Can ultrasound elastography be used as a new technique in the differentiation of undescended testes and reactive lymph nodes in children?

AIM: To determine the diagnostic performance of ultrasound elastography in the differentiation of reactive lymph nodes and undescended testes in children. MATERIALS AND METHODS: Seventy-two undescended testes and 34 reactive lymph nodes were prospectively examined with the elastography technique. Four elastographic patterns were used for classification based on the distribution of the blue area. The strain ratios and elasticity patterns of the undescended testes and reactive lymph nodes were evaluated independently by two radiologists. Interobserver agreement and diagnostic performance were analysed. RESULTS: Thirty of the 34 reactive lymph nodes were classified as exhibiting high-strain elastographic patterns (considered Type 1 or Type 2, with blue areas in ˂50% of the tissue) by both observers; in contrast, 67 and 71 of 72 undescended testes were classified as exhibiting low-strain elastographic patterns (considered Type 3 or Type 4, with blue areas in >50% of tissue) by radiologists 1 and 2, respectively. The respective mean strain ratios measured by the two radiologists were 0.60±0.03 and 0.62±0.02 for the reactive lymph nodes and 0.25±0.08 and 0.25±0.09 for the undescended testes. There were significant differences in the elasticity patterns and strain ratios between the reactive lymph nodes and the undescended testes (p<0.001). The interobserver agreement was excellent for the four elasticity patterns with a weighted kappa coefficient of 0.872. The concordance of the strain ratios between the observers was excellent in the present study (intra-class correlation score: 0.988). CONCLUSIONS: In the majority of cases, conventional two-dimensional ultrasound could be used to differentiate undescended testes from reactive lymph nodes with acceptable accuracy. Although the incremental value of elastography is limited, this technique might have a role in some specific cases.

The effect of vitamin D on expression of TGF ß1 in ovary.

The transforming growth factor ß (TGF-ß) is thought to have important roles in several stages of folliculogenesis. Vitamin D is effective in cell proliferation, differentition and on estrogen biosynthesis. The aim of the present study was to determine the respective role of 1,25-dihydroxyvitamin D3 on expression of TGF-ß1 in developing rat ovaries. 24 (one-mounth-old n = 12 and adult n = 12) female Wistar rats were enrolled in this study. All animals were divided into 4 groups. Group I and II that consist of one-month-old (n = 6) and adult rats (n = 6) respectively served as control groups. Intramuscular vitamin D3 ( 0,05 µgr/kg/every other day) was injected for 8 weeks to group III and IV which consist of one-mounth-old and adult rats respectively. After last injection, ovaries of animals were removed and processed for immunohistochemistry assay. No remarkable differences in staining intensity and localization for TGF-ß1 were observed in group I and group III. TGF immunostaining was also predominantly found in oocytes. In granulosa cells, TGF-ß1 immunoreactivity was negative. TGF-ß1 immunostaining were observed both in nuclei and cytoplasm of granulosa cells in group II. But in group IV granulosa cells and oocytes were negative for TGF-ß1. We found that vitamin D administration resulted in a decrease in TGF-ß1 levels in the adult rats, but, TGF-ß1 expression did not significantly decrease in the newborn rats. However, in multiple linear regression analysis, TGF-ß1 expressions were independently associated with vitamin D administration. It is observed that Vitamin D attenuated TGF-ß1 expression. The results of this study suggest that vitamin D may play role in folliculogenesis via TGF-ß1.