Study Of The Application Of Multimodal Ultrasound In Evaluation Of Lupus Nephritis And Its Different Pathological Types

ObjectiveTo investigate the value of multimodal ultrasound imaging,which composed of conventional ultrasound imaging,superb microvascular imaging(SMI),shear wave elastography(SWE),in diagnosing lupus nephritis(LN),and to analyze the differences of each ultrasound parameter between different pathological types of LN.Materials and Methods84 patients with LN treated in our hospital were prospective collected,of whom underwent renal puncture were classified into types Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,and Ⅵ according to the pathologic criteria,the clinical biochemical parameters of the patients were recorded.50 healthy volunteers were recruited,and the basic information of all enrolled subjects were recorded in detail.All subjects underwent conventional ultrasound,SWE,and SMI to obtain the corresponding ultrasound values.The differences in ultrasound parameters between LN patients with normal controls and between different pathological types of LN were compared.Spearman correlation analysis was used to determine the relationship between ultrasound parameters and clinical biochemical parameters.To obtain the efficacy of various ultrasound techniques for diagnosing LN alone and in combination.Result1.There were no statistical differences in sex,age,BMI,upper and lower renal diameters,left and right renal diameters,and anterior and posterior renal diameters between the two groups(P>0.05).Renal cortical thickness,interlobar artery peak systolic velocity(PSV),interlobar artery resistance index(RI),vascular index(VI),and Young’s modulus(YM)values were significantly different between the two groups(P<0.05).2.In LN patients,YM values in the renal cortex were positively correlated with serum creatinine(r=0.228),uric acid(r=0.259),interlobar artery RI(r=0.597),while negatively correlated with eGFR(r=0.392),renal cortex thickness(r=0.318),interlobar artery PSV(r=0.428),and renal cortex Ⅵ(r=-0.779);There was no correlation between the upper and lower renal diameters,left and right renal diameters,anterior and posterior renal diameters,or 24-h urinary protein quantification(P>0.05).3.The upper and lower renal diameters,left and right renal diameters,and anterior and posterior renal diameters were not statistically different between patients with different pathological types of LN(P>0.05),whereas the renal cortical thickness,interlobar artery PSV,interlobar artery RI,VI,and YM values were statistically significantly different(P<0.05),the YM value was the only ultrasound parameter with statistically significant differences between any two comparisons4.The area under the ROC curve=0.757 for conventional ultrasound evaluation of LN,which showed a sensitivity and specificity of 78%and 63.1%respectively.The area under the ROC curve=0.891 for SMI assessment of LN and the optimal cut-off value of LN renal cortex VI was 57.2%,meanwhile its diagnostic sensitivity and specificity were 76%,88.1%,respectively.The area under the ROC curve=0.912 for SWE evaluation of LN,and the optimal cut-off value of YM value of LN renal cortex was 5.82kPa,whose diagnostic sensitivity and specificity were 84.5%,72%,respectively.The area under the ROC curve of multimodal ultrasound for the evaluation of LN was 0.954,and its sensitivity and specificity were 92%and 89.3%,respectively.The diagnostic efficiency of multimodal ultrasound model was better than that of single ultrasound technology,and high sensitivity and specificity were obtained.ConclusionLN can be identified by conventional ultrasound,SMI technique and SWE technique,and the multimodal ultrasound model composed of each ultrasound technique has better diagnostic efficacy than single ultrasound technique,which has a large potential of clinical application.