24 Mikkonen RH, Kreula JM, Virkkunen PJ. Reproducibility of Doppler ultrasound measurements. Acta Radiol 1996; 37: 545-550 . doi:10.1177/02841851960373P224