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Purpose <p>This study aimed to evaluate the diagnostic value of a multimodal ultrasound approach integrating shear wave elastography (SWE), superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) with conventional ultrasound for the early non-invasive detection of renal allograft dysfunction.</p> Methods <p>This prospective study stratified renal transplant recipients into stable function and dysfunction group based on clinical criteria. All patients underwent conventional ultrasound, SWE, SMI, and CEUS examinations. Ultrasound parameters and clinical indicators were compared between groups, followed by variable screening via LASSO regression and construction of a logistic regression model.</p> Results <p>A total of 76 patients (mean age 46 ± 10 years; 54 male) were included. Compared to the stable function group (<i>n</i> = 35), the dysfunction group (<i>n</i> = 41) showed a higher incidence of prolonged cold ischemia time (&gt; 4&#xa0;h) and delayed graft function, along with significantly increased cortical echogenicity, reduced segmental and main renal artery PSV, elevated cortical and medullary stiffness, decreased VI, and lower CEUS perfusion parameters (PI, slope, Area, AreaWI, AreaWO) (all <i>p</i> &lt; 0.05). A logistic regression model incorporating six predictors—cortical stiffness, medullary stiffness, VI, AreaWI, main renal artery PSV, and prolonged cold ischemia time—achieved an AUC of 0.946 (95% CI: 0.899–0.992), with 97.1% sensitivity and 85.4% specificity. The model also demonstrated good calibration (low Brier score) and clinical utility on decision-curve analysis.</p> Conclusion <p>Multiparametric ultrasound offers a comprehensive panel of quantitative biomarkers that enable accurate and timely identification of renal allograft dysfunction, supporting its potential role in non-invasive graft monitoring.</p>

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Multimodal quantitative ultrasound for non-invasive assessment of renal allograft dysfunction: a prospective diagnostic study

  • 期刊论文

  • 发表日期：

    2026年2月13日

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  • Lingxi Zhu,
  • Tianyi Lin,
  • He Sun,
  • Chunyan Ma,
  • Tan Li

摘要

Purpose

This study aimed to evaluate the diagnostic value of a multimodal ultrasound approach integrating shear wave elastography (SWE), superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) with conventional ultrasound for the early non-invasive detection of renal allograft dysfunction.

Methods

This prospective study stratified renal transplant recipients into stable function and dysfunction group based on clinical criteria. All patients underwent conventional ultrasound, SWE, SMI, and CEUS examinations. Ultrasound parameters and clinical indicators were compared between groups, followed by variable screening via LASSO regression and construction of a logistic regression model.

Results

A total of 76 patients (mean age 46 ± 10 years; 54 male) were included. Compared to the stable function group (n = 35), the dysfunction group (n = 41) showed a higher incidence of prolonged cold ischemia time (> 4 h) and delayed graft function, along with significantly increased cortical echogenicity, reduced segmental and main renal artery PSV, elevated cortical and medullary stiffness, decreased VI, and lower CEUS perfusion parameters (PI, slope, Area, AreaWI, AreaWO) (all p < 0.05). A logistic regression model incorporating six predictors—cortical stiffness, medullary stiffness, VI, AreaWI, main renal artery PSV, and prolonged cold ischemia time—achieved an AUC of 0.946 (95% CI: 0.899–0.992), with 97.1% sensitivity and 85.4% specificity. The model also demonstrated good calibration (low Brier score) and clinical utility on decision-curve analysis.

Conclusion

Multiparametric ultrasound offers a comprehensive panel of quantitative biomarkers that enable accurate and timely identification of renal allograft dysfunction, supporting its potential role in non-invasive graft monitoring.