Standardization of the method of contrast-enhanced ultrasound of kidneys in patients with type 2 diabetes
Authors: Borsukov A. V. , Gorbatenko O. A. 
Published: September 2021

Aim of the research. Standardization of the quantitative assessment of the contrast-enhanced ultrasound examination of the kidneys in patients with type 2 diabetes.

Materials and methods. On the basis of the Fundamental research laboratory “Diagnostic researches and minimally invasive technologies”, of the Federal State Budgetary Educational Institution of Higher Education “Smolensk State Medical University” of Smolensk State Medical University, the Ministry of Health of the Russian Federation, 12 patients with type 2 diabetes were examined in 2020. The age of the examined patients was 36–64 years old. Average age – 44 ± 1.8 years, of which 7 women (58.33%) and 5 men (41.67%). All patients were examined using a single diagnostic algorithm, which included 2 stages: 1 stage. Ultrasound examination of the kidneys (Aloka Hitachi Arietta 850 (Hitachi Medical Corporation, Japan) in B-mode; stage 2 – contrast-enhanced ultrasound examination (CEUS) of the kidneys. All patients were divided into 2 groups: the 1st group consisted of patients with type 2 diabetes type (n = 6), who underwent CEUS with subsequent assessment of the renal parenchyma in different areas of the cortex and medulla; group 2 consisted of patients with type 2 diabetes (n = 6) who underwent CEUS with subsequent standardized assessment in the indicated 5-th points of the arterial bed and 3 points of the venous bed.

Results and discussions. Taking into account the current epidemiological situation in 2020, the number of performed radiation diagnostic methods, such as X-ray and computer examinations of the chest organs, significantly increased the overall background of radiation exposure on the bulk of patients. Taking into account the anxiety index of patients, ionizing research methods for the diagnosis of angionephrosclerosis are undesirable. The standardized method for quantitative parameters of CEUS showed good agreement (0.61–0.76). In turn, the assessment of the quantitative parameters of renal CEUS when using the routine technique showed low consistency (0.21–0.3). Cohen's kappa (CK) scores of 0 to 0.2 indicate a lack of agreement among clinicians; 0.21–0.4 – weak consistency; 0.41–0.6 – moderate agreement between doctors; 0.61–0.8 – good consistency; 0.81–1.0 – complete consistency.

The circulatory system of the kidneys is characterized by the presence of a developed capillary network and, accordingly, low peripheral resistance, which confirms the importance of a standardized approach in conducting this study. In the context of the prevailing epidemiological circumstances, we understand that it is necessary to choose a reference research method that would allow us to accurately assess the characteristics of the experimental evaluation of this method. As a result of renal C EUS using a routine technique, hypoperfusion of the right kidney was revealed in 50% (n = 3) cases and the data were interpreted as normal in 50% (n = 3) cases. As a result of the renal CEUS using the proposed method, pronounced hypoperfusion of the right kidney was revealed in 100% (n = 6) cases. Dynamic nephroscintigraphy was used as a reference method to determine the functional work of the kidneys. According to the results of dynamic nephroscintigraphy of the kidneys, hypoperfusion of the right kidney was revealed in all cases in both groups of patients.

Conclusion. 1. The standardized method for assessing the quantitative parameters of the kidney CEUS is more reproducible by the ultrasound doctors than the routine one. 2. Enhanced ultrasound can be used to assess the efficacy of hypoperfusion with the maximum efficacy of an equivalent dose per patient.