Arterial-Washout Temporal Profiling in CEUS LI-RADS: A Diagnostic Algorithm for Reducing Hepatocellular Carcinoma Misclassification
December 16, 2025Role of elastography and dynamic contrast-enhanced ultrasound in the evaluation of pancreas transplantation rejection
| Background | Rejection is the leading cause of graft failure, and its diagnosis remains a challenge. Elastography and dynamic contrast-enhanced ultrasound (DCE-US) are novel non-invasive techniques for quantifying tissue elasticity and perfusion. |
| Authors |
Bassaganyas C, Ventura-Aguiar P, Sapena V, Soler-Perromat JC, Darnell A, Soler-Perromat A, Cuatrecasas M, Ferrer-Fàbrega J, Ayuso C, Garcia-Criado Á.
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| Journal |
Eur Radiol. 2025 Dec;35(12):7915-7926. doi: 10.1007/s00330-025-11772-1.
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| Objectives | To determine the role of elastography and DCE-US in pancreas graft rejection. |
| Methods |
All pancreas transplantations performed in one institution were prospectively studied with elastography and DCE-US at 1 week, 3 weeks, and 12 months post-transplantation. Surveillance biopsies were performed at 3 weeks and 12 months. Elastography and DCE-US were also conducted in all requested biopsies during this period (regardless of the date of transplantation). Patients were categorized according to the biopsy result: normal/rejection. Grafts with other complications were excluded. Cut-off values were established.
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| Results |
One hundred twenty-one elastography and 127 DCE-US in 56 patients were included. All parameters showed a high dispersion during the first 90 days post-transplantation. After this period, the rejection group presented higher stiffness (0.97 vs 1.46 m/s, p < 0.001) and lower perfusion. The optimal cut-off value for elastography was 1.27 m/s (AUC 0.80), and for DCE-US were: peak enhancement 601 a.u. (AUC 0.67), wash-in AUC 2748 a.u. (AUC 0.70), wash-in rate 118 a.u. (AUC 0.65), wash-in perfusion index 369 a.u. (AUC 0.67), wash-out AUC 5181 a.u. (AUC 0.69) and total AUC 6388 a.u. (AUC 0.68). A combined predictive score showed that alteration of elastography and DCE-US was associated with a 23.2-fold probability of rejection.
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| Conclusions |
After the first 90 days post-transplantation, pancreas graft rejection is associated with higher stiffness and lower graft perfusion.
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| Key points | Pancreas graft rejection remains a clinical challenge, as there are currently no reliable non-invasive tests for its diagnosis.
After the first 90 days post-transplantation, elastography and DCE-US show higher stiffness and lower pancreas graft perfusion in the presence of rejection. These non-invasive tools, which can be easily integrated into daily routine practice, may be useful in identifying grafts at higher risk of rejection, allowing closer follow-up or early biopsy to establish early rejection treatment, improving graft and patient survival. |
| Link (DOI) | https://dx.doi.org/10.1007/s00330-025-11772-1 |
| Ultrasound speciality | Contrast sonography, elastography |
Short-Review by:
Prof. Dr. Zeno Sparchez
Department of Ultrasound
Institute for Gastroenterology and Hepatology
University of Medicine and Pharmacy
Cluj Napoca, Romania
Strengths:
a) Utilization of non-invasive, radiation-free, and repeatable ultrasound-based methods.
b) A powerful, multi-parametric approach combining two different functional imaging techniques (elastography and DCE-US).
c) The creation of a strong combined predictive score (23.2-fold probability of rejection) for identifying at-risk grafts.
d) addressing an urgent clinical need for better tools to guide biopsies and improve graft survival rates.
Weaknesses:
Personally thinking:
