Evaluation of the Achilles Tendon Using B-Mode Ultrasound and Strain Elastography in Patients With Chronic Kidney Disease.

OBJECTIVES: To investigate the B-mode ultrasound (US) features and elasticity of the Achilles tendon in patients with chronic kidney disease (CKD) using US elastography and to compare them with those of healthy individuals. METHODS: From March 2019 through May 2019, 30 consecutive patients with variable stages of CKD and 30 healthy individuals were prospectively included in this study. Ultrasound and strain elastographic examinations were performed on both Achilles tendons of all individuals. Degrees of tendinopathy, if existed, were classified as defined by Archambault et al (J Clin Ultrasound 1998; 26:335-339), and thicknesses were documented with US. Strain ratios (SRs) were calculated by measuring the strain values from the Achilles tendon and Kager fat pad. Statistical differences in the SRs of Achilles tendons between the control group and patients with CKD were calculated. RESULTS: The 30 patients with CKD ranged in age from 24 to 73 years, and the 30 healthy individuals ranged in age from 25 to 78 years. Both distal and left middle thirds of the Achilles tendons were thicker in patients with CKD than in healthy individuals (P < .05). The mean SRs ± SDs in the patient group (4.71 ± 0.95 and 4.85 ± 1.47 on the right and left, respectively) were significantly higher (P < .05) than in healthy individuals (2.31 ± 0.42 and 2.65 ± 0.55 on the right and left), which indicated an increased stiffness of Achilles tendons in the patient group. CONCLUSIONS: As a semiquantitative and noninvasive imaging modality, strain elastography has the potential to detect the morphologic and elasticity changes of Achilles tendons in patients with CKD, which may give an opportunity to help physicians predict possible leading partial or complete tears.

Efficacy of Strain Elastography in Diagnosis and Staging of Acute Appendicitis in Pediatric Patients.

BACKGROUND In the present study, the role and efficiency of strain elastography (SE) were evaluated in diagnosis and staging of acute appendicitis in pediatric patients. MATERIAL AND METHODS We enrolled 225 pediatric patients with suspected clinical and laboratory findings of acute appendicitis. Gray-scale sonographic findings were recorded and staging was made by the colorization method of SE imaging. Appendectomy was performed in all patients and the results of the surgical pathology were compared with the imaging findings. The sensitivity, specificity, and accuracy of SE imaging were determined in terms of evaluating the "acute appendicitis". RESULTS Sonographic evaluation revealed acute appendicitis in 100 patients. Regarding the SE analysis, cases with appendicitis were classified into 3 groups as: mild (n=17), moderate (n=39), and severe (n=44). The pathological evaluation revealed 95 different stages of appendicitis and normal appendix in 5 cases: acute focal (n=10), acute suppurative (n=46), phlegmonous (n=27), and perforated (n=12), regarding the results of surgical pathology. Five patients with pathologically proven "normal" appendix were noted as "mild stage appendicitis" based on gray scale and SE analysis. In total, when gray-scale and SE results were compared with pathology results regardless of the stage of appendicitis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96%, 96%, 95%, 96.8%, and 96%, respectively. No statistically significant difference was detected between other groups (P<0.05). CONCLUSIONS In acute appendicitis, the use of SE imaging as a supportive method for the clinical approach can be useful in diagnosis, and its results are closely correlated with the histopathologic stage of appendix inflammation.

Use of ARFI elastography in the prediction of placental invasion anomaly via a new Virtual Touch Quantification Technique.

We aimed to evaluate the efficiency of placental elasticity in predicting a placental invasion anomaly with the Virtual Touch Quantification (VTQ) technique. Pregnant women in the third trimester with suspected placental invasion anomaly were enrolled into the research (n = 58). The placenta was evaluated and divided into three equal parts as foetal edge (inner 1/3 of placenta), maternal edge (outer 1/3 of placenta) and the central part (central 1/3 of placenta). Shear wave velocity (SWV) measurements were used in the elastographic evaluation of placentas by VTQ. We performed the measurements at the different regions of placenta for sampling the variety areas of the placenta. Acoustic Radiation Force Impulse (ARFI) Elastography scores were significantly higher in the group in which an invasion was detected during the surgery of patients with preoperative placental invasion suspicion. A significant difference in the measurements of the inner, central and outer third of the placenta between the groups was found (p < .001). In this study, we have shown higher SWV scores of placental measurements of the patients with preoperative suspected anomalies and an invasion detected during their surgery. These findings may reflect an event at the tissue elasticity level and we hope that the use of the VTQ technique may contribute to an early prediction of placental invasions before surgery in the future via new research. Impact statement What is already known on this subject? Placenta invasion anomalies (PIA's) are characterized by haemorrhages which can threat the mother's life. Placental invasion anomalies are among the most important causes of maternal mortality and morbidity. Early diagnosis is very important condition in reducing the mortality and morbidity. Gray scale ultrasonography (US) is mostly used in early diagnosis of PIA's. Acoustic radiation force impulse elastography (ARFI) is a new elastographic ultrasonography technic. We aimed to evaluate a new method in the early diagnosis of PIA's using ARFI technique. There is no study in the diagnosis of PIA's by ARFI in the literature to our knowledge. We think that this original study will contribute to the literature. What do the results of this study add? We showed the accuracy of ARFI in determination of PIA's. ARFI scores were significantly higher in the group in which invasion was detected during surgery of patients with preoperative placental invasion suspicion. What are the implications are of these findings for clinical practice and/or further research? Our findings may reflect an event at the tissue elasticity level and we hope that the use of VTQ technique may contribute to early predict of placental invasions before surgery in the future via new researches. Early diagnosis of placental invasion anomalies may reduce mortality and morbidity.

Posterior reversible encephalopathy syndrome in IgA vasculitis: Neuroimaging of a 14-year-old child.

IgA vasculitis (IgAV) is a leukocytoclastic vasculitis and characterized by involvement of small vessels in skin, gastrointestinal system, joints, kidneys, and less frequently other organs. It is the commonest vasculitis in childhood and etiology is not completely known. Neurological manifestations of IgAV are very rare and usually seen in patients with severe hypertension or as an uncommon feature such as peripheral neuropathy. Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiologic entity characterized with temporary vasogenic edema developing typically in posterior circulation of the brain and has been reported as a rare manifestation of IgAV. In this paper, a PRES case of 14-year-old male with IgAV is reported and etiopathogenesis was discussed with literature. Diagnosis was made by magnetic resonance imaging because of the existence of neurological symptoms (headache and visual loss) during the course of disease. His radiological findings have resolved with therapy. Although neurological involvement is a rare manifestation in IgAV, we recommend magnetic resonance imaging in such patients for diagnosis and evaluation of complications.

Contribution of diffusion weighted MRI to diagnosis and staging in gastric tumors and comparison with multi-detector computed tomography.

BACKGROUND: Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared. PATIENTS AND METHODS: We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used. RESULTS: Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%. CONCLUSIONS: The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.

Pulsatility Index of Popliteal Artery in Patients with Isolated Calf Vein Thrombosis: A Novel Technique for Detecting Thrombosis.

BACKGROUND: To investigate the usefulness of popliteal artery spectral doppler findings as a complimentary approach to isolated calf vein thrombosis (DVT). MATERIAL/METHODS: We included consecutive patients presenting with symptomatic and sonographically proven acute isolated calf DVT. Patients with thrombosis of any other vein were excluded. We classified calf vein into into four main types. We investigated how many of these four vessels had DVT and compared them with respect to the pulsatility index (PI) value of the popliteal artery. RESULTS: We evaluated spectral doppler characteristics of the popliteal artery on the same side as the isolated calf vein thrombosis as well as on the opposite side. The relationship between PI values of the popliteal artery and the number of thrombosed calf veins was investigated. In patients with 1 and/or 2 thrombosed veins, the mean PI was 6.03±0.54 on the side of cDVT and 5.68±0.39 on the opposite side (p=0.008), respectively. Inpatients with 3 and/or 4 thrombosed veins, the mean PI was 8.05±0.61 on the side of cDVT and 6.34±0.47 on the opposite side (p=0.001), respectively. CONCLUSIONS: Venous doppler sonography for the evaluation of calf DVT may be limited by patient characteristics such as obesity, edema, and tenderness., Arterial PI can be used as a complimentary technique for the detection of venous thrombosis in such of cases.

Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis.

BACKGROUND Because loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. The aim of this study was to compare the vertebral artery values between subjects with and without loss of cervical lordosis. MATERIAL AND METHODS Thirty patients with loss of cervical lordosis and 30 controls matched for age, sex, and body mass index were included in the study. Sixty vertebral arteries in patients with loss of cervical lordosis and 60 in controls without loss of cervical lordosis were evaluated by Doppler ultrasonography. Vertebral artery hemodynamics, including lumen diameter, flow volume, peak systolic velocity, end-diastolic velocity, and resistive index, were measured, and determined values were statistically compared between the patient and the control groups. RESULTS The means of diameter (p=0.003), flow volume (p=0.002), and peak systolic velocity (p=0.014) in patients were significantly lower as compared to controls. However, there was no significant difference between the 2 groups in terms of the end-diastolic velocity (p=0.276) and resistive index (p=0.536) parameters. CONCLUSIONS The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity. Further studies are required to confirm these findings and to investigate their possible clinical implications.

Ultrasound Elastography for Distinction Between Parathyroid Adenomas and Thyroid Nodules.

OBJECTIVES: The aim of this study was to detect the level of stiffness of parathyroid adenomas and to distinguish them from benign and malignant thyroid nodules using ultrasound elastography with acoustic radiation force impulse imaging. METHODS: Twenty-one patients with parathyroid adenomas and 71 patients with thyroid nodules were evaluated by acoustic radiation force impulse imaging in this study. Acoustic radiation force impulse elastograms were obtained after evaluation of the thyroid nodules, which were predicted to undergo fine-needle aspiration biopsy, and patients with a diagnosis of hyperparathyroidism, which was identified by sonography at the same time. RESULTS: An analysis of mean shear wave velocity (SWV) values for parathyroid adenomas and thyroid nodules showed that parathyroid adenomas had significantly higher stiffness levels compared to benign thyroid nodules (mean SWV ± SD, 3.09 ± 0.75 versus 2.20 ± 0.39 m/s; P < .001) and lower stiffness levels compared to malignant thyroid nodules (mean SWV, 3.09 ± 0.75 versus 3.59 ± 0.43 m/s; P < .001). CONCLUSIONS: Acoustic radiation force impulse imaging has high sensitivity and specificity for differentiating parathyroid adenomas from benign and malignant thyroid nodules. As an adjunctive tool, it can help distinguish parathyroid adenomas from thyroid nodules, including posteriorly located nodules.

Hemolytic Uremic Syndrome Causing Multicystic Leukoencephalomalacia.

BACKGRUND: Hemolytic uremic syndrome is a disease characterized by hemolytic anemia, thrombocytopenia and acute renal failure with multiple organ involvement. Central nervous system involvement is detected in 20-50% of the patients and this leads to increased morbidity and mortality. CASE REPORT: We report the neuroimaging findings in a four-month-old male with hemolytic uremic syndrome. The cerebral cortex and white matter showed mild signal intensity on T2-weighted images. The diffusion weighted imaging demonstrated restricted diffusion in the cerebral cortex and white matter with corresponding low signal intensity on the apparent diffusion coefficient maps representing cytotoxic edema. These findings ended in multicystic leukoencephalomalacia. CONCLUSIONS: In hemolytic uremic syndrome with brain involvement symptoms develop due to the different level of actions of factors and thus MRI protocol towards cerebral parenchyma should include DWI, especially in pediatric patients.

Acoustic radiation force impulse imaging for evaluation of renal parenchyma elasticity in diabetic nephropathy.

OBJECTIVE. The goal of this study is to evaluate the changes in the elasticity of the renal parenchyma in diabetic nephropathy using acoustic radiation force impulse imaging. SUBJECTS AND METHODS. The study included 281 healthy volunteers and 114 patients with diabetic nephropathy. In healthy volunteers, the kidney elasticity was assessed quantitatively by measuring the shear-wave velocity using acoustic radiation force impulse imaging based on age, body mass index, and sex. The changes in the renal elasticity were compared between the different stages of diabetic nephropathy and the healthy control group. RESULTS. In healthy volunteers, there was a statistically significant correlation between the shear-wave velocity values and age and sex. The shear-wave velocity values for the kidneys were 2.87, 3.14, 2.95, 2.68, and 2.55 m/s in patients with stage 1, 2, 3, 4, and 5 diabetic nephropathy, respectively, compared with 2.35 m/s for healthy control subjects. Acoustic radiation force impulse imaging was able to distinguish between the different diabetic nephropathy stages (except for stage 5) in the kidneys. The threshold value for predicting diabetic nephropathy was 2.43 m/s (sensitivity, 84.1%; specificity, 67.3%; positive predictive value, 93.1%; negative predictive value 50.8%; accuracy, 72.1%; positive likelihood ratio, 2.5; and negative likelihood ratio, 0.23). CONCLUSION. Acoustic radiation force impulse imaging could be used for the evaluation of the renal elasticity changes that are due to secondary structural and functional changes in diabetic nephropathy.