Skip to main content


Log in

Assessment of renal tissue elasticity by acoustic radiation force impulse quantification with histopathological correlation: preliminary experience in chronic kidney disease

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript



Chronic kidney disease (CKD), a progressive and irreversible pathological syndrome, is the major cause of renal failure. Renal fibrosis is the principal process underlying the progression of CKD. Acoustic radiation force impulse (ARFI) quantification is a promising noninvasive method for assessing tissue stiffness. We evaluated whether the technique could reveal renal tissue fibrosis in CKD patients.


ARFI assessments were performed in 45 patients with CKD referred for renal biopsies to measure cortical shear wave velocity (SWV). During measurement, a standardized method was employed, which aimed to minimize the potential impact of variation of transducer force, sampling error of non-cortical tissue and structural anisotropy of the kidney. Then SWV was compared to patients’ CKD stage and pathological fibrosis indicators.


ARFI could not predict the different stages of CKD. Spearman correlation analysis showed that SWV did not correlate with any pathological indicators of fibrosis.


ARFI assesses tissue stiffness of CKD kidneys by measuring cortical SWV. However, SWV did not show significant correlations with CKD stage and fibrosis indicators despite using standardized measurement methods. We therefore suggest that it would be necessary to evaluate the effect of pathological complexity and tissue perfusion of the kidney on stiffness assessment in future studies.

Key points

Acoustic radiation force impulse (ARFI) can quantify tissue elasticity of CKD kidney.

Despite standardized measurement, ARFI-estimated elasticity did not correlate with renal fibrosis.

Effects of pathological complexity and tissue perfusion on renal stiffness warrant further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Levey AS, de Jong PE, Coresh J et al (2011) The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 80:17–28

    Article  PubMed  Google Scholar 

  2. Jha V, Garcia-Garcia G, Iseki K et al (2013) Chronic kidney disease: global dimension and perspectives. Lancet 382:260–272

    Article  PubMed  Google Scholar 

  3. López-Novoa JM, Rodríguez-Peña AB, Ortiz A, Martínez-Salgado C, López Hernández FJ (2011) Etiopathology of chronic tubular, glomerular and renovascular nephropathies: clinical implications. J Transl Med 9:13

    Article  PubMed Central  PubMed  Google Scholar 

  4. Bosmans JL, Ysebaert DK, Verpooten GA (2008) Chronic allograft nephropathy: what have we learned from protocol biopsies? Transplantation 85:S38–S41

    Article  PubMed  Google Scholar 

  5. Bamber J, Cosgrove D, Dietrich CF et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 34(2):169–184

    Article  CAS  PubMed  Google Scholar 

  6. Palmeri ML, Wang MH, Dahl JJ, Frinkley KD, Nightingale KR (2008) Quantifying hepatic shear modulus in vivo using acoustic radiation force. Ultrasound Med Biol 34:546–558

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Lupsor M, Badea R, Stefanescu H et al (2009) Performance of a new elastographic method (ARFI technology) compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results. J Gastrointestin Liver Dis 18:303–310

    PubMed  Google Scholar 

  8. Friedrich-Rust M, Wunder K, Kriener S et al (2009) Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 252:595–604

    Article  PubMed  Google Scholar 

  9. Chen L, Faulhaber-Walter R, Wen Y et al (2010) Renal failure in mice with Gsalpha deletion in juxtaglomerular cells. Am J Nephrol 32:83–94

    Article  PubMed Central  PubMed  Google Scholar 

  10. Roberts IS, Cook HT, Troyanov S et al (2009) The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int 76:546–556

    Article  PubMed  Google Scholar 

  11. Boor P, Sebeková K, Ostendorf T, Floege J (2007) Treatment targets in renal fibrosis. Nephrol Dial Transplant 22:3391–3407

    Article  CAS  PubMed  Google Scholar 

  12. Levey AS, Cattran D, Friedman A et al (2009) Proteinuria as a surrogate outcome in CKD: report of a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration. Am J Kidney Dis 54:205–226

    Article  PubMed  Google Scholar 

  13. Cai L, Rubin J, Han W, Venge P, Xu S (2010) The origin of multiple molecular forms in urine of HNL/NGAL. Clin J Am Soc Nephrol 5:2229–2235

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Garra BS (2007) Imaging and estimation of tissue elasticity by ultrasound. Ultrasound Q 23:255–268

    Article  PubMed  Google Scholar 

  15. Arndt R, Schmidt S, Loddenkemper C (2010) Noninvasive evaluation of renal allograft fibrosis by transient elastography–a pilot study. Transpl Int 23:871–877

    PubMed  Google Scholar 

  16. Stock KF, Klein BS, Vo Cong MT et al (2010) ARFI-based tissue elasticity quantification in comparison to histology for the diagnosis of renal transplant fibrosis. Clin Hemorheol Microcirc 46:139–148

    CAS  PubMed  Google Scholar 

  17. Syversveen T, Brabrand K, Midtvedt K et al (2011) Assessment of renal allograft fibrosis by acoustic radiation force impulse quantification–a pilot study. Transpl Int 24:100–105

    Article  PubMed  Google Scholar 

  18. Grenier N, Poulain S, Lepreux S et al (2012) Quantitative elastography of renal transplants using supersonic shear imaging: a pilot study. Eur Radiol 22:2138–2146

    Article  PubMed  Google Scholar 

  19. Syversveen T, Midtvedt K, Berstad AE, Brabrand K, Strøm EH, Abildgaard A (2012) Tissue elasticity estimated by acoustic radiation force impulse quantification depends on the applied transducer force: an experimental study in kidney transplant patients. Eur Radiol 22:2130–2137

    Article  PubMed  Google Scholar 

  20. Stock KF, Klein BS, Cong MT et al (2011) ARFI-based tissue elasticity quantification and kidney graft dysfunction: first clinical experiences. Clin Hemorheol Microcirc 49:527–535

    CAS  PubMed  Google Scholar 

  21. Gallotti A, D'Onofrio M, Pozzi Mucelli R (2010) Acoustic radiation force impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen. Radiol Med 115:889–897

    Article  CAS  PubMed  Google Scholar 

  22. Bruno C, Caliari G, Zaffanello M et al (2013) Acoustic radiation force impulse (ARFI) in the evaluation of the renal parenchymal stiffness in paediatric patients with vesicoureteral reflux: preliminary results. Eur Radiol 23:3477–3484

    Article  PubMed  Google Scholar 

  23. Guo LH, Xu HX, Fu HJ, Peng A, Zhang YF, Liu LN (2013) Acoustic radiation force impulse imaging for noninvasive evaluation of renal parenchyma elasticity: preliminary findings. PLoS One 8:e68925

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Gennisson JL, Grenier N, Combe C, Tanter M (2012) Supersonic shear wave elastography of in vivo pig kidney: influence of blood pressure, urinary pressure and tissue anisotropy. Ultrasound Med Biol 38:1559–1567

    Article  PubMed  Google Scholar 

  25. Sagir A, Erhardt A, Schmitt M, Häussinger D (2008) Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 47:592–595

    Article  CAS  PubMed  Google Scholar 

  26. Syversveen T, Brabrand K, Midtvedt K, Strøm EH, Hartmann A, Berstad AE (2011) Non-invasive assessment of renal allograft fibrosis by dynamic sonographic tissue perfusion measurement. Acta Radiol 52:920–926

    Article  PubMed  Google Scholar 

  27. Warner L, Yin M, Glaser KJ et al (2011) Noninvasive in vivo assessment of renal tissue elasticity during graded renal ischemia using MR elastography. Invest Radiol 46:509–514

    Article  PubMed Central  PubMed  Google Scholar 

Download references


The scientific guarantor of this publication is Ke Lv, the lead author of this article. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by Key Project of Chinese National Program for Fundamental Research and Development (973 Program 2012CB517803 to C.L.), National Natural Scientific Foundation, China (81170674 to C.L). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported.

Methodology: prospective, diagnostic, performed at one institution.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ke Lv.

Additional information

Liang Wang and Peng Xia contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, L., Xia, P., Lv, K. et al. Assessment of renal tissue elasticity by acoustic radiation force impulse quantification with histopathological correlation: preliminary experience in chronic kidney disease. Eur Radiol 24, 1694–1699 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: