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Dynamic Contrast-Enhanced Ultrasound Shows Promise for Diagnosing Renal Obstruction

Dynamic Contrast-Enhanced Ultrasound Shows Promise for Diagnosing Renal Obstruction 480 320 Pam Georgiana

Feasibility study demonstrates DCEUS may be a safer, more accessible alternative to nuclear medicine.

In a recent study, Bryan S. Sack, MD, chief of Pediatric Urology at Nationwide Children’s Hospital – Toledo, and colleagues demonstrated the potential of dynamic contrast-enhanced ultrasound (DCEUS) to diagnose ureteropelvic junction obstruction or blockages where the kidney connects to the ureter. Their findings, published in The Journal of Ultrasound in Medicine, suggest that this imaging modality may provide a safer, more accessible alternative to traditional diagnostic approaches.

“Diagnosing kidney obstruction in children is often complex and requires multiple imaging studies,” says Dr. Sack. “Traditional modalities such as MRI and nuclear medicine imaging are resource-intensive, often require sedation in children and involve exposure to ionizing radiation. We were looking for a viable, more efficient and safer option.”

The research team selected DCEUS for its ability to evaluate microvascular perfusion in the kidney’s working tissue. It gives direct insight into changes caused by obstruction. Nuclear medicine shows how well urine drains from the kidney. In contrast, DCEUS captures blood flow in the renal parenchyma. These are fundamentally different approaches to assessing obstruction.

“In addition to avoiding radiation and sedation, DCEUS allows us to evaluate dynamic changes in kidney perfusion secondary to obstruction,” Dr. Sack explains. “That makes it especially promising for pediatric patients.”

The prospective study enrolled eight adult patients with unilateral ureteropelvic junction obstruction confirmed by nuclear medicine imaging and scheduled for surgery. Each participant underwent DCEUS before and after surgery. The researchers used the ultrasound contrast data to create time-intensity curves, which show how the contrast moves through the kidney over time. From these curves, they measured three key indicators:

  • Mean-transit time: How long it takes the contrast to pass through the kidney.
  • Time-to-peak: How quickly it reaches its peak intensity.
  • Full-width at half-maximum: How wide the peak intensity is.

Each measurement was taken before and after surgery and compared to the measurements of clinically normal kidneys.

The results showed that mean-transit time was significantly longer in obstructed kidneys compared to normal ones before surgery, indicating compromised perfusion. After surgery, mean-transit values improved and more closely matched those of the healthy kidneys. Although time-to-peak and full-width measures followed similar patterns, they did not reach statistical significance.

“These measurements give us a new way to detect and confirm obstruction, and to verify that surgery worked,” says Dr. Sack. “It is a promising step toward less invasive, more accessible diagnostics for children.”

The study’s findings suggest DCEUS may serve as a complementary tool or even a replacement for nuclear medicine in some instances. This is especially valuable in low-resource or rural settings, where access to nuclear medicine facilities may be limited.

Importantly, the ultrasound contrast agents used in this study already have FDA approval for use in pediatric patients in other organ systems.

“We are preparing to launch an IRB-approved pediatric trial at Nationwide Children’s, building on the strong safety and feasibility profile established in adults,” Dr. Sack notes.

While limited by sample size, this feasibility study supports the clinical utility of DCEUS and sets the stage for larger trials. Future studies will assess whether DCEUS can reliably distinguish between obstructive and non-obstructive hydronephrosis (kidney swelling) in children.

“Our goal is to reduce reliance on invasive and expensive testing and provide a faster, safer way to guide care for children with suspected kidney obstruction,” Dr. Sack concludes.

 

Reference:

Kalayeh K, Ambani SN, Zhang M, Daignault-Newton S, Viglianti BL, Mediratta R, Schultz WW, Fowlkes JB, Sack BS. Quantitative Dynamic Contrast-Enhanced Ultrasound Confirms Renal Obstruction: A Feasibility Study. Journal of Ultrasound Medicine. 2025 Aug;44(8):1425-1435.

 

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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