title: Sonographic detection of acute parenchymal injury in an experimental porcine model of renal hemorrhage: gray-scale imaging using a sonographic contrast agent.
abstract: OBJECTIVE
  The purpose of this study was to determine the usefulness of contrast-enhanced sonography in the detection of acute parenchymal injury.
  
  
  METHODS
  In a model of acute renal injury in pigs, four separate renal parenchymal bleeds were created by puncturing an interlobar artery of the upper and lower poles of the kidneys. B-mode gray-scale scans of the kidneys before and after injury, and after the administration of i.v. and intraarterial (i.a.) contrast agents were recorded on videotape for 5 min for each condition (baseline, after injury, after i.v. contrast administration, and after i.a. contrast administration). For each condition and injury, selected frames were analyzed with regions of interest of the normal renal parenchyma, the area of injury, and the perinephric space. Randomized videotape clips from each of the experimental conditions were rated by three sonologists as to the presence or absence of increased intrarenal parenchymal echogenicity, perinephric echogenicity, and confidence as to whether renal injury was present.
  
  
  RESULTS
  Areas of renal injury were isoechoic with normal parenchyma on unenhanced scans. After both i.v. and i.a. contrast material injection, areas of injury were visible as areas of increased echogenicity. Contrast increased from 0.2 on unenhanced images to 4.0 and 4.5, respectively, after i.v. and i.a. administration of the new contrast agent. The three observers' ability to diagnose renal injury increased from 0.61, 0.64, and 0.54 to 0.71, 0.70, and 0.74 after i.v. injection and to 0.93, 0.92, and 0.97 after i.a. injection as indicated by the area under the curve in the receiver operating characteristic analysis.
  
  
  CONCLUSIONS
  Transabdominal contrast-enhanced gray-scale sonography can reveal the area of acute renal hemorrhage. This procedure may be applicable in patients when sonographic contrast agents, imaging procedures, and modes of contrast administration are optimized for clinical use in trauma.
authors.affiliation: Department of Radiology, University of Washington Medical Center, University of Washington School of Medicine, Seattle 98195, USA.
authors.forename: U P
authors.initials: UP
authors.lastname: Schmiedl
authors.forename: S
authors.initials: S
authors.lastname: Carter
authors.forename: R W
authors.initials: RW
authors.lastname: Martin
authors.forename: W
authors.initials: W
authors.lastname: Eubank
authors.forename: T
authors.initials: T
authors.lastname: Winter
authors.forename: P P
authors.initials: PP
authors.lastname: Chang
authors.forename: A
authors.initials: A
authors.lastname: Bauer
authors.forename: L A
authors.initials: LA
authors.lastname: Crum
mesh_terms: D000818:Animals; D003287:Contrast Media; D004195:Disease Models, Animal; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D007668:Kidney / Q000293:injuries*; D015588:Observer Variation; D011134:Polysaccharides; D013552:Swine; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508