Point Shear Wave Elastography Detected Liver Stiffness Increased in Pediatric Patient With Thalassemia Major.

ABSTRACT: Transient elastography (TE) and point shear wave elastography (pSWE) are 2 elastographic ultrasound examinations used in liver stiffness (LS) measurement. It was shown that the LS value detected by TE in pediatric ß-thalassemia major patients has increased, and there was no LS evaluation obtained with pSWE in literature. Thus, in this study, it was aimed to evaluate LS with pSWE examination in children with thalassemia major and to determine LS-related parameters in these patients. Sixty-three schoolchildren with a diagnosis of ß-thalassemia major and 21 healthy controls between the ages of 7 and 18 years were included. In addition to routine anamnesis, physical examination, and laboratory examinations, renal and liver ultrasounds were performed. Liver stiffness values were measured by pSWE examination. Serum levels of urea, aspartate-aminotransferase, alanine-aminotransferase, iron, and ferritin were significantly higher in patients, and serum creatinine, iron binding capacity, and hemoglobin levels were found to be significantly lower (P < 0.05 for each). Liver stiffness values were significantly higher in patients compared with healthy controls. In linear regression analysis, serum iron and iron binding capacity values were found to be closely related with LS (P < 0.001 vs. ß = 0.482 and P = 0.047 vs. ß = 0.237, respectively). Liver stiffness values obtained by pSWE examination increase significantly in patients. According to the results of our study, in addition to the previously known TE method, we think that the LS evaluation obtained by pSWE, a new method that can make more accurate measurements, can be used in the possible early detection of target organ damage in children with thalassemia major.

Usability of Real-Time Elastography for the Diagnosis of Primary Open Angle and Pseudoexfoliation Glaucoma.

OBJECTIVES: This study aims to investigate real-time elastography (RTE) use in the evaluation of the optic nerve head (ONH) and peripapillary structures for the diagnosis of primary open angle (POAG) and pseudoexfoliation (PEX) glaucoma. METHODS: This case-controlled study included 30 patients with POAG, 30 patients with PEX glaucoma, and 30 age-matched control subjects. All of the participants underwent comprehensive ophthalmological examinations covering vessel density of optic nerve and retinal nerve fiber layer (RNFL) thickness measurements with optical cohorence tomography angiography and mean deviation (MD) measurements with Humphrey II Perimetry Visual Field Analyzer. In vivo evaluation of the biomechanical properties of the ONH and peripapillary structures were performed with RTE in all participants. RESULTS: We observed higher ratios of orbital fat to optic nerve head (ROFON) values (P = .008) and strain ratios of orbital fat to scleral-choroidal-retinal complex (ROFSCR) values (P = .004) in the POAG group compared with PEX glaucoma group and higher ROFON (P = .012) and ROFSCR values (P = .004) in PEX glaucoma group than the control group. ROFON and ROFSCR values were positively correlated with glaucoma duration and negatively correlated with MD, radial peripapillary vessel density (RPCVD), and inside disc vessel density in both glaucoma groups (P < .005; only in the PEX glaucoma group for MD and ROFSCR, P = .445). CONCLUSION: Determining the biomechanical properties of ONH and peripapillary structures with RTE in glaucomatous eyes may offer a new perspective on the diagnosis and follow-up of the progression of the disease.

Evaluation of Liver Stiffness After Atrial Septal Defect Closure.

ABSTRACT: In this study, we aimed to evaluate the liver stiffness (LS) values and the right ventricle (RV) functions after atrial septal defect (ASD) closure treatment. Sixty-six patients were included (38 female, 28 male) in the study. Patients were grouped into 3 subgroups (group I = 21 patients without ASD closure, group II = 38 patients who underwent ASD closure, and group III = 11 patients with ASD and Eisenmenger syndrome). After 1-year follow-up of the patients who underwent ASD closure, LS was assessed using the liver elastography technique. Echocardiographic changes and LS changes over time were compared. Absolute Δ-LS and Δ-liver size were found to be significantly decreased in group II compared with the other groups. While liver size, LS levels, RV and left ventricle (LV) dimensions, and tricuspid regurgitation pressure gradient were found to be significantly decreased; the tricuspid annular plane systolic excursion and the LV ejection fraction were significantly increased in group II. In addition, Δ-LV and Δ-RV dimensions and Δ-tricuspid regurgitation pressure gradient values were statistically significant and Δ-tricuspid annular plane systolic excursion and LV ejection fraction values were statistically higher in group II compared with the other groups. In conclusion, our study demonstrates that the LS is another parameter, which significantly decreases in patients treated with ASD occluder devices and can be used as an objective follow-up parameter in addition to classic echocardiographic measurements.

Ovarian Stiffness Is Significantly Increased in Polycystic Ovary Syndrome and Related With Anti-Mullerian Hormone: A Point Shear Wave Elastography Study.

OBJECTIVES: Parenchymal stiffness obtained by point shear-wave elastography (pSWE) in solid organs is used as a sign of damage in these organs. However, its clinical use and whether patients with polycystic ovary syndrome (PCOS) have increased ovarian tissue stiffness are still unclear. The aim of this study is to determine the parameters related to ovarian stiffness and whether there is an increase in ovarian stiffness in patients with PCOS compared with healthy controls. METHODS: Forty-five women who were followed up regularly with the diagnosis of PCOS and 30 healthy controls similar to age and sex were included in this study. In addition to the routine follow-up parameters for PCOS, serum homeostatic model assessment of insulin resistance and anti-Mullerian hormone (AMH) levels were examined in all patients, and pSWE examination was performed with pelvic ultrasound (US) and ElastPQ technique. RESULTS: Serum dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment of insulin resistance, and AMH were higher in PCOS compared with healthy controls (P < 0.001). Right, left, and mean ovary stiffness and volumes were significantly higher in PCOS group than healthy controls (P < 0.001). Correlation analysis was performed between mean ovary stiffness and dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment, and AMH and ovary volumes (P < 0.01 for each one). In linear regression analysis, only AMH was found to be related to mean ovary stiffness (P < 0.001 and ß = 0.734). CONCLUSIONS: Ovarian stiffness value obtained by ElastPQ technique and pSWE method increases in PCOS patients compared with healthy controls and is closely related to serum AMH levels. In patients with PCOS, in addition to the conventional US, ovarian stiffness measured by pSWE may be an auxiliary examination in the follow-up of the disease. However, it was concluded that the ovarian stiffness measurement obtained in our current study should be supported by studies involving more patients and the transvaginal US method.

A rare case of pontine and extrapontine myelinolysis in a pediatric patient with chronic renal failure.

Osmotic demyelination syndrome (ODS) is a very rare condition in childhood occurring usually secondary to the rapid increase of serum sodium levels. This situation occurring secondary to the rapid correction of hyponatremia can be seen more rarely in the form of extrapontine myelinolysis and even the coexistence of these two conditions besides central pontine demyelinolysis. However, osmotic demyelination syndrome due to the rapid correction of hyponatremia in chronic renal failure (CRF) patients is very rare depending on existing uremia. In this article, we present an extremely rare case of pontine and extrapontine myelinolysis, which occurred in a pediatric patient with chronic renal failure, secondary to the rapid correction of hyponatremia. In the diffusion and cranial magnetic resonance imaging (MRI), bilateral symmetrical caudate, putamen, and thalamus involvements and hyperintense linear lesions at the pons, cortical, and subcortical areas were revealed. It was evaluated as pontine and extrapontine myelinolysis. This clinical situation presents that the presence of severe hyponatremia and extremely rapid correction of it can develop pontine and extrapontine myelinolysis even though it is very rare in uremic patients.

Liver Stiffness Is Increased in Polycystic Ovary Syndrome and Related With Complement C1q/Tumor Necrosis Factor-Related Protein 3 Levels: A Point Shear Wave Elastography Study.

ABSTRACT: Nonalcoholic fatty liver disease is very common in patients with polycystic ovary syndrome (PCOS). In patients with PCOS, the clinical use of liver stiffness (LS) and whether LS increases or decreases are still unclear. The purpose of this study was to determine the parameters related to LS and whether there is an increase in LS in patients with PCOS compared with healthy controls. Thirty-eight women diagnosed with PCOS according to Rotterdam criteria and 28 healthy age- and sex-matched controls were included in this study. In addition to routine follow-up parameters for all patients, serum homeostatic model assessment of insulin resistance (HOMA-IR) and complement C1q/tumor necrosis factor-related protein 3 (CTRP3) levels were measured, and point shear wave elastography was performed. Body mass index; waist circumference; systolic blood pressure; serum glucose, alanine aminotransferase, highly sensitive C-reactive protein, and dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels; and luteinizing hormone/follicle-stimulating hormone ratio were higher in PCOS group compared with healthy controls (P < 0.05). Serum CTRP3 levels were lower in patients with PCOS (P < 0.05). Liver stiffness value was significantly higher in PCOS group than healthy controls (P < 0.001). Positive correlation was found between LS and waist circumference as well as calcium, dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels (P < 0.05 for each one). Negative correlation was found between LS and CTRP (P < 0.01 for each one). In linear regression analysis, only CTRP3 level was found to be related to LS (P < 0.001 and ß = 0.734). Liver stiffness value obtained by point shear wave elastography increases in patients with PCOS compared with healthy controls and is closely and negatively related to serum CTRP3 levels.

Spontaneous subarachnoidal hemorrhage in patients with Covid-19: case report.

In this article, subarachnoidal hemorrhage developing in a case with Covid-19-related pneumonia was evaluated. In the presence of respiratory system infection signs such as cough and weakness in patient who present with sudden loss of consciousness, performing lung imaging as well as performing brain computerized tomography scan can allow the detection of an underlying Covid-19 infection.

Aortic intima-media thickness can be used to determine target organ damage in adult patients with coronary artery disease risk factors.

INTRODUCTION: We aimed to evaluate the relationship between abdominal aortic intima-media thickness (AA-IMT) and thoracic aortic intima-media thickness (TA-IMT) values and to investigate their relationship with common carotid intima-media thickness (CC-IMT) in patients with coronary artery disease (CAD) risk factors. MATERIAL AND METHODS: This study included 100 patients who underwent transesophageal echocardiography (TEE) examination for different reasons with at least one CAD risk factor. CC-IMT, AA-IMT, and TA-IMT values were measured. Patients with CC-IMT > 0.9 mm were considered as having increased CC-IMT. Patients were divided into two groups with and without increased CC-IMT. RESULTS: Mean AA-IMT and TA-IMT values of all patients were 1.55 ±0.27 mm and 1.39 ±0.25 mm, respectively. In patients with increased CC-IMT, blood pressure, hyperlipidemia and hypertension frequency, creatinine, total and low-density lipoprotein (LDL) cholesterol, triglyceride, high-sensitivity C-reactive protein (hs-CRP) and uric acid levels, AA-IMT and TA-IMT values were higher, while the high-density lipoprotein (HDL) cholesterol level was lower than the normal CC-IMT group. AA-IMT, systolic blood pressure (SBP), total and HDL cholesterol levels independently determined the patients with CC-IMT > 0.9 mm. Each 0.1 mm increase in AA-IMT value was found to increase the probability of having CC-IMT > 0.9 mm. In addition, linear regression analysis showed that CC-IMT was closely and independently related to AA-IMT (p < 0.001 and ß = 0.599). When the cut-off value for AA-IMT was taken as 1.5 mm, it determined the patients with CC-IMT > 0.9 mm with 86% sensitivity and 82% specificity. CONCLUSIONS: The AA-IMT value was found to be higher than TA-IMT in the same patient. Also it was found that AA-IMT was more closely related to CC-IMT.

Liver stiffness obtained by ElastPQ ultrasound shear wave elastography independently determines mean right atrial pressure.

PURPOSE: We aimed to investigate the relationship between right atrial pressure (RAP) and liver stiffness (LS) determined by liver elastography (LE) during cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and conventional pacemaker (PM) implantation in patients without HF. METHODS: 60 patients with HF who underwent CRT and 60 patients without HF who underwent PM were enrolled. Routine echocardiography and laboratory examinations were performed. Systolic, diastolic, and mean RAP measurements were performed inversely during PM implantation and LS measurement with ElastPQ technique. RESULTS: Systolic, diastolic, and mean RAP, left ventricular (LV) systolic-diastolic, right ventricular (RV) diastolic and left atrial diameters, tricuspid regurgitation pressure gradient, and RV-myocardial performance index (MPI) values were significantly higher in patients with HF (p < 0.05 each-one). LV ejection fraction and tricuspid annular plane systolic excursion values were significantly lower in patients with HF group (p < 0.05 each-one). LS values and inspiratory (Ins) and expiratory inferior vena cava (IVC) diameters were significantly higher in the patients with HF (p < 0.05 each-one). Mean RAP was found to be closely related to LS value, Ins-IVC diameter, RV-MPI, and NT-proBNP levels. LS value and Ins-IVC diameter were found to determine patients with mean RAP > 5 mmHg and > 10 mmHg. When the cut-off value of LS was taken as 7 kPa, it was found that the mean RAP > 10 mmHg with 89.6% sensitivity and 87.5% specificity. CONCLUSIONS: The non-invasive LS value determined by LE independently determines the mean RAP in patients with and without HF. According to our study results, > 7 kPa value for LS determined in liver US may be predictive for increased mean RAP.

Increased renal cortical stiffness obtained by share-wave elastography imaging significantly predicts the contrast-induced nephropathy in patients with preserved renal function.

PURPOSE: We aimed to investigate the relation between renal cortical stiffness (CS) obtained by shear-wave elastography (SWE) and contrast-induced nephropathy (CIN) development in interventional treatment-planned acute coronary syndrome (ACS) patients. METHODS: Our study group consisted of 465 ACS patients. Routine laboratory assessments, B-mode, Doppler, and SWE renal ultrasonography (USG) evaluations were performed. Renal resistive index (RRI), renal pulsatility index (RPI), and acceleration time (AT) and CS were measured. Patients were grouped as with and without CIN. RESULTS: Among the study group, 55 patients (11.8%) had CIN. Age, diabetes mellitus (DM), hypertension (HT), basal creatinine, CK-MB and troponin I levels, contrast volume, contrast volume/weight ratio, SYNTAX score, RRI, RPI, AT, and CS values were significantly higher in patients with CIN. eGFR was lower in patients who developed CIN. Age, contrast volume/weight ratio, and CS were determined as independent predictors of CIN occurrence in logistic regression analysis. In multivariate logistic analysis, increase of age (each year), contrast volume/weight (each 0.2 mL/kg), and CS (each 1 kPa) were found to augment the development of CIN by 7.1, 59.5, and 62.3%, respectively. In the ROC analysis, CS had the highest AUROC value. The cutoff value of CS obtained by the ROC curve analysis was 7 kPa for the CIN development (sensitivity: 74.5%, specificity: 72.5%). CONCLUSION: CS value is a simple, cheap, reproducible, noninvasive, and objective parameter for the detection of CIN development. ACS patients should be directed to renal USG, and routine CS value should be written besides USG measurements in reports.

Usability of Achilles tendon strain elastography for the diagnosis of coronary artery disease.

PURPOSE: There are close relationships between major coronary artery disease (CAD) risk factors and Achilles tendon thickness (AT-T) and AT strain ratio (AT-SR). Our aim was to evaluate the diagnostic importance of AT-T and AT-SR as obtained by ultrasonography (USG) and strain elastography (SE) for predicting CAD. MATERIALS AND METHODS: One hundred and eighty-four patients scheduled to undergo coronary angiography were included in the study. Achilles tendon USG (B-mode and SE) and laboratory tests were performed on all patients. The patients were divided into two groups, i.e., patients with and without CAD. RESULTS: The patients with CAD (72.8%) were more likely to be male, exhibited higher frequencies of diabetes mellitus (DM) and hyperlipidemia, exhibited higher levels of basal creatinine and glucose, and had higher AT-T and AT-SR values (p < 0.05 for all). Age, DM, AT-T, and AT-SR independently predicted the probability of CAD in a logistic regression analysis (p < 0.05 for all). Age (each year), DM (presence), AT-T (each 1 mm), and AT-SR (each 0.1) increased the CAD risk by 3.4%, 2.9 times, 47.1%, and 16.0%, respectively. ROC analysis revealed AUCs of 0.665 and 0.730 for the AT-T and AT-SR values, respectively (p < 0.05). The AT-SR cutoff value of 1.2 predicted the presence of CAD with 75.4% sensitivity and 72.7% specificity. CONCLUSIONS: AT-SR is a simple, inexpensive, noninvasive, reproducible, and objective parameter for the prediction of CAD. We think that AT-SR evaluation should become a part of conventional USG assessments in patients who are at a high risk of CAD.