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Gowda H, Bhatia A, Tiewsoh K, Saxena AK, Dawman L, Bansal M, Sodhi KS. Shear wave elastography of kidneys in children: utility in distinguishing steroid-resistant and steroid-sensitive nephrotic syndrome. Abdom Radiol (NY) 2024; 49:551-559. [PMID: 38150144 DOI: 10.1007/s00261-023-04138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE To assess the renal elasticity values using (SWE) and correlate the values with steroid sensitivity to distinguish between steroid-resistant nephrotic syndrome (SRNS) and steroid-sensitive nephrotic syndrome (SSNS) in children. METHODS In this IRB-approved cross-sectional study, 83 children (4-14 years) diagnosed with nephrotic syndrome were included from July 2021 to December 2022. SWE measurements were done for each kidney's upper pole, interpolar region, and lower pole. Mean as well as median SWE were calculated. Correlation of the renal stiffness values was done with different laboratory findings (blood urea, serum creatinine, 24 h urine protein, serum albumin, and serum cholesterol), the grayscale findings (cortical echogenicity, and corticomedullary differentiation), and the final diagnosis of SRNS and SSNS. The statistical tests were done at a significance level of α = 0.05. RESULTS The median (IQR) overall SWE of kidneys was higher in SRNS group 12.64 (8.4-19.68) kPa than SSNS group 9.87 (8.20-12.56) kPa. The difference was significant (p = 0.004). At a cut-off of ≥ 10.694 kPa (AUROC- 0.641), the overall SWE predicted SRNS group with a sensitivity of 70% and a specificity of 63%. A significant correlation (p < 0.05) was found between the SWE and 24-h urine protein, cortical echogenicity, and corticomedullary differentiation in SSNS, while only between SWE and corticomedullary differentiation in SRNS. CONCLUSION The mean SWE was higher in children with SRNS. While SWE has potential to differentiate SSNS from SRNS, a different study design where SWE is performed at presentation is needed for confirmation.
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Affiliation(s)
- Harshith Gowda
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Karalanglin Tiewsoh
- Division of Pediatric Nephrology, Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Lesa Dawman
- Division of Pediatric Nephrology, Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Madhav Bansal
- Institute of Medical Sciences and Sum Hospital, Bhubaneswar, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Bhatia A, Dua A, Mehta V, Chhabra M, Sodhi KS, Saxena AK. 2D Shear wave elastography for evaluation of renal cortex and medulla: stiffness values in healthy children. Abdom Radiol (NY) 2023; 48:3183-3188. [PMID: 37436450 DOI: 10.1007/s00261-023-04001-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To evaluate renal cortical and medullary stiffness using 2D Shear-wave elastography (SWE) in healthy children. METHODS In this IRB approved prospective study, we measured the stiffness of cortex and medulla of children (4 months-17 years) at the upper pole, mid pole, and lower pole in bilateral kidneys. RESULTS The median (IQR) values of renal cortex in <1 year age group was 8.7 (5.7-11.7) kPa for right and 8.7 (4.2-14.1) kPa for the left side. For 1-5 years age group, it was 7.3 (5.3-10) kPa for the right and 8.9 (6-12.3) kPa for the left side. For >5 years, it was 7.4 (5.3-11.2) kPa for the right and 9.6 (6.2-12.7) kPa for the left side. The median (IQR) values of renal medulla in <1 year age group was 7.1 (5.1-12.5) kPa for right and 6.8 (4-10.6) kPa for the left side. For 1-5 years age group, it was 7.2 (4.9-9.7) kPa for the right and 6.9 (5.6-9.9) kPa for the left side. For >5 years, it was 6.8 (5.1-9.6) kPa for the right and 7 (5-10.2) kPa for the left side. The differences in the elasticity values amongst these groups were statistically insignificant (p>0.05). There was a significant correlation between SWE values of cortex and medulla of right kidney (ρ=0.64) and of left kidney (ρ=0.61), respectively. CONCLUSION SWE values of renal cortical and medullary stiffness in healthy children do not correlate with age. There is a significant correlation between SWE values of cortex and medulla of the kidneys in healthy children.
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Affiliation(s)
- Anmol Bhatia
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Ashish Dua
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Vansha Mehta
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Manika Chhabra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Kushaljit Singh Sodhi
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Akshay Kumar Saxena
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
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Soundararajan R, Dutta U, Bhatia A, Gupta P, Nahar U, Kaman L, Bhattacharya A, Kumar A, Sandhu MS. Two-dimensional Shear Wave Elastography: Utility in Differentiating Gallbladder Cancer From Chronic Cholecystitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1577-1585. [PMID: 36655621 DOI: 10.1002/jum.16178] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To study the utility of 2D shear wave elastography (SWE) and ascertain cut-off values of shear wave elasticity (SWe) to differentiate benign and malignant thickening of the gallbladder wall. METHODS This study was a prospective study of patients with symptomatic gallstone disease (GSD, n = 51) and gallbladder cancer (GBC, n = 46) and controls without any biliary disease (n = 46). All the participants underwent 2D USG and SWE of the gallbladder. Grey-scale ultrasound and SWE were done in the different regions in the gallbladder. RESULTS The median age of the patients with GSD was 49 years (interquartile range [IQR]: 33-55), GBC was 55 years (IQR: 46-65), and controls was 37 years (IQR: 27-48.25). In patients with GBC, asymmetrical mural thickening was the predominant imaging pattern (n = 24, 52.2%). The mean SWe of the abnormal area in GBC (34.99 ± 17.77 kPa [n = 46]) was significantly higher than that of the uninvolved region (18.27 ± 8.12 kPa [n = 35]; P < .01). The mean SWe of the uninvolved region in GBC (18.27 ± 8.12 kPa [n = 35]) was also significantly higher (P < .01) than that of GSD (12.27 ± 4.13 kPa [n = 51]) and controls (10.52 ± 3.75 kPa [n = 46]). On ROC analysis, AUC of 0.927, at a cut-off of 20 kPa, sensitivity was 91.3%, specificity was 83.5%, positive likelihood ratio was 5.54, and negative likelihood ratio was 0.10 to diagnose GBC. CONCLUSION The 2D SWE is a reliable adjunctive tool to grey-scale USG in differentiating the malignant from benign gallbladder wall and may help to pick up early malignancy in GSD.
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Affiliation(s)
- Raghuraman Soundararajan
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Koca SB, Seber T. Can thyroid elastography with ultrasound be used to stage children with Hashimoto's thyroiditis? J Pediatr Endocrinol Metab 2023; 36:346-352. [PMID: 36843220 DOI: 10.1515/jpem-2022-0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES We aimed to evaluate the stiffness of the thyroid parenchyma with Shear wave elastography (SWE) in children with Hashimoto's thyroiditis (HT) and healthy controls. METHODS A total of 130 children with HT and 46 healthy controls were included in this study. The clinical and laboratory characteristics of the groups, thyroiditis stages in thyroid ultrasonography, and SWE scores which was obtained as kilopascal (kPa), were analysed. RESULTS We observed that SWE scores were significantly higher in children with HT compared to healthy controls, and SWE scores increased significantly in HT group, as the thyroiditis stage increased (p<0.001). Median, 1st (Q1) and 3rd (Q3) quartiles of SWE scores were as follows; healthy control: 7.4 kPa (6-10.6), stage 1 HT: 9.6 kPa (7.4-11.2), stage 2 HT: 15.2 kPa (10.8-19.9), stage 3 HT: 17.9 kPa (13.7-25.8), (p<0.001). Children with HT were divided into subgroups according to serum TSH and free T4 levels as euthyroid (103; 79.2% of children), euthyroid but subclinical TSH elevation (7; 5.4% of children), hypothyroidism (11; 8.5% of children) and hyperthyroidism (9; 6.9% of children). The SWE scores were significantly higher in children with hypothyroidism with HT compared to healthy controls 17.9 kPa (13.6-27.5) vs. 7.4 kPa (6-10.6), and in euthyroid children with HT compared to healthy controls 11.5 kPa (9.2-15.6) vs. 7.4 kPa (6-10.6), (p=0.006 and p<0.001, respectively). CONCLUSIONS The SWE scores increase as the thyroiditis stage increases in children with HT. There was no significant difference in SWE scores between stage 2 and stage 3 thyroiditis.
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Affiliation(s)
- Serkan Bilge Koca
- Department of Pediatrics, Division of Pediatric Endocrinology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
| | - Turgut Seber
- Department of Radiology, Division of Pediatric Radiology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
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Decker T, Schnittka E, Stolzenberg L, Yalowitz J. Shear-Wave Elastography for the Diagnosis of Pediatric Hashimoto’s Thyroiditis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e35490. [PMID: 37007310 PMCID: PMC10049949 DOI: 10.7759/cureus.35490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/26/2023] [Indexed: 02/27/2023] Open
Abstract
Shear-wave elastography (SWE) has emerged as a novel ultrasonographic technique for the diagnosis of pediatric Hashimoto's Thyroiditis (HT). This systematic review and meta-analysis aim to summarize current evidence to determine the diagnostic value of SWE for HT. MEDLINE, a comprehensive search yielded five studies inclusive of 392 subjects. A meta-analysis comparing SWE values (kPa) between children with HT and healthy controls yielded a Cohen's d-value of 1.34 (CI 1.02-1.65), suggesting statistically significant differences in SWE values. Such evidence indicates that SWE may serve as a valuable tool in diagnosing HT in the pediatric population.
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Bhatia A, Bhatia H, Saxena AK, Lal SB, Sodhi KS. Shear wave elastography of the spleen using elastography point quantification: stiffness values in healthy children. Abdom Radiol (NY) 2022; 47:2128-2134. [PMID: 35437707 DOI: 10.1007/s00261-022-03519-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the shear wave elastography (SWE) values of the spleen in healthy children using Elastography Point Quantification (ElastPQ). METHODS In this IRB approved prospective study, spleen stiffness was measured in 146 healthy children (2-15 years) using ElastPQ. SWE values were recorded in upper pole, mid pole, and lower pole of the spleen in all the children. RESULTS The mean (± SD) SWE values of the spleen in children in ≤ 5 years age group, > 5-10 years age group, and > 10-15 years age group were 5.6 (± 4.2) kPa, 6.5 (± 3.2) kPa, and 5.9 (± 3.6) kPa, respectively. No statistically significant difference was seen in SWE values of the spleen between these three groups (p > 0.5). The mean (± SD) SWE values in ≤ 10 years and > 10 years age group were 6.1 (± 3.6) kPa and 5.9 (± 2.6) kPa, respectively. No statistically significant difference was seen in SWE values of the spleen between these two groups (p > 0.5). There was no significant difference in the SWE values for boys and girls. Statistically significant difference was seen between the mean SWE values in the two groups based on the median splenic length, which was 5.5 (± 3.8) kPa in the group with a length of ≤ 7.6 cm and 6.7 (± 2.8) kPa in the group with a length of > 7.6 cm. CONCLUSION SWE values of the spleen in healthy children do not correlate with age, and no significant difference is there in the SWE values for boys and girls. There was a statistically significant difference in the SWE values of the spleen while comparing the groups based on the median splenic length.
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Affiliation(s)
- Anmol Bhatia
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Harsimran Bhatia
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Akshay Kumar Saxena
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Sadhna B Lal
- Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Kushaljit Singh Sodhi
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
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