Quantitative Assessment of Muscular Stiffness in Children With Chronic Kidney Disease Using Acoustic Radiation Force Impulse Ultrasound Elastography.

ABSTRACT: The aim of this study was to evaluate the feasibility of quantitative analysis of muscle stiffness in the rectus femoris muscle (RFM) by acoustic radiation force impulse (ARFI) ultrasound elastography in children with chronic kidney disease (CKD). Twenty-three children with CKD and 22 healthy children participated in the study in our radiology department. The strength of each CKD group and healthy group participants' tight extensors was assessed by a physiatrist using a handheld dynamometer. Acoustic radiation force impulse was used to measure the shear wave velocities (SWVs) of the RFM. The mean SWV value of the RFM correlated with the strengths of the tight extensors in the CKD and healthy groups. The mean ± SD SWV values of the RFM in the CKD group for the right (n = 23) and left sides (n = 21) were 1.23 ± 0.25 and 1.26 ± 0.30 m/s, respectively. The mean ± SD SWV values of the RFM in the healthy group for the right (n = 23) and left sides (n = 21) were 1.62 ± 0.33 and 1.65 ± 0.35 m/s, respectively. The SWV of the RFM significantly decreased in the patients with CKD when compared with controls (P < 0.001). The SWV values were not correlated to the handheld dynamometry. The interobserver agreement expressed as the interclass correlation coefficient was 0.65 (95% confidence interval, 0.33-0.84; P < 0.001). The acoustic radiation force impulse demonstrates a difference in RFM muscle stiffness between the CKD and healthy groups. This method is a feasible imaging method for the noninvasive assessment of muscle weakness in children with CKD.

Is gynecomastia related to the disease characteristics and prognosis in testicular germ cell tumor patients?

PURPOSE: We aimed to assess the relationship between gynecomastia and tumor markers, histologic subtypes, and prognosis in patients with testicular germ cell tumors. METHODS: This study included 73 testicular germ cell cancer patients with pretreatment chest, abdomen and pelvis computed tomography (CT) scans and tumor markers (ß-human chorionic gonadotropin [ß-hCG], lactate dehydrogenase [LDH], α-fetoprotein [AFP]). The volumetric analysis of the breast glandular tissue, the presence of gynecomastia and metastatic disease were determined using CT scans. Patients were classified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification. The association between gynecomastia, breast glandular tissue volume, tumor markers, metastatic disease, and disease prognosis were evaluated. RESULTS: Thirty-four of the patients (46.6%) had gynecomastia. A breast volume cutoff value of 0.78 cm3 to diagnose gynecomastia led to 85% sensitivity and 95% specificity. Serum ß-hCG level correlated with the breast glandular tissue volume weakly (r=0.242, P = 0.039). Gynecomastia was more common in patients with elevated ß-hCG levels (P = 0.047), and was not associated with pulmonary, nonpulmonary distant, or nodal metastases (P = 0.378, P = 0.884, P = 0.333, respectively). No significant association was found between the disease prognosis and gynecomastia (P = 0.556). CONCLUSION: Gynecomastia was common among testicular germ cell cancer patients with elevated ß-hCG. However, it was not associated with metastatic disease and prognosis.

Contribution of 3-T Susceptibility-Weighted MRI to Detection of Intraarticular Hemosiderin Accumulation in Patients With Hemophilia.

OBJECTIVE: The purpose of this study was to assess the feasibility of 3-T susceptibility-weighted imaging (SWI) for detecting intraarticular hemosiderin accumulation in patients with hemophilia. SUBJECTS AND METHODS: Forty-one joints in 24 patients with hemophilia were imaged with conventional MRI and SWI sequences. Two experienced musculoskeletal radiologists and one general radiologist (reader 3) interpreted the images for hemosiderin accumulation. The final decision was determined in consensus by readers 1 and 2 using both conventional MRI and SWI sequences. The diagnostic consistencies of each MRI sequence with the reference and pairwise agreements between interpreters were assessed. RESULTS: For conventional MRI sequences, the diagnostic consistencies of the two experienced musculoskeletal radiologists with the reference were substantial (κ = 0.63 and 0.62), whereas the consistency of the general radiologist with the reference was moderate (κ = 0.47). The SWI interpretations of all readers had almost perfect agreement with the reference (κ = 1, κ = 1, κ = 0.97). Interobserver agreement also improved at SWI interpretations. CONCLUSION: SWI contributes to more accurate grading of intraarticular hemosiderin accumulation than is achieved with conventional MRI sequences.

The diagnostic value of shear wave elastography for parathyroid lesions and comparison with cervical lymph nodes.

AIMS: The aim of this study was to prospectively assess the feasibility of the Virtual Touch tissue imaging quantification (VTIQ) method of shear wave elastography (SWE) for the discrimination of parathyroid lesions and to compare the lesions' stiffness with that of cervical lymph nodes. MATERIALS AND METHODS: SWE using VTIQ was performed on 66 patients with 87 histopathologically proven parathyroid lesions (54 parathyroid adenomas and 33 parathyroid hyperplasia) and 29 patients with 31 inflammatory cervical lymph nodes. The mean SWVs of the lesions were compared and receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. RESULTS: The mean SWV of parathyroid adenomas (2.16±0.33 m/s) differed significantly from those of parathyroid hyperplasia and lymph nodes (1.75±0.28 m/s and 1.86±0.37 m/s respectively, p<0.001). Selecting a cutoff value of 1.92 m/s for diagnosing adenoma led to 80% sensitivity and 82% specificity (area under the curve [AUC]: 0.832 [95% confidence interval (CI): 0.742-0.921], p< 0.001). CONCLUSIONS: The VTIQ method of SWE can contribute to the differentiation of parathyroid adenoma from parathyroid hyperplasia and cervical lymphnodes.