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AIM: Our study aimed to assess the usefulness of contrast-enhanced ultrasound (CEUS) in the initial evaluation of the graft function. MATERIALS AND METHOD: A cross-sectional study was conducted in the early postoperative period on patients with kidney transplantation, between September 2017 to November 2018. Two groups of patients were investigated; delayed graft function (DGF) and early graft function (EGF). All patients were examined by grey scale, Doppler ultrasound and CEUS. RESULTS: Nineteen patients, aged from 23 to 64 years (mean age 50 years), 7 in the DGF group and 12 in the EGF group were evaluated. The resistive index (RI) show significantly higher values in the DGF group at the level of upper interlobar artery (p=0.025) and medium interlobar artery (p=0.02). The CEUS investigation shows a greater region of interest (ROI) area (p=0.02) and lower values for wash-out area under the curve (WoAUC) (p=0.047) and respectively wash-in and wash-out area under the curve (WiWoAUC) (p=0.031) for the DGF group. The quality of fit (QoF) proved lower in the DGF group either for evaluation of global graft (p=0.012), cortex (p=0.025), or medulla (p=0.009).A significant relationship among all patients was found between the glomerular filtration rate (GFR) [ml/min] and the renal artery fall time (FT) [s] (p=0.012), WoAUC [a.u.] (p=0.03), and WiWoAUC [a.u.] (p=0.024). The arterial QoF [%] was associated with the arterial ROI area (p=0.048). CONCLUSIONS: Intensity CEUS parameters WoAUC and WiWoAUC may be useful to diagnose and follow-up grafts with delayed function. Additional studies on larger cohorts are required for the recommendation of CEUS as a routine evaluation of the transplanted kidney.
Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Transplante de Rim , Rim/fisiologia , Cuidados Pós-Operatórios/métodos , Ultrassonografia/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Shear-wave elastography (SWE) showed the absence or presence of significant differences among stable kidney allograft function and allograft dysfunction. We evaluated the variability of kidney allograft stiffness in relation to allograft dysfunction, respectively, in terms of a correlation of stiffness with patients' characteristics. A single-center prospective study on patients who had undergone renal transplantation was conducted between October 2017 and November 2018. Patients were clinically classified as having a stable allograft function or allograft dysfunction. SWE examinations performed by the same radiologist with a LOGIQ E9 were evaluated. Ten measurements were done for Young's modulus (kPa) at the level of allograft cortex and another ten at the level of medulla. Eighty-three SWE examinations from 63 patients, 69 stable allografts, and 14 allografts with dysfunction were included in the analysis. The intra-examinations stiffness showed high variability, with the quantile covariation coefficient ranging from 2.21% to 45.04%. The inter-examinations stiffness showed heterogeneity (from 28.66% to 42.38%). The kidney allograft cortex stiffness showed significantly higher values in cases with dysfunction (median = 28.70 kPa, interquartile range (IQR) = (25.68-31.98) kPa) as compared to those with stable function (median = 20.99 kPa, interquartile range = (16.08-27.68) kPa; p-value = 0.0142). Allograft tissue stiffness (both cortex and medulla) was significantly negatively correlated with body mass index (-0.44, p-value < 0.0001 for allograft cortex and -0.42, p-value = 0.0001 for allograft medulla), and positively correlated with Proteinuria/Creatinuria ratio (0.33, p-value = 0.0021 for allograft cortex and 0.28, p-value = 0.0105 for allograft medulla) but remained statistically significant only in cases with stable function. The cortical tissue stiffness proved significantly higher values for patients with allograft dysfunction as compared to patients with stable function, but to evolve as an additional tool for the evaluation of patients with a kidney transplant and to change the clinical practice, more extensive studies are needed.
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High flow priapism caused by perineal trauma is a relatively rare disorder. Early diagnosis represents a mandatory condition for the therapeutic resolution. Ultrasound examination is affordable and a within reach method for diagnosis also in an emergency context. We present the case of a 56-year-old male patient with traumatic priapism which was subsequently investigated by contrast-enhanced ultrasound and shear wave elastography. This may be one of the first cases presented in the literature.
Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Pênis/diagnóstico por imagem , Pênis/lesões , Priapismo/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: To identify the mean values of Shear Wave Elastography (SWE) in pancreatic neoplasms. MATERIAL AND METHOD: This pilot case-control study was conducted in a tertiary care setting and data were collected in a prospective manner. Thirty-three subjects were included and divided into two groups: 18 healthy subjects and 15 patients with pancreatic neoplasm, from which 14 patients were diagnosed with adenocarcinoma and one with intraductal papillary mucinous neoplasia. Inclusion criteria for patients with pancreatic neoplasia were histopathological confirmation obtained by endoscopic ultrasonography (EUS) with fine needle aspiration or surgically and imaging confirmation by computed tomography with contrast enhancement. A number of minimum 5 shear wave velocity (SWV) measurements regarding each segment respectively at the tumoral level was obtained among a series of elastograms. RESULTS: The mean SWV of the pancreas in the control group was 1.21±0.27 m/s. Data regarding the pathological parenchyma indicated an increase of the SWV at the tumoral (cephalic) level corresponding to 1.54±0.32 m/s, with significant statistical difference between the control batch and tumoral group, p=0.02. CONCLUSIONS: Transabdominal SWE represents a surrogate but feasible method for differentiation cancer from the normal pancreatic tissue. In a clinical setting, data regarding the stiffness complementary to an ultrasound evaluation could guide high-risk patients for a close-up pancreatic monitoring.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Neoplasias Intraductais Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Intraductais Pancreáticas/patologia , Projetos Piloto , Estudos Prospectivos , Curva ROC , Valores de Referência , Sensibilidade e Especificidade , Centros de Atenção Terciária , Ultrassonografia Doppler em CoresRESUMO
AIM: The purpose of this study is to evaluate pancreatic stiffness by ARFI abdominal elastography. In the current literature, there are relatively few studies that have assessed the clinical utility of this technique. MATERIAL AND METHOD: A number of 37 healthy subjects were included. The data were collected in a prospective manner and afterwards included in an observational, analytical and longitudinal study. Subsequently viewing the pancreatic parenchyma in bidimensional mode (2D-US) mode, 10 shear wave velocity (SWV) measurements for each segment: head, body and tail were performed. Statistical analysis by regression models targeted also the possible influence of other factors in assessing SWV. A comparative analysis was performed regarding the statistical significance of 5 versus 10 SWV measurements for each segment. RESULTS: The pancreas was entirely evaluated in all subjects. The mean SWV from the entire parenchyma was 1.216 m/s±0.36 and between the three segments SWV were similar (head: 1.224 m/s, body: 1.227 m/s and tail: 1.191 m/s). A ratio of the IQR/Median >0.4 was interpreted as statistically invalid, relevant data being highlighted in the percentage of 83.78% for the head of the pancreas, 78.37% for the body, and 67.56% at the caudal level. Significant correlations were observed between the data (mean and median SWV) provided by the group with 5 measurements of the SWV versus the standard group: 93.9% for the head, 96.6% for the body, and 98.7% accordingly to the tail. CONCLUSIONS: SWV determination by percutaneous approach represents a useful imaging method for evaluating pancreatic stiffness, of course within these limitations. Because we did not observe statistically significant differences between the results obtained by 5 or 10 measurements, we suggest that it would be sufficient to perform only five measurements of the SWV per pancreatic segment. The data obtained in the normal pancreas could be used in future comparative assessments regarding the inflammatory or tumoral pathology of the pancreas.
Assuntos
Módulo de Elasticidade/fisiologia , Técnicas de Imagem por Elasticidade/normas , Interpretação de Imagem Assistida por Computador/normas , Pâncreas/diagnóstico por imagem , Pâncreas/fisiologia , Valores de Referência , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Gravidez , Reprodutibilidade dos Testes , Romênia , Sensibilidade e Especificidade , Estresse Mecânico , Resistência à Tração/fisiologia , Adulto JovemRESUMO
Ultrasonography is generally accepted and performed as a first choice imaging technique in patients with jaundice. The method allows the discrimination between cholestatic and mechanical jaundice. The existing procedures are multiple: gray scale, Doppler, i.v. contrast enhancement, elastography, tridimensional ultrasonography, each of these with different contribution to the positive and differential diagnosis regarding the nature of the jaundice. The final diagnosis is a multimodal one and the efficiency is dependent on the level of the available technology, the examiner's experience, the degree and modality of integration of the data within the clinical context, as well as on the portfolio of available imaging procedures. This review shows the main ultrasonographic methods consecrated in the evaluation of the biliary tree. It also underlines the integrated character of the procedures, as well as the necessity to correlate with other imaging methods and the clinical situation.
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Doenças Biliares/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade , Humanos , Imageamento Tridimensional , Ultrassonografia DopplerRESUMO
Ultrasonography (US) is the essential imaging method in gallbladder examination being the most widespread and inexpensive technique. The method is indicated both in congenital and acquired disorders, inflammatory, tumoral, or degenerative pathology. Besides the basic technique (grey scale US), new sophisticated techniques exist: Doppler US, i.v. contrast enhanced harmonic examination, tridimensional US, elastography. Each technique provides specific information, while their combination helps, in most cases, to establish the accurate non-invasive diagnosis. However, the US findings should be correlated with the patient's clinical exam and other imaging methods. This paper is a synthesis of literature combined with our own experience, aiming to present the US features of gallbladder pathology and the correlations within the clinical picture and other imaging methods. Relevant images for this integrative approach are presented. The final conclusion is the necessity for a correlation of all clinical and imaging data in order to obtain an accurate diagnosis.