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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. In silico analysis reveals the prospects of renal anisotropy in improving chronic kidney disease detection using ultrasound shear wave elastography. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3857. [PMID: 39075679 DOI: 10.1002/cnm.3857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/07/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024]
Abstract
Renal anisotropy is a complex property of the kidney and often poses a challenge in obtaining consistent measurements when using shear wave elastography to detect chronic kidney disease. To circumvent the challenge posed by renal anisotropy in clinical settings, a dimensionless biomarker termed the 'anisotropic ratio' was introduced to establish a correlation between changes in degree of renal anisotropy and progression of chronic kidney disease through an in silico perspective. To achieve this, an efficient model reduction approach was developed to model the anisotropic property of kidneys. Good agreement between the numerical and experimental data were obtained, as percentage errors of less than 5.5% were reported when compared against experimental phantom measurement from the literature. To demonstrate the applicability of the model to clinical measurements, the anisotropic ratio of sheep kidneys was quantified, with both numerical and derived experimental results reporting a value of .667. Analysis of the anisotropic ratio with progression of chronic kidney disease demonstrated that patients with normal kidneys would have a lower anisotropic ratio of .872 as opposed to patients suffering from renal impairment, in which the anisotropic ratio may increase to .904, as determined from this study. The findings demonstrate the potential of the anisotropic ratio in improving the detection of chronic kidney disease using shear wave elastography.
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Affiliation(s)
- William T H Lim
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Ean H Ooi
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Bandar Sunway, Malaysia
- Medical Engineering and Technology Hub, School of Engineering, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Ji J Foo
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Kwan H Ng
- Faculty of Medicine, Department of Biomedical Imaging, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Sciences, UCSI University, Springhill, Malaysia
| | - Jeannie H D Wong
- Faculty of Medicine, Department of Biomedical Imaging, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Centre of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Malaysia
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Lucas JT, Abramson ZR, Epstein K, Morin CE, Jaju A, Lee JW, Lee CL, Sitaram R, Voss SD, Hudson MM, Constine LS, Hua CH. Imaging Assessment of Radiation Therapy-Related Normal Tissue Injury in Children: A PENTEC Visionary Statement. Int J Radiat Oncol Biol Phys 2024; 119:669-680. [PMID: 38760116 DOI: 10.1016/j.ijrobp.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 05/19/2024]
Abstract
The Pediatric Normal Tissue Effects in the Clinic (PENTEC) consortium has made significant contributions to understanding and mitigating the adverse effects of childhood cancer therapy. This review addresses the role of diagnostic imaging in detecting, screening, and comprehending radiation therapy-related late effects in children, drawing insights from individual organ-specific PENTEC reports. We further explore how the development of imaging biomarkers for key organ systems, alongside technical advancements and translational imaging approaches, may enhance the systematic application of imaging evaluations in childhood cancer survivors. Moreover, the review critically examines knowledge gaps and identifies technical and practical limitations of existing imaging modalities in the pediatric population. Addressing these challenges may expand access to, minimize the risk of, and optimize the real-world application of, new imaging techniques. The PENTEC team envisions this document as a roadmap for the future development of imaging strategies in childhood cancer survivors, with the overarching goal of improving long-term health outcomes and quality of life for this vulnerable population.
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Affiliation(s)
| | - Zachary R Abramson
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Katherine Epstein
- Division of Radiology and Medical Imaging, UC Department of Radiology, Cincinnati, Ohio
| | - Cara E Morin
- Division of Radiology and Medical Imaging, UC Department of Radiology, Cincinnati, Ohio
| | - Alok Jaju
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Chang-Lung Lee
- Department of Radiation Oncology and; Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Ranganatha Sitaram
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephan D Voss
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Louis S Constine
- Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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Tyagi N, Pandey A, Parihar A, Verma S, Pant N, Kumar P, Singh S, Rawat J. Analysis of the Efficacy of Elastography in Comparison with Dynamic Renal Nuclear Scintigraphy in the Evaluation of Unilateral Pelvi-Ureteric Junction Obstruction. J Pediatr Surg 2024; 59:605-609. [PMID: 38142192 DOI: 10.1016/j.jpedsurg.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION In hydronephrosis due to pelviureteric junction obstruction (PUJO), an obstruction to urine flow may lead to increased pelvic pressure, which may cause interstitial fibrosis and renal impairment. Recently, there have been reports on renal pelvic assessment using ultrasound elastography (USE). This study was conducted to see if USE can evaluate PUJO and if it can be correlated to the findings of the dynamic renal nuclear scan. MATERIAL AND METHODS In this observational study, only patients with unilateral PUJO underwent acoustic radiation force impulse (ARFI) elastography. A rectangular region of interest (ROI) measuring 5 × 10 mm was positioned on the cortex region of the upper, mid, and lower poles of the affected kidney. Three valid measurements were obtained, from which a mean value was calculated. A dynamic renal nuclear scan using Technetium-99m ethylene dicysteine (EC or TC99 m EC) was obtained and split renal function (SRF) was used for comparison. RESULTS In the group of 20 patients, the mean age was 3.37 years. The mean SRF of the affected kidney was 26.65 %, and the corresponding USE value was 0.45 kpa. The Spearman's rho correlation coefficient for SRF and USE was 1 and 0.672, respectively (p = 0.001). Elastography was not feasible if SRF was less than 20 %. CONCLUSION USE may be able to comment on the renal functional status of hydronephrosis. If USE is reported as non-feasible, it may suggest that renal function is grossly compromised. It may serve as an alternative diagnostic modality for renal functional evaluation. LEVEL OF EVIDENCE Level II, Prospective Cohort Study.
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Affiliation(s)
- Nirpex Tyagi
- Department of Pediatric Surgery, King George's Medical University, Lucknow 226003, UP, India
| | - Anand Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow 226003, UP, India.
| | - Anit Parihar
- Department of Radiodiagnosis, King George's Medical University, Lucknow 226003, UP, India
| | - Shashwat Verma
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, UP, India
| | - Nitin Pant
- Department of Pediatric Surgery, King George's Medical University, Lucknow 226003, UP, India
| | - Piyush Kumar
- Department of Pediatric Surgery, King George's Medical University, Lucknow 226003, UP, India
| | - Sudhir Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow 226003, UP, India
| | - Jiledar Rawat
- Department of Pediatric Surgery, King George's Medical University, Lucknow 226003, UP, India
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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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Yao S, Cai Y, Hu S, Liu X, Gao X, Li G, Wang H, Yu H. The value of shear wave elasticity and shear wave dispersion imaging to evaluate the viscoelasticity of renal parenchyma in children with glomerular diseases. BMC Nephrol 2023; 24:306. [PMID: 37858094 PMCID: PMC10588180 DOI: 10.1186/s12882-023-03357-1] [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: 06/19/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To study the value of shear wave elasticity and shear wave dispersion imaging to evaluate the viscoelasticity of renal parenchyma in children with glomerular diseases. METHODS Forty-three children with glomerular diseases were prospectively evaluated by shear wave elasticity (SWE) and shear wave dispersion imaging (SWD); 43 healthy volunteers served as the control group. The shear wave velocities (SWV) and the dispersion slopes were measured at the upper, middle, and lower poles of both kidneys. The analysis of mean SWV and mean dispersion slope in control and patient groups was used to further evaluate the value of SWE and SWD in the viscoelasticity of renal parenchyma in children with glomerular disease. RESULTS The mean SWV in children with glomerular disease was higher than that in the healthy control group (1.61 ± 0.09 m/s vs. 1.43 ± 0.07 m/s, p < 0.001). Compared with healthy group, the mean dispersion slope in children with glomerular disease was significantly increased (13.5 ± 1.39 (m/s)/kHz vs. 12.4 ± 1.40 (m/s)/kHz, p < 0.001). Correlation analysis showed absence of correlation between the SWV and dispersion slope of occult blood, serum creatinine, 24-h urine protein, blood albumin, BMI and ROI box depth of children with glomerular disease. CONCLUSIONS The present study shows that it is feasible to use SWE and SWD to evaluate the difference of viscoelasticity of the renal parenchyma between healthy children and those with glomerular disease.
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Affiliation(s)
- Shixiang Yao
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China
| | - Yingying Cai
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China
| | - Shanshan Hu
- The Sixth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xia Gao
- Nephrology department, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's medical center, Guangzhou city, China
| | - Guanyu Li
- Nephrology department, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's medical center, Guangzhou city, China
| | - Hongying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China
| | - Hongkui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China.
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Ono S, Nishino T, Takahashi K, Mimaki M. A Case of Shear Wave Velocity Reflecting the Disease Activity in Glomerulonephritis. J Med Ultrasound 2023; 31:235-237. [PMID: 38025002 PMCID: PMC10668900 DOI: 10.4103/jmu.jmu_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2023] Open
Abstract
Ultrasound elastography can measure tissue elasticity using the shear wave velocity (SWV). Evaluating disease activity with elastography instead of renal biopsy may be less invasive. However, to the best of our knowledge, although there are studies comparing different glomerular diseases using SWV, there are no reports that have measured glomerulonephritis longitudinally from the acute phase of the disease. This study aimed to assess whether SWV reflects disease activity in glomerulonephritis, and we continued to observe children with post-streptococcal acute glomerulonephritis (PSAGN) from the acute phase to over a year later. In this case, a 6-year-old boy diagnosed with PSAGN had impaired renal function, and was admitted and tested. He was placed in a prone resting position and measurements were taken from the back. SWV was measured ≥50 times at each examination, and the mean was calculated when the net amount of effective SWV was ≥50%. The tests were performed once in the acute phase and thrice during the recovery phase for 13 months. SWV was found to be significantly lower in the recovery period than during the disease onset, and continued to stay lower at each test during the recovery period (P < 0.02). In conclusion, this indicated that SWV fluctuated similarly to the disease activity of glomerulonephritis; therefore, we suggest using SWV measurement to estimate the disease activity in glomerulonephritis in children. Although more clinical cases are needed, SWV measurement is a noninvasive and reproducible imaging modality to estimate the disease activity in glomerulonephritis.
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Affiliation(s)
- Sayaka Ono
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomohiko Nishino
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. The role of shear viscosity as a biomarker for improving chronic kidney disease detection using shear wave elastography: A computational study using a validated finite element model. ULTRASONICS 2023; 133:107046. [PMID: 37247461 DOI: 10.1016/j.ultras.2023.107046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
The application of ultrasound shear wave elastography for detecting chronic kidney disease, namely renal fibrosis, has been widely studied. A good correlation between tissue Young's modulus and the degree of renal impairment has been established. However, the current limitation of this imaging modality pertains to the linear elastic assumption used in quantifying the stiffness of renal tissue in commercial shear wave elastography systems. As such, when underlying medical conditions such as acquired cystic kidney disease, which may potentially influence the viscous component of renal tissue, is present concurrently with renal fibrosis, the accuracy of the imaging modality in detecting chronic kidney disease may be affected. The findings in this study demonstrate that quantifying the stiffness of linear viscoelastic tissue using an approach similar to those implemented in commercial shear wave elastography systems led to percentage errors as high as 87%. The findings presented indicate that use of shear viscosity to detect changes in renal impairment led to a reduction in percentage error to values as low as 0.3%. For cases in which renal tissue was affected by multiple medical conditions, shear viscosity was found to be a good indicator in gauging the reliability of the Young's modulus (quantified through a shear wave dispersion analysis) in detecting chronic kidney disease. The findings show that percentage error in stiffness quantification can be reduced to as low as 0.6%. The present study demonstrates the potential use of renal shear viscosity as a biomarker to improve the detection of chronic kidney disease.
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Affiliation(s)
- William T H Lim
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia.
| | - Ean H Ooi
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia.
| | - Ji J Foo
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Kwan H Ng
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Faculty of Medicine and Health Sciences, UCSI University, Springhill, Negri Sembilan, Malaysia
| | - Jeannie H D Wong
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Centre of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
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Yao S, Liu X, Wang H, Yu H. Evaluation of renal parenchyma stiffness in children with nephropathy by shear wave elastography: A systematic review and meta-analysis. Int J Urol 2023; 30:28-35. [PMID: 36125940 DOI: 10.1111/iju.15054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of shear wave elastography (SWE) in assessing renal parenchymal stiffness in children with nephropathy is obscure. This systematic review and meta-analysis investigated this issue. MATERIALS AND METHODS PubMed, Embase, Web of Science, and the Cochrane Library databases were searched for studies evaluating renal parenchyma stiffness in children with nephropathy by SWE from inception to October 2021. The search was not limited by language. Two investigators independently screened the literature and extracted data. Any discrepancies were resolved via discussion with the senior professor. Study quality was assessed by the Newcastle-Ottawa Scale and the standardized mean difference of shear wave velocity (SWV) for the evaluation of renal parenchyma stiffness was determined. RESULTS Eight studies involving a total of 496 children with nephropathy and 353 healthy children were selected. Eight studies used SWV as parameters of renal parenchyma stiffness. The SWV was not significantly different in children with renal lesion than in those without renal lesion, with a standardized mean difference of 0.49 (95% confidence level, -0.40 to 1.39, p = 0.28). There was a high heterogeneity between studies. CONCLUSION Although there was significant difference in SWE of renal parenchyma between controls and patients in each study we included, statistical differences were not seen after results of all research were amalgamated due to different diseases with different pathomechanisms. SWE could be used to evaluate renal parenchymal stiffness in children with kidney disease after more well-designed and high-quality studies with a large sample size will be performed in the future.
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Affiliation(s)
- Shixiang Yao
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Hongying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hongkui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Mentzel HJ, Glutig K, Gräger S, Krüger PC, Waginger M. Ultrasound elastography in children - nice to have for scientific studies or arrived in clinical routine? Mol Cell Pediatr 2022; 9:11. [PMID: 35668217 PMCID: PMC9169959 DOI: 10.1186/s40348-022-00143-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
Ultrasound elastography (USE) is a modality that in addition to fundamental B-mode, Doppler, and contrast-enhanced sonography is suitable to make qualitative and quantitative statements about the stiffness of tissues. Introduced more than 20 years ago in adults, USE becomes now a diagnostic tool also in children. The aim of this paper is to describe current available techniques for USE in children. The significance for routine use in children is shown, and further interesting applications are reported.
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Affiliation(s)
- Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Katja Glutig
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Stephanie Gräger
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Paul-Christian Krüger
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Waginger
- Section of Pediatric Radiology, Department of Radiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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Hwang J, Kim HW, Kim PH, Suh CH, Yoon HM. Technical Performance of Acoustic Radiation Force Impulse Imaging for Measuring Renal Parenchymal Stiffness: A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2639-2653. [PMID: 33599306 DOI: 10.1002/jum.15654] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To estimate the technical performance of acoustic radiation force impulse (ARFI) imaging (two-dimensional shear wave elastography [2D-SWE] and point shear wave elastography [p-SWE]) for measuring renal parenchymal stiffness. METHODS EMBASE and PubMed databases were searched for studies reporting technical performance of ARFI imaging in terms of technical failure, interobserver agreement, and/or intraobserver agreement. The proportion of technical failure and intraclass correlation coefficients (ICCs) for interobserver and intraobserver agreement was pooled. The pooled estimates of native and transplanted kidneys were obtained separately. Meta-regression and subgroup analyses were conducted to explore heterogeneity. RESULTS Twenty-four studies (2993 patients) were included. The pooled proportions of technical failure were 4.3% (95% confidence interval [CI] 2.2-8.5%) and 6.6% (95% CI 4.0-10.7%) in native and transplanted kidneys, respectively. The pooled ICCs of interobserver agreement were 0.70 (95% CI 0.68-0.83) and 0.81 (95% CI 0.68-0.89), indicating moderate and good agreement in native and transplanted kidneys, respectively. The pooled ICC showed good (0.77; 95% CI 0.49-0.91) intraobserver agreement in native kidneys. Regarding interobserver agreement in transplanted kidneys, ROI location (mid pole only versus others) was a significant factor of heterogeneity (P = .04). CONCLUSIONS The ARFI-based SWE techniques show good technical performance for measuring renal parenchymal stiffness. The wide range of SWE protocols necessitates development of standardized guidelines on the use of renal ARFI imaging.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Republic of Korea
| | - Hae Won Kim
- Department of Radiology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Technical feasibility and correlations between shear-wave elastography and histology in kidney fibrosis in children. Pediatr Radiol 2021; 51:1879-1888. [PMID: 33893848 DOI: 10.1007/s00247-021-05068-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/18/2020] [Accepted: 03/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ultrasound elastography has been suggested for assessing organ fibrosis. OBJECTIVE To study the feasibility of shear-wave elastography in children with kidney disease and the correlation between elasticity and kidney fibrosis in order to reduce the indications for kidney biopsy and its complications. MATERIALS AND METHODS Four operators measured kidney elasticity in children with kidney diseases or transplants, all of whom also had a renal biopsy. We assessed the feasibility and the intraobserver variability of the elasticity measurements for each probe used and each kidney explored. Then we tested the correlation between elasticity measurements and the presence of fibrosis. RESULTS Overall, we analyzed 95 children and adolescents, 31 of whom had renal transplant. Measurements with the convex probe were possible in 100% of cases. Linear probe analysis was only possible for 20% of native kidneys and 50% of transplants. Intraobserver variabilities ranged from moderate to high, depending on the probe and kidney studied. Elasticity was higher with the linear probe than with the convex probe (P<0.001 for left kidney and P=0.03 for right kidney). Measurements did not differ from one kidney to another in the same child. Elasticity and fibrosis were both higher in transplant patients (P=0.02 with convex probe; P=0.01 with linear probe; P=0.04 overall). There was no correlation between elasticity and fibrosis. CONCLUSION Of the devices used in this work, kidney elastography was more accurately analyzed with a convex probe. Our study did not identify any correlation between elasticity and kidney fibrosis.
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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. Shear Wave Elastography: A Review on the Confounding Factors and Their Potential Mitigation in Detecting Chronic Kidney Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2033-2047. [PMID: 33958257 DOI: 10.1016/j.ultrasmedbio.2021.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Early detection of chronic kidney disease is important to prevent progression of irreversible kidney damage, reducing the need for renal transplantation. Shear wave elastography is ideal as a quantitative imaging modality to detect chronic kidney disease because of its non-invasive nature, low cost and portability, making it highly accessible. However, the complexity of the kidney architecture and its tissue properties give rise to various confounding factors that affect the reliability of shear wave elastography in detecting chronic kidney disease, thus limiting its application to clinical trials. The objective of this review is to highlight the confounding factors presented by the complex properties of the kidney, in addition to outlining potential mitigation strategies, along with the prospect of increasing the versatility and reliability of shear wave elastography in detecting chronic kidney disease.
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Affiliation(s)
- William T H Lim
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Ean H Ooi
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.
| | - Ji J Foo
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Kwan H Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeannie H D Wong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Reddy C, Sai V, Shah U, Babu R. Utility of ultrasound elastography in postoperative follow-up of children with unilateral ureteropelvic junction obstruction. Indian J Urol 2020; 36:101-105. [PMID: 32549660 PMCID: PMC7279094 DOI: 10.4103/iju.iju_379_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: We aimed to determine whether shear wave velocity (SWV) on ultrasound elastography is useful in follow-up of children with ureteropelvic junction obstruction (UPJO) following pyeloplasty. Methods: Consecutive children with unilateral UPJO who were co-operative for elastography (n = 31) were included. SWV of normal kidney was used as control, and it was compared with that of the affected kidney (UPJO) in the same patient. They were followed up with elastography at 3 months and elastography + renogram at 6 months postoperatively. In patients with a static renogram at 6 months, the study was repeated at 1 year. Patient outcomes were classified as improved at 6 months, static at 6 months, and worsened at 1 year based on ultrasound and renogram findings. The SWV was compared between the different outcomes. Results: Thirty-one children with a median age of 8.5 years were studied (m:f = 29:2; L:R = 22:9). The mean SWV was significantly higher (3.21 m/s) in UPJO kidney compared to the SWV (2.72 m/s) found in normal kidney (P = 0.011). The mean SWV was significantly less at 3 months (2.73 m/s) and 6 months (2.57 m/s) postoperative follow-up (P = 0.018 and P= 0.001). Among the patients who improved, the mean SWV was 2.65 m/s. This SWV was significantly raised (3.57 m/s) in patients whose condition remained static (P = 0.006) and even higher (4.36 m/s) in those who worsened (P = 0.001). Conclusions: SWV was significantly higher in UPJO compared to normal kidneys in children. It is useful in assessing postoperative resolution, and a rising velocity can be useful as an early marker of recurrence in UPJO.
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Affiliation(s)
- Chakradhar Reddy
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Venkata Sai
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Utsav Shah
- Department of Paediatric Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Ramesh Babu
- Department of Paediatric Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Ultraschallelastographie im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kalyoncu Ucar A, Cicek RY, Alis D, Akbas S, Arioz Habibi H, Arslan MU, Eral G, Suleyman A, Caliskan S, Adaletli I. Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:379-385. [PMID: 30027586 DOI: 10.1002/jum.14698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux. METHODS We prospectively evaluated 49 patients with unilateral grade 2 or higher-degree VUR. All patients underwent dimercaptosuccinic acid (DMSA) scintigraphy for evaluation of the renal parenchymal scar. After the DMSA scan, 2 radiologists, who were blinded to clinical data and each other's measurements, evaluated the kidneys of the patients using SWE. The kidneys were divided into 3 parts: upper pole, middle region, and lower pole, and 3 regions of interest were placed to each part. Shear wave velocity (SWV) values were calculated using meters per second as a unit and recorded for each region. Afterward, SWV values were compared to DMSA results. RESULTS There was no significant difference between the observers' mean SWV values of kidneys with VUR without scar formation (mean ± SD, 2.11 ± 0.06 and 2.09 ± 0.05 m/s) and the contralateral normal kidney SVW values (2.11 ± 0.06 and 2.10 ± 0.05 m/s; P = .936 and .724, respectively). We observed a significant difference between the mean SWV values of the kidneys with VUR accompanied by scar formation (2.28 ± 0.10 and 2.27 ± 0.11 m/s) and the mean SWV values of the contralateral normal kidneys (2.09 ± 0.05 and 2.10 ± 0.04 m/s; P < .001 for both observers). CONCLUSIONS Shear wave elastography could detect scar tissue in kidneys; however, the variability of the stiffness due to the kidney's complex structure, and variations in blood perfusion and the glomerular filtration rate of the kidney might limit the use of SWE in current clinical diagnostic algorithms for VUR.
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Affiliation(s)
- Ayse Kalyoncu Ucar
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Deniz Alis
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serkan Akbas
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hatice Arioz Habibi
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mine Usta Arslan
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gokalp Eral
- Biostatistics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ayse Suleyman
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Salim Caliskan
- Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Departments of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Radulescu D, Peride I, Petcu LC, Niculae A, Checherita IA. Supersonic Shear Wave Ultrasonography for Assessing Tissue Stiffness in Native Kidney. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2556-2568. [PMID: 30154036 DOI: 10.1016/j.ultrasmedbio.2018.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 05/28/2023]
Abstract
Recent years have brought shear wave elastography to the attention of nephrologists as a non-invasive method for detecting kidney fibrosis and, therefore, as a potential tool for reducing the need for kidney biopsy. Few studies are performed on native kidney. We aimed to compare cortical stiffness, assessed by measuring Young's modulus (YM, kPa) with SuperSonic Imaging technology, in patients with various degrees of chronic kidney disease (CKD) compared with healthy individuals. Cortical stiffness was measured by two operators, in different sessions, in 32 patients with CKD stages 3-5 and 20 healthy individuals. Comparison between mean YM values in CKD and those in controls and also between the different stages of CKD was our primary objective. The influence of other possible confounders on YM readings was also investigated and analyzed. Mean YM was significantly greater in CKD patients than in controls. Estimated YM was not able to differentiate the stages of CKD, except stage 5. Intra-subject variability was greater in CKD than in controls. Body mass index was the most important confounder in multiple analyses, in both the CKD and control groups. Our results highlight a positive correlation between increased cortical stiffness and presence of CKD. Further studies are needed to validate this method for implementation in daily clinical practice.
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Affiliation(s)
- Daniela Radulescu
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ileana Peride
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania.
| | - Lucian Cristian Petcu
- Department of Biostatistics and Biophysics, Faculty of Dental Medicine, "Ovidius" University Constanta, Constanta, Romania
| | - Andrei Niculae
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Ionel Alexandru Checherita
- Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Bucharest, Romania; Clinical Department No. 3, "Carol Davila" University of Medicine, Bucharest, Romania
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Muttray J, Mehrabi A, Hafezi M, Saffari A, Bui-Ta TTT, Meyburg J, Wühl E, Schenk JP. ARFI shear-wave elastography with simulation of acute urinary tract obstruction in an ex vivo porcine kidney model. Diagn Interv Radiol 2018; 24:308-315. [PMID: 30211684 PMCID: PMC6135057 DOI: 10.5152/dir.2018.17353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 04/08/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
Abstract
METHODS A total of 20 heparinized pig kidneys were investigated at 10 intrapelvic hydrostatic pressure steps (0-90 mmHg). SWE (ARFI; Virtual TouchTM IQ, Siemens) measurements were taken at three different measuring regions and in two measuring sequences using a linear ultrasonography probe (9L4, Siemens). Median values of 10 shear-wave speed (SWS) measurements were calculated for each pressure step. Logarithmic transformed median SWS values were analyzed in a linear mixed model. RESULTS SWS increased significantly with increasing intrapelvic pressure. Median SWS for all kidneys in both measuring sequences and all measuring regions was 1.47 m/s (interquartile range [IQR], 0.38 m/s) at 0 mmHg, 1.94 m/s (IQR, 0.42 m/s) at 30 mmHg, 2.07 m/s (IQR, 0.43 m/s) at 60 mmHg, 2.24 m/s (IQR, 0.49 m/s) at 90 mmHg. The correlation between pelvic pressure increase and median SWS values for the central parenchyma was significantly higher compared with the peripheral parenchyma. CONCLUSION Acutely increased renal pelvic pressure correlates with increasing SWS values in ARFI elastography in an ex vivo porcine kidney model.
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Affiliation(s)
- Jens Muttray
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Arianeb Mehrabi
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Mohammadreza Hafezi
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Arash Saffari
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Thi Thanh Tam Bui-Ta
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Jochen Meyburg
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
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Palabiyik FB, Inci E, Turkay R, Bas D. Evaluation of Liver, Kidney, and Spleen Elasticity in Healthy Newborns and Infants Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2039-2045. [PMID: 28417472 DOI: 10.1002/jum.14202] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Elasticity measurements of tissues can be valuable in the diagnosis and management of various diseases. The aim of this study was to determine the elasticity values for normal liver, kidney, and spleen of healthy newborns and infants using shear wave elastography (SWE) imaging. METHODS A total of 50 healthy term newborns and infants (19 girls and 31 boys; mean age 20.1 days, range 1 to 70 days) were examined by an experienced pediatric radiologist using SWE. None of them had any liver, kidney or spleen disease, or any other systemic disease that could affect these organs secondarily. All newborns and infants had a normal abdominal ultrasound scan. RESULTS Age, sex, weight, height, and body mass index had no significant effects on shear wave velocity (SWV) values of liver and spleen. The SWV values of both kidneys decreased with age, weight, height, and body mass index. The mean SWV values were 1.70 m/s (range: 1.23-2.43 m/s) for the liver, 1.69 m/s (range: 0.8-2.40 m/s) for the right kidney, 1.70 m/s (range: 0.9-2.49 m/s) for the left kidney, and 2.03 m/s (range: 1.28-2.48 m/s) for the spleen. CONCLUSIONS Shear wave elastography can be used to measure liver, kidney, and spleen elasticity in newborns and infants. The standard values for abdominal organs allow differentiation of healthy versus pathological tissue. We measured the normal values of SWE in healthy newborns and infants as reference data.
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Affiliation(s)
- Figen Bakirtas Palabiyik
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ercan Inci
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Rustu Turkay
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Derya Bas
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Bilgici MC, Bekci T, Genc G, Tekcan D, Tomak L. Acoustic Radiation Force Impulse Quantification in the Evaluation of Renal Parenchyma Elasticity in Pediatric Patients With Chronic Kidney Disease: Preliminary Results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1555-1561. [PMID: 28390141 DOI: 10.7863/ultra.16.08033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/11/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate renal parenchymal elasticity with acoustic radiation force impulse imaging in pediatric patients with chronic kidney disease (CKD) and compare with healthy volunteers. METHODS Thirty-eight healthy volunteers and 30 pediatric CKD patients were enrolled in this prospective study. The shear wave velocity (SW) values of both kidneys in CKD patients and healthy volunteers were evaluated. RESULTS The mean SW in healthy volunteers was 2.21 ± 0.34 m/s, whereas the same value was 1.81 ± 0.49, 1.72 ± 0.63, 1.66 ± 0.29, 1.48 ± 0.37, and 1.23 ± 0.27 for stages 1, 2, 3, 4, and 5 in CKD patients, respectively. The SW was significantly lower for each stage in the CKD patients compared with healthy volunteers. Acoustic radiation force impulse could not predict the different stages of CKD, with the exception of stage 5. The cut-off value for predicting CKD was 1.81 m/s; at this threshold, sensitivity was 76.5% and specificity was 92.1% (area under the curve = 0.870 [95% confidence interval: 0.750-0.990]; P < .001). Interobserver agreement expressed as intraclass coefficient correlation was 0.65 (95% confidence interval: 0.34 to 0.83; P < .001). CONCLUSIONS Acoustic radiation force impulse may be a potentially useful tool in detecting CKD in pediatric patients.
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Affiliation(s)
- Meltem Ceyhan Bilgici
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Tumay Bekci
- Zonguldak Atatürk State Hospital, Radiology Clinic, Zonguldak, Turkey
| | - Gurkan Genc
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Demet Tekcan
- Van Region Education and Research Hospital, Pediatrics Clinic, Van, Turkey
| | - Leman Tomak
- Department of Medical Biostatistics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Singh H, Panta OB, Khanal U, Ghimire RK. Renal Cortical Elastography: Normal Values and Variations. J Med Ultrasound 2017; 25:215-220. [PMID: 30065495 PMCID: PMC6029337 DOI: 10.1016/j.jmu.2017.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction Renal cortical elastography has shown conflicting but promising results in evaluation of chronic kidney disease and other renal disorders. The purpose of this study was to establish a normogram of renal cortical elasticity values and assess their variation between right and left kidney and their relation with age, gender, body mass index, renal dimensions and skin to cortex distance. Methods The study was a hospital based cross sectional study performed at Tribhuvan University Teaching Hospital, a tertiary care center in Kathmandu, Nepal. All individuals referred for Ultrasound from General Health Check up clinic were included in the study. Patient with abnormal ultrasound findings and abnormal renal function test were excluded from the study. Renal morphometry including length, cortical thickness, and skin to cortex distance were measured in B mode imaging and renal cortical elastography was measured with region of interest box of 1 × 0.5 cm. All analyses were done using Statistical Package for Social Sciences 20.0 soft ware. Results A total of 95 individuals who met the inclusion criteria were included in the study. The mean values of right and left renal cortical shear wave velocity were 1.49 ± 0.19 m/s and 1.54 ± 0.19 m/s respectively. Statistical significant difference was observed between the renal cortical shear wave velocity of right and left kidney. The renal shear wave velocity was seen to decrease with age, however the correlation was not statistically significant. No significant difference was also noted in renal shear wave velocity among various sex or Body mass index groups. Statistically significant negative correlation was noted between skin to cortex distance and renal cortical shear wave velocities. However no statistically significant correlation was noted between renal dimensions and renal cortical shear wave velocities. Conclusions The normal cortical elasticity values in terms of shear wave velocity of right and left kidney were established. Renal elasticity is independent of the age, gender, Body mass index and renal dimensions.
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Affiliation(s)
- Harsh Singh
- Department of Radiodiagnosis, King George Medical University, Lucknow, India
| | - Om Biju Panta
- Department of Intervention Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Umesh Khanal
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Nepal
| | - Ram Kumar Ghimire
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Nepal
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Association of Renal Elasticity and Renal Function Progression in Patients with Chronic Kidney Disease Evaluated by Real-Time Ultrasound Elastography. Sci Rep 2017; 7:43303. [PMID: 28240304 PMCID: PMC5327389 DOI: 10.1038/srep43303] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/24/2017] [Indexed: 12/13/2022] Open
Abstract
Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal elasticity. This study was designed to evaluate the predictive ability of renal elasticity in patients with chronic kidney disease (CKD). 148 non-CKD patients and 227 patients with CKD were recruited. 145 (38.7%) were female, 166 (73.1%) had diabetes, the mean estimated glomerular filtration rate (eGFR) was 33.9 ± 15.8 ml/min/1.73 m2 and the median urinary protein-to-creatinine ratio (UPCR) 502 (122–1491) mg/g. Patients with later stages of CKD had lower renal elasticity values, indicating stiffer kidneys (p < 0.001), and smaller kidney (p < 0.001). Renal elasticity correlated with log-transformed UPCR (β = −7.544, P < 0.001). Renal length correlated with age (β = −0.231, P < 0.001), sex (β = −3.730, P < 0.001), serum albumin level (β = −3.024, P = 0.001), body mass index (β = 0.390, P = 0.009) and eGFR (β = 0.146, P < 0.001). In fully-adjusted logistic regression model, the odds ratio (OR) per 10 unit change in renal elasticity for rapid renal deterioration was 0.928 (95% CI, 0.864–0.997; P = 0.042). The OR per 1 mm change in renal length for rapid renal deterioration was 1.022 (95% CI, 0.994–1.050; P = 0.125). Renal elasticity is associated with proteinuria and rapid renal deterioration in patients with CKD.
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Cygan S, Januszewicz M. Acoustic radiation force impulse imaging of kidneys - a phantom study. J Ultrason 2017; 16:329-338. [PMID: 28138404 PMCID: PMC5269520 DOI: 10.15557/jou.2016.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 11/22/2022] Open
Abstract
Aim of the study Since there have been only few works reporting the diagnosis of kidneys using Acoustic Radiation Force Impulse technique and those works do not provide consistent results of shear wave velocity measurements in renal tissue, we have decided to use kidney phantoms with known properties to examine the reliability of the method itself in a controlled setup similar to kidneys examination. Materials and methods Four gelatin-based phantoms imitating different clinical situations were manufactured – two with thick and two with thin renal cortex, each type at a depth similar to a normal-weight or overweight patient. For each phantom, a series of interest points was chosen and for each point 20 Shear Wave Velocity measurements were taken using the build-in Virtual Touch Tissue Quantification™ tool in a Siemens Acuson S2000 ultrasound scanner equipped with a 6C1 HD Transducer (Siemens Mountainview, USA). Results Mean Shear Wave Velocity values obtained for all the examined points ranged from 2.445 to 3.941 m/s, with standard deviation exceeding 0.1 in only one case out of 29 points, but differing significantly between all points. Conclusions The obtained results indicate that the method is highly reliable as long as the measurement volume contains a uniform tissue region. If the measurement window covers a region with different properties even partially, the obtained results are affected. The variance of measured values on the other hand is not affected by the said non-uniformity of material under examination. Furthermore, the variance of measured values does not show a clear dependency on the depth at which the shear wave velocities are measured.
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Affiliation(s)
- Szymon Cygan
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
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Bekci T, Ceyhan Bilgici M, Genc G, Tekcan D, Veysel Polat A, Tomak L. Evaluation of Renal Parenchyma Elasticity With Acoustic Radiation Force Impulse Quantification in Nutcracker Syndrome and Comparisons With Grayscale Doppler Sonography and Laboratory Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:61-67. [PMID: 27925644 DOI: 10.7863/ultra.16.03010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES We sought to evaluate renal parenchymal elasticity with Virtual Touch quantification of acoustic radiation force impulse imaging in nutcracker syndrome and to compare shear-wave velocity (SWV) values with grayscale Doppler sonography and laboratory findings. METHODS Thirty-eight healthy volunteers and forty-three nutcracker syndrome patients were enrolled in this prospective study. SWV values for both kidneys in nutcracker syndrome patients and healthy volunteers were evaluated. Grayscale Doppler ultrasound and laboratory findings were obtained and compared with SWV values in both nutcracker syndrome patients and healthy volunteers. RESULTS In nutcracker syndrome patients, SWV values for the left kidney were significantly lower than those for the right kidney (n = 43; 1.93 ± 0.43 m/s vs 2.53 ± 0.45 m/s [P < .001]). Healthy volunteers' SWV values for both kidneys had no statistically significant differences. There was a statistically significant difference between nutcracker syndrome patients and healthy volunteers for the SWV values and body mass index values. There was no statistically significant correlation between SWV values of nutcracker syndrome patients and age, gender, glomerular filtration rate, body mass index, vein diameter ratio, peak velocity ratio, or resistive indices. CONCLUSIONS Acoustic radiation force impulse imaging offers new, additional information on the affected left kidney parenchymal changes in nutcracker syndrome patients.
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Affiliation(s)
- Tumay Bekci
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Meltem Ceyhan Bilgici
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Gurkan Genc
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Demet Tekcan
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Veysel Polat
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Leman Tomak
- Department of Biomedical Statistics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Habibi HA, Cicek RY, Kandemirli SG, Ure E, Ucar AK, Aslan M, Caliskan S, Adaletli I. Acoustic radiation force impulse (ARFI) elastography in the evaluation of renal parenchymal stiffness in patients with ureteropelvic junction obstruction. J Med Ultrason (2001) 2016; 44:167-172. [PMID: 27933438 DOI: 10.1007/s10396-016-0760-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the role of acoustic radiation force impulse (ARFI) elastography in the detection of renal parenchymal damage in kidneys with and without ureteropelvic junction obstruction (UPJO). METHODS Twenty-five pediatric patients with a diagnosis of UPJO who underwent surgery and 15 pediatric patients with conservatively managed UPJO were prospectively evaluated with ARFI elastography. Sixteen healthy volunteers constituted the control group. Shear wave velocity (SWV) measurements in the upper, mid, and lower poles of the affected kidney were performed. SWV values of kidneys based on presence of UPJO and hydronephrosis grade were compared. The correlation of SWV values with residual renal function obtained from diethylenetriaminepentaacetic acid or mercaptoacetyltriglycine-3 renal scan was evaluated. RESULTS Significantly, higher SWV values were found in control kidneys compared to kidneys affected by UPJO. The median SWVs were 2.82 (2.51-3.07) m/s for the control kidneys and 2.36 (2.09-2.53) m/s for the kidneys in the UPJO group (p < 0.001). When UPJO patients were grouped according to the grade of hydronephrosis, grade 0 hydronephrotic kidneys [2.35 (2.11-2.50) m/s] and grade 3-4 hydronephrotic kidneys [1.86 (1.96-2.25) m/s] had significantly lower SWV values compared to grade 1-2 hydronephrotic kidneys [2.62 (2.37-2.90) m/s] (p < 0.05). CONCLUSIONS ARFI as a noninvasive, radiation-free procedure for evaluating parenchymal stiffness may prove useful in the diagnostic work-up and follow-up of children with UPJO-induced renal disease.
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Affiliation(s)
- Hatice Arioz Habibi
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Rumeysa Yasemin Cicek
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sedat Giray Kandemirli
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Emel Ure
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mine Aslan
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Salim Caliskan
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Research on pediatric glomerular disease and normal kidney with shear wave based elastography point quantification. Jpn J Radiol 2016; 34:738-746. [PMID: 27659447 DOI: 10.1007/s11604-016-0582-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/07/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the renal cortex stiffness in children with glomerular disease by shear wave based elastography point quantification (ElastPQ), and to investigate the association between shear wave velocity (SWV) in the renal cortex and age in normal children, and the inter-gender differences. MATERIALS AND METHODS One hundred and five children who were pathologically confirmed with glomerular diseases were selected as the disease group. Meanwhile, 120 healthy children were selected as the control group. Effective values were measured 5 times at the same kidney sites on each side. RESULTS Comparisons of SWV measurements between left and right kidneys in the disease and control groups all showed significant differences (left kidney t = 6.896, P = 0.004; right kidney t = 7.415, P = 0.001). In the control group, left and right kidney SWV measurements were all positively correlated with age (left kidney r = 0.792, P = 0.003; right kidney r = 0.794, P = 0.004). Moreover, inter-gender difference was present in the right kidney measurements. CONCLUSIONS ElastPQ technology has certain advantages in predicting pediatric glomerular disease compared to conventional ultrasound. ElastPQ technology contributes to the early diagnosis of the disease.
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Correas JM, Anglicheau D, Joly D, Gennisson JL, Tanter M, Hélénon O. Ultrasound-based imaging methods of the kidney-recent developments. Kidney Int 2016; 90:1199-1210. [PMID: 27665116 DOI: 10.1016/j.kint.2016.06.042] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/05/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
In recent years, several novel ultrasound (US)-based techniques have emerged for kidney diagnostic imaging, including tissue stiffness assessment with elastography, Ultrasensitive Doppler techniques, and contrast-enhanced ultrasonography to assess renal microvascularization. Renal elastography has become available with the development of noninvasive quantitative techniques, following the rapidly growing field of liver fibrosis diagnosis. With the increased incidence of chronic kidney disease, noninvasive diagnosis of renal fibrosis can be of critical value. However, it is difficult to simply extend the application of US elastography from one organ to the other due to anatomic and technical issues. Today, renal elastography appears to be a promising application that, however, still requires optimization and validation. New ultrasensitive Doppler techniques improve the detection of slow blood flow and can be used alone or after administration of US contrast agents. These microbubble-based agents are extremely well tolerated and can be administered even in cases of impaired renal function. Despite the lack of approval, they improve the characterization of atypical renal masses, complex cystic renal masses, and peripheral vascular disorders. Dynamic contrast-enhanced US is based on quantification of the signal intensity from region of interest and mathematical fits of the time-intensity curves. Perfusion-related parameters can be extracted for the monitoring of vascular changes in the renal parenchyma and in tumors in order to evaluate drug response. This estimation of renal perfusion depends on many parameters that should be kept constant for follow-up studies, and, when possible, an internal reference should be used to normalize the measurements.
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Affiliation(s)
- Jean-Michel Correas
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France; Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France.
| | - Dany Anglicheau
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Nephrology and Transplantation, Necker University Hospital, Paris, France; Necker - Sick Children Institute, INSERM U1151, Paris, France
| | - Dominique Joly
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Nephrology and Transplantation, Necker University Hospital, Paris, France
| | - Jean-Luc Gennisson
- Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
| | - Mickael Tanter
- Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
| | - Olivier Hélénon
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France
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Bruno C, Minniti S, Bucci A, Pozzi Mucelli R. ARFI: from basic principles to clinical applications in diffuse chronic disease-a review. Insights Imaging 2016; 7:735-46. [PMID: 27553006 PMCID: PMC5028343 DOI: 10.1007/s13244-016-0514-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/05/2016] [Accepted: 07/19/2016] [Indexed: 12/11/2022] Open
Abstract
Abstract The many factors influencing the shear wave velocity (SWV) measured with Acoustic Radiation Force Impulse (ARFI) are examined in order to define the most correct examination technique. In particular, attention is given to the information achieved by experimental models, such as phantoms and animal studies. This review targets the clinical applications of ARFI in the evaluation of chronic diffuse disease, especially of liver and kidneys. The contribution of ARFI to the clinical workout of these patients and some possible perspectives are described. Teaching Points • Stiffness significantly varies among normal and abnormal biological tissues. • In clinical applications physical, geometrical, anatomical and physiological factors influence the SWV. • Elastographic techniques can quantify fibrosis, which is directly related to stiffness. • ARFI can be useful in chronic diffuse disease of liver and kidney.
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Affiliation(s)
- Costanza Bruno
- Department of Radiology, Verona University, P.le LA Scuro 10, 37134, Verona, Italy.
| | | | - Alessandra Bucci
- Department of Radiology, Verona University, P.le LA Scuro 10, 37134, Verona, Italy
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Wang L. Applications of acoustic radiation force impulse quantification in chronic kidney disease: a review. Ultrasonography 2016; 35:302-8. [PMID: 27599890 PMCID: PMC5040133 DOI: 10.14366/usg.16026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022] Open
Abstract
Acoustic radiation force impulse (ARFI) imaging is an emerging technique with great promise in the field of elastography. Previous studies have validated ARFI quantification as a method of estimating fibrosis in chronic liver disease. Similarly, fibrosis is the principal process underlying the progression of chronic kidney disease, which is the major cause of renal failure. However, the quantification of tissue stiffness using ARFI imaging is more complex in the kidney than in the liver. Moreover, not all previous studies are comparable because they employed different procedures. Therefore, subsequent studies are warranted, both in animal models and in clinical patients, in order to better understand the histopathological mechanisms associated with renal elasticity and to further improve this imaging method by developing a standardized guidelines for its implementation.
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Affiliation(s)
- Liang Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
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Renal elasticity quantification by acoustic radiation force impulse applied to the evaluation of kidney diseases: a review. J Investig Med 2016; 63:605-12. [PMID: 25738649 DOI: 10.1097/jim.0000000000000186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For centuries, clinicians have used palpation to evaluate abdominal organs. After exploring almost all the different methods of interaction between x-rays, ultrasound, and magnetic fields on tissues, recent interest has focused on the evaluation of their mechanical properties.Acoustic radiation force impulse (ARFI) is a recent, established ultrasound-based diagnostic technique that allows physicians to obtain a measure of the elastic properties of an organ. Shear wave velocity, obtained by the ARFI technique, depends on the elasticity of tissues.To date, there are studies on the ARFI technique applied to normal kidneys, chronic kidney diseases, and kidney transplants. Mechanical properties of the kidney, such as stiffness and deformity, depend on various conditions that alter its histology, in particular the amount of fibrosis in the renal parenchyma; urinary pressure and renal blood perfusion may be other important contributing factors. Unfortunately, the ARFI technique applied to native renal pathologies is still limited, and not all studies are comparable because they used different methods. Therefore, the results reported in recent literature encourage further improvement of this method and the drawing up of standardized guidelines of investigation.
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Anvari A, Barr RG, Dhyani M, Samir AE. Clinical application of sonoelastography in thyroid, prostate, kidney, pancreas, and deep venous thrombosis. ACTA ACUST UNITED AC 2015; 40:709-22. [PMID: 25750099 DOI: 10.1007/s00261-015-0383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article reviews the clinical applications of current ultrasound elastography methods in non-hepatic conditions including thyroid nodules, prostate cancer, chronic kidney disease, solid renal lesions, pancreatic lesions, and deep vein thrombosis. Pathophysiology alters tissue mechanical properties via ultrastructural changes including fibrosis, increased cellularity, bleeding, and necrosis, creating a target biomarker, which can be imaged qualitatively or quantitatively with US elastography. US elastography methods can add information to conventional US methods and improve the diagnostic performance of conventional US in a range of disease processes.
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Affiliation(s)
- Arash Anvari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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D'Onofrio M, De Robertis R, Crosara S, Poli C, Canestrini S, Demozzi E, Pozzi Mucelli R. Acoustic radiation force impulse with shear wave speed quantification of pancreatic masses: A prospective study. Pancreatology 2015; 16:106-9. [PMID: 26746355 DOI: 10.1016/j.pan.2015.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 10/14/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acoustic Radiation Force Impulse (ARFI) is a new ultrasound technique that evaluates mechanical properties of tissues. To evaluate the use of ARFI with shear waves speed quantification for pancreatic masses characterization during the ultrasound examination. METHODS 123 pancreatic lesions were prospectively evaluated. Median shear waves speeds were compared with Mann-Whitney U test. Two reading methods were applied for the characterization of adenocarcinoma: more than one measurement above the top shear waves speed (SWS) value. Two reading methods were applied to diagnose mucinous lesion: at least 2 (method 1) or 3 (method 2) numerical measurements. Sensitivity, specificity, positive and negative predictive values and accuracy of each reading method were calculated. Forty volunteers were included for normal ARFI values. RESULTS In the adenocarcinoma group median SWS value was 2.74 m/s. In the volunteers group the median SWS value was 1.17 m/s. Significant difference between SWS median values of adenocarcinoma and normal pancreas was found (P < 0.05). For the diagnosis of pancreatic solid masses if more than one measurement is above the top SWS value of 4.00 m/s results in the study, the diagnosis of ductal adenocarcinoma is highly specific with specificity and PPV of 100%. Good sensitivity (73.3%) and specificity (83.3%) were obtained for the characterization of mucinous cystic lesions. CONCLUSIONS Acoustic Radiation Force Impulse imaging could help in the non-invasive characterization of solid and cystic lesions of the pancreas during a conventional US examination.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Riccardo De Robertis
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Stefano Crosara
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Cristina Poli
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Stefano Canestrini
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Emanuele Demozzi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Roberto Pozzi Mucelli
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
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A comparison of acoustic radiation force impulse imaging and scintigraphy in the functional evaluation of the major salivary glands. Nucl Med Commun 2015; 36:1220-6. [DOI: 10.1097/mnm.0000000000000391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zaffanello M, Bruno C. Clinical perspective on renal elasticity quantification by acoustic radiation force impulse: Where we are and where we are going. World J Clin Urol 2015; 4:100-103. [DOI: 10.5410/wjcu.v4.i3.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/26/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Recent interests have focused on the exploration of the mechanical properties (elasticity, stiffness and deformity) of parenchymatous organs using tissue strain imaging techniques and elastosonography. Measures of the mechanical properties of the kidneys have given conflicting results. There are various conditions that affect the variability of renal parenchymal measures, the main target of the investigations. They can be classified as intrinsic (depending upon the patient), extrinsic (depending upon the operator) and mixed (both intrinsic and extrinsic). Indeed, the mechanical properties of the kidney depend on various conditions that alter its histology, mainly the amount of fibrosis in the renal parenchymal interstitium. Anatomical factors play an important role because the kidney is a highly anisotropic organ with important differences when considering the cortex and the medulla. Physical factors include the frequency of the probe, compression and distance from source to target. Many factors can affect measurements and it is necessary to find an accurate technique in order to avoid mistakes and to obtain reproducible data. Indeed, it is imperative to define a standardized examination technique in order to get comparable results. Therefore, the utility of acoustic radiation force imaging technique to predict only renal fibrosis or progression of chronic kidney disease is of dubious value because several variables - blood perfusion and urinary pressure - can contribute to a given measure, even with a standardized method able to minimize intra- and inter-operator variability.
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Intravoxel incoherent motion magnetic resonance imaging to predict vesicoureteral reflux in children with urinary tract infection. Eur Radiol 2015; 26:1670-7. [PMID: 26373765 DOI: 10.1007/s00330-015-3986-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/18/2015] [Accepted: 08/31/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To compare the diffusion parameters of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) between the "reflux" and the "non-reflux" kidneys, and to evaluate the feasibility of using IVIM DWI to predict vesicoureteral reflux (VUR) in children with a urinary tract infection (UTI). METHODS Eighty-three kidneys from 57 pediatric patients with a UTI were classified into "reflux" and "non-reflux" groups according to voiding cystourethrography (VCUG) results. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (PF) were measured and compared in the renal pelvis of both groups. Four indices (D*/ADC, PF/ADC, D*/D, and PF/D) were calculated and receiver operating characteristic (ROC) curve analyses were performed. RESULTS VURs were detected on VCUG in 21 kidneys. PF and D* were significantly higher in the "reflux" group than in the "non-reflux" group. The indices were all significantly higher. The PF/D index showed the best diagnostic performance in predicting VUR in children with UTI (Az = 0.864). CONCLUSION PF and D* were significantly higher in the "reflux" kidney than in the "non-reflux" kidney. Our new index (PF/D) could prove useful for predicting VUR. KEY POINTS • IVIM DWI is both radiation-free and contrast media-free. • IVIM DWI index is easily calculated by combining diffusion parameters. • IVIM DWI may help predict VUR in children with UTI. • PF is significantly higher in the "reflux" than the "non-reflux" kidneys. • A new VUR index, PF/D could prove useful for predicting VUR.
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Bob F, Bota S, Sporea I, Sirli R, Popescu A, Schiller A. Relationship between the estimated glomerular filtration rate and kidney shear wave speed values assessed by acoustic radiation force impulse elastography: a pilot study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:649-54. [PMID: 25792580 DOI: 10.7863/ultra.34.4.649] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The aim of the study was to establish the relationship between the estimated glomerular filtration rate (GFR) and kidney shear wave speed values assessed by acoustic radiation force impulse (ARFI) elastography. METHODS Our study included 104 patients with or without chronic kidney disease in which the kidney shear wave speed was evaluated by ARFI elastography and correlated with the estimated GFR. Five ARFI measurements were performed in the parenchyma of each kidney. A median value expressed as meters per second was calculated. RESULTS Five valid ARFI elastographic measurements were obtained in the right kidney in all patients and in the left kidney in 97.1% of patients. The mean kidney shear wave speed values ± SD in the right and left kidneys were similar: 2.17 ± 0.81 versus 2.06 ± 0.75 m/s (P = .30). The mean kidney shear wave speed decreased with the decrease in the estimated GFR. Statistically significant differences were obtained only when kidney shear wave speed values obtained in patients with an estimated GFR of greater than 90 mL/min/1.73 m(2) were compared to values in patients with stage 4 (estimated GFR, 15-29 mL/min/1.73 m(2)) and stage 5 (estimated GFR, <15 mL/min/1.73 m(2)) chronic kidney disease: 2.32 ± 0.83 versus 1.62 ± 0.75 m/s (P = .03) and 2.32 ± 0.83 versus 1.66 ± 0.72 m/s (P = .04), respectively. For a cutoff value of 2.26 m/s or lower, kidney shear wave speed had 86.7% sensitivity, 48.3% specificity, a 22.1% positive predictive value, and a 95.6% negative predictive value (area under the receiver operating characteristic curve, 0.692; P = .008) for predicting the presence of an estimated GFR of less than 30 mL/min/1.73 m(2). CONCLUSIONS Kidney shear wave speed values obtained by ARFI elastography decrease with the decrease in the estimated GFR.
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Affiliation(s)
- Flaviu Bob
- Departments of Nephrology (F.B., A.S.) and Gastroenterology and Hepatology (S.B., I.S., R.S., A.P.), Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Simona Bota
- Departments of Nephrology (F.B., A.S.) and Gastroenterology and Hepatology (S.B., I.S., R.S., A.P.), Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania.
| | - Ioan Sporea
- Departments of Nephrology (F.B., A.S.) and Gastroenterology and Hepatology (S.B., I.S., R.S., A.P.), Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Roxana Sirli
- Departments of Nephrology (F.B., A.S.) and Gastroenterology and Hepatology (S.B., I.S., R.S., A.P.), Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Alina Popescu
- Departments of Nephrology (F.B., A.S.) and Gastroenterology and Hepatology (S.B., I.S., R.S., A.P.), Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Adalbert Schiller
- Departments of Nephrology (F.B., A.S.) and Gastroenterology and Hepatology (S.B., I.S., R.S., A.P.), Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
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Dillman JR, Chen S, Davenport MS, Zhao H, Urban MW, Song P, Watcharotone K, Carson PL. Superficial ultrasound shear wave speed measurements in soft and hard elasticity phantoms: repeatability and reproducibility using two ultrasound systems. Pediatr Radiol 2015; 45:376-85. [PMID: 25249389 PMCID: PMC4346477 DOI: 10.1007/s00247-014-3150-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is a paucity of data available regarding the repeatability and reproducibility of superficial shear wave speed (SWS) measurements at imaging depths relevant to the pediatric population. OBJECTIVE To assess the repeatability and reproducibility of superficial shear wave speed measurements acquired from elasticity phantoms at varying imaging depths using three imaging methods, two US systems and multiple operators. MATERIALS AND METHODS Soft and hard elasticity phantoms manufactured by Computerized Imaging Reference Systems Inc. (Norfolk, VA) were utilized for our investigation. Institution No. 1 used an Acuson S3000 US system (Siemens Medical Solutions USA, Malvern, PA) and three shear wave imaging method/transducer combinations, while institution No. 2 used an Aixplorer US system (SuperSonic Imagine, Bothell, WA) and two different transducers. Ten stiffness measurements were acquired from each phantom at three depths (1.0 cm, 2.5 cm and 4.0 cm) by four operators at each institution. Student's t-test was used to compare SWS measurements between imaging techniques, while SWS measurement agreement was assessed with two-way random effects single-measure intra-class correlation coefficients (ICCs) and coefficients of variation. Mixed model regression analysis determined the effect of predictor variables on SWS measurements. RESULTS For the soft phantom, the average of mean SWS measurements across the various imaging methods and depths was 0.84 ± 0.04 m/s (mean ± standard deviation) for the Acuson S3000 system and 0.90 ± 0.02 m/s for the Aixplorer system (P = 0.003). For the hard phantom, the average of mean SWS measurements across the various imaging methods and depths was 2.14 ± 0.08 m/s for the Acuson S3000 system and 2.07 ± 0.03 m/s Aixplorer system (P > 0.05). The coefficients of variation were low (0.5-6.8%), and interoperator agreement was near-perfect (ICCs ≥ 0.99). Shear wave imaging method and imaging depth significantly affected measured SWS (P < 0.0001). CONCLUSION Superficial shear wave speed measurements in elasticity phantoms demonstrate minimal variability across imaging method/transducer combinations, imaging depths and operators. The exact clinical significance of this variation is uncertain and may change according to organ and specific disease state.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA,
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Göya C, Ece A, Hamidi C. Reply to Ozkan et al. regarding 'Acoustic radiation force impulse elastography for detection of renal damage in children'. Pediatr Radiol 2015; 45:462. [PMID: 25301382 DOI: 10.1007/s00247-014-3190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Cemil Göya
- Department of Radiology, Medical School, Dicle University, Yenişehir, 21280, Diyarbakir, Turkey
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Acoustic radiation force impulse elastography for evaluating renal parenchymal stiffness in children. Pediatr Radiol 2015; 45:461. [PMID: 25252829 DOI: 10.1007/s00247-014-3174-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/22/2014] [Indexed: 01/10/2023]
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Affiliation(s)
- Øystein E. Olsen
- Radiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
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Göya C, Hamidi C, Ece A, Okur MH, Taşdemir B, Çetinçakmak MG, Hattapoğlu S, Teke M, Şahin C. Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children. Pediatr Radiol 2015; 45:55-61. [PMID: 25064187 DOI: 10.1007/s00247-014-3072-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/28/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acoustic radiation force impulse (ARFI) imaging is a promising method for noninvasive evaluation of the renal parenchyma. OBJECTIVE To investigate the contribution of ARFI quantitative US elastography for the detection of renal damage in kidneys with and without vesicoureteral reflux (VUR). MATERIALS AND METHODS One hundred seventy-six kidneys of 88 children (46 male, 42 female) who had been referred for voiding cystourethrography and 20 healthy controls were prospectively investigated. Patients were assessed according to severity of renal damage on dimercaptosuccinic acid (DMSA) scintigraphy. Ninety-eight age- and gender-matched healthy children constituted the control group. Quantitative shear wave velocity (SWV) measurements were performed in the upper and lower poles and in the interpolar region of each kidney. DMSA scintigraphy was performed in 62 children (124 kidneys). Comparisons of SWV values of kidneys with and without renal damage and/or VUR were done. RESULTS Significantly higher SWV values were found in non-damaged kidneys. Severely damaged kidneys had the lowest SWV values (P < 0.001). High-grade (grade V-IV) refluxing kidneys had the lowest SWV values, while non-refluxing kidneys had the highest values (P < 0.05). Significant negative correlations were found between the mean quantitative US elastography values and DMSA scarring score (r = -0.788, P < 0.001) and VUR grade (r = -0.634, P < 0.001). SWV values of the control kidneys were significantly higher than those of damaged kidneys (P < 0.05). CONCLUSION Our findings suggest decreasing SWV of renal units with increasing grades of vesicoureteric reflux, increasing DMSA-assessed renal damage and decreasing DMSA-assessed differential function.
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Affiliation(s)
- Cemil Göya
- Department of Radiology Medical School, Dicle University, Diyarbakir, Turkey
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Wang L, Xia P, Lv K, Han J, Dai Q, Li XM, Chen LM, Jiang YX. Assessment of renal tissue elasticity by acoustic radiation force impulse quantification with histopathological correlation: preliminary experience in chronic kidney disease. Eur Radiol 2014; 24:1694-9. [PMID: 24744199 DOI: 10.1007/s00330-014-3162-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/21/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Chronic kidney disease (CKD), a progressive and irreversible pathological syndrome, is the major cause of renal failure. Renal fibrosis is the principal process underlying the progression of CKD. Acoustic radiation force impulse (ARFI) quantification is a promising noninvasive method for assessing tissue stiffness. We evaluated whether the technique could reveal renal tissue fibrosis in CKD patients. METHODS ARFI assessments were performed in 45 patients with CKD referred for renal biopsies to measure cortical shear wave velocity (SWV). During measurement, a standardized method was employed, which aimed to minimize the potential impact of variation of transducer force, sampling error of non-cortical tissue and structural anisotropy of the kidney. Then SWV was compared to patients' CKD stage and pathological fibrosis indicators. RESULTS ARFI could not predict the different stages of CKD. Spearman correlation analysis showed that SWV did not correlate with any pathological indicators of fibrosis. CONCLUSION ARFI assesses tissue stiffness of CKD kidneys by measuring cortical SWV. However, SWV did not show significant correlations with CKD stage and fibrosis indicators despite using standardized measurement methods. We therefore suggest that it would be necessary to evaluate the effect of pathological complexity and tissue perfusion of the kidney on stiffness assessment in future studies. KEY POINTS • Acoustic radiation force impulse (ARFI) can quantify tissue elasticity of CKD kidney. • Despite standardized measurement, ARFI-estimated elasticity did not correlate with renal fibrosis. • Effects of pathological complexity and tissue perfusion on renal stiffness warrant further study.
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Affiliation(s)
- Liang Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, 1 Shuaifuyuan Wangfujing, Beijing, 100730, China
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Sohn B, Kim MJ, Han SW, Im YJ, Lee MJ. Shear wave velocity measurements using acoustic radiation force impulse in young children with normal kidneys versus hydronephrotic kidneys. Ultrasonography 2014; 33:116-21. [PMID: 24936504 PMCID: PMC4058982 DOI: 10.14366/usg.14002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/28/2014] [Indexed: 11/12/2022] Open
Abstract
Purpose: To measure shear wave velocities (SWVs) by acoustic radiation force impulse (ARFI) ultrasound elastography in normal kidneys and in hydronephrotic kidneys in young children and to compare SWVs between the hydronephrosis grades. Methods: This study was approved by an institutional review board, and informed consent was obtained from the parents of all the children included. Children under the age of 24 months were prospectively enrolled. Hydronephrosis grade was evaluated on ultrasonography, and three valid ARFI measurements were attempted using a high-frequency transducer for both kidneys. Hydronephrosis was graded from 0 to 4, and high-grade hydronephrosis was defined as grades 3 and 4. Results: Fifty-one children underwent ARFI measurements, and three valid measurements for both kidneys were obtained in 96% (49/51) of the patients. Nineteen children (38.8%) had no hydronephrosis. Twenty-three children (46.9%) had unilateral hydronephrosis, and seven children (14.3%) had bilateral hydronephrosis. Seven children had ureteropelvic junction obstruction (UPJO). Median SWVs in kidneys with high-grade hydronephrosis (2.02 m/sec) were higher than those in normal kidneys (1.75 m/sec; P=0.027). However, the presence of UPJO did not influence the median SWVs in hydronephrotic kidneys (P=0.362). Conclusion: Obtaining ARFI measurements of the kidney is feasible in young children with median SWVs of 1.75 m/sec in normal kidneys. Median SWVs increased in high-grade hydronephrotic kidneys but were not different between hydronephrotic kidneys with and without UPJO.
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Affiliation(s)
- Beomseok Sohn
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Pediatric Urology, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jae Im
- Department of Pediatric Urology, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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