title: Contrast-enhanced diagnostic ultrasound causes renal tissue damage in a porcine model.
abstract: OBJECTIVE
  Glomerular capillary hemorrhage (GCH) has been reported and confirmed as a consequence of contrast-enhanced diagnostic ultrasound (CEDUS) imaging of rat kidney. This study assessed renal tissue injury in the larger porcine model.
  
  
  METHODS
  The right kidneys of anesthetized pigs were imaged in 8 groups of 4 pigs. A Vingmed System Five ultrasound machine (General Electric Co, Cincinnati, OH) was used at 1.5 MHz in the B-mode to intermittently scan the kidney at 4-second intervals. An Acuson Sequoia 512 machine (Siemens Medical Solutions, Mountain View, CA) was used in the 1.5-MHz Cadence contrast pulse sequencing mode with intermittent agent clearance bursts at 4-second intervals. Kidneys were scanned transabdominally or after laparotomy through a saline standoff. The second machine's probe was placed in contact with the kidney for 1 group. A perflutren lipid microsphere contrast agent (Definity; Lantheus Medical Imaging, Inc, North Billerica, MA) was infused at 4 μL/kg/min (diluted 33:1 in saline) for 4 minutes during scanning.
  
  
  RESULTS
  Blood-filled urinary tubules were evident on the kidney surface for all groups except the group with the probe in contact with the kidney. Glomerular capillary hemorrhage was found by histologic processing in 31.7% ± 9.8% (mean ± SD) of glomeruli in the center of the scan plane for 1.7-MPa transabdominal scanning and 1.5% ± 2.9% of glomeruli in sham samples (P < .05). In addition, hematuria was detected after scanning, and tubular obstruction occurred in some nephrons.
  
  
  CONCLUSIONS
  Renal tissue damage was induced by CEDUS in the porcine model. This result, together with previous studies in rats, support a hypothesis that GCH would occur in humans from similar CEDUS exposure.
authors.affiliation: Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-0553, USA. douglm@umich.edu
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Miller
authors.forename: Chunyan
authors.initials: C
authors.lastname: Dou
authors.forename: Roger C
authors.initials: RC
authors.lastname: Wiggins
mesh_terms: D000818:Animals; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000209:etiology*; D007089:Image Enhancement / Q000379:methods; D007668:Kidney / Q000000981:diagnostic imaging*; D007674:Kidney Diseases / Q000139:chemically induced; D007678:Kidney Glomerulus / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects; D013552:Swine; D018084:Ultrasonography, Interventional / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren