The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial.

AIM: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. MATERIALS AND METHODS: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. RESULTS: A total of 45 children with a median age was 8 (2-17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. CONCLUSION: RDUS parameters didn't show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.

Superb Microvascular Imaging Compared With Power Doppler Ultrasound in Assessing Synovitis of the Knee in Juvenile Idiopathic Arthritis: A Preliminary Study.

OBJECTIVES: To investigate the efficiency of Superb Microvascular Imaging (SMI; Toshiba Medical Systems, Tustin, CA) in assessing inflammation of the synovium in the knee of patients with juvenile idiopathic arthritis (JIA) compared with power Doppler ultrasound (PDUS). METHODS: Both knees of patients with a diagnosis of clinically active JIA were examined with grayscale ultrasound (US). The knees with positive US and physical examination findings were included in group A, whereas the knees with positive US findings despite negative physical examination findings were included in group B. The observers calculated the vascularity index (VI) by manually drawing a region of interest onto the thickest part of the synovium using PDUS and SMI. RESULTS: The median SMI VI (observer 1, 4.9% [interquartile range (IQR), 3.6%]; observer 2, 4.1% [IQR, 4.6%]) exceeded the median PDUS VI (observer 1, 1.5% [IQR, 1.8%]; observer 2, 1.5 [IQR, 1.9%]; P < .0001). In group B, the median SMI VI (observer 1, 2.85% [IQR, 8%]; observer 2, 3.1% [IQR, 6.3%]) exceeded the median PDUS VI (observer 1, 0.5% [IQR, 2%]; observer 2, 0.55% [IQR, 2.3%]; P = .002 and .001 for observers 1 and 2, respectively). No significant differences were observed between groups concerning the PDUS VI and SMI VI (P > .05). CONCLUSIONS: Superb Microvascular Imaging was superior to PDUS in depicting blood flow in the hypertrophied synovial tissue in the knee of patients with clinically active JIA. Superb Microvascular Imaging seems to a promising tool and a valuable adjunct to conventional US in assessing inflammation of the synovial tissue in patients with JIA.

Increased vein wall thickness in Behçet disease.

OBJECTIVE: Lower extremity (LE) deep venous thrombosis (DVT) is the main feature of vascular involvement in Behçet disease (BD). We thought that vein wall thickness (VWT) could be a surrogate marker for venous inflammation and hence predict future vascular involvement. We assessed VWT in proximal LE veins in BD patients without DVT, BD patients with DVT, and healthy controls in a formal, masked protocol. METHODS: We studied 50 (43 male and 7 female) BD patients with LE DVT (group 1), 50 (43 male and 7 female) BD patients without any vascular involvement (group 2), and 50 (43 male and 7 female) age- and sex-matched apparently healthy controls (group 3). Two radiologists blinded to the diagnosis of BD used ultrasound to measure VWT of common femoral vein, femoral vein, and great saphenous vein in both legs. Interobserver reliability was assessed using the intraclass correlation coefficient and Bland-Altman plots. RESULTS: There was good agreement between the two observers. The mean VWT was significantly increased in both BD patients with LE DVT and those without apparent vascular involvement compared with the healthy controls, whereas those with LE DVT had the highest VWT. CONCLUSIONS: VWT of proximal deep and superficial LE veins is increased among the BD patients without any clinical and radiologic vascular involvement. This information, after prospective work, might be useful in management and elucidating disease mechanisms in vascular BD.

Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux.

OBJECTIVES: To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux. METHODS: We prospectively evaluated 49 patients with unilateral grade 2 or higher-degree VUR. All patients underwent dimercaptosuccinic acid (DMSA) scintigraphy for evaluation of the renal parenchymal scar. After the DMSA scan, 2 radiologists, who were blinded to clinical data and each other's measurements, evaluated the kidneys of the patients using SWE. The kidneys were divided into 3 parts: upper pole, middle region, and lower pole, and 3 regions of interest were placed to each part. Shear wave velocity (SWV) values were calculated using meters per second as a unit and recorded for each region. Afterward, SWV values were compared to DMSA results. RESULTS: There was no significant difference between the observers' mean SWV values of kidneys with VUR without scar formation (mean ± SD, 2.11 ± 0.06 and 2.09 ± 0.05 m/s) and the contralateral normal kidney SVW values (2.11 ± 0.06 and 2.10 ± 0.05 m/s; P = .936 and .724, respectively). We observed a significant difference between the mean SWV values of the kidneys with VUR accompanied by scar formation (2.28 ± 0.10 and 2.27 ± 0.11 m/s) and the mean SWV values of the contralateral normal kidneys (2.09 ± 0.05 and 2.10 ± 0.04 m/s; P < .001 for both observers). CONCLUSIONS: Shear wave elastography could detect scar tissue in kidneys; however, the variability of the stiffness due to the kidney's complex structure, and variations in blood perfusion and the glomerular filtration rate of the kidney might limit the use of SWE in current clinical diagnostic algorithms for VUR.

Amyloid Goiter: A Diagnosis to Consider in Diffuse Fatty Infiltration of the Thyroid.

An amyloid goiter is the presence of amyloid protein in the thyroid in sufficient amounts to produce enlargement of the gland, accompanied by fat deposition of varying extents. It can be seen in long-standing inflammatory disorders such as familial Mediterranean fever. Imaging findings depend on the amount of fat and amyloid deposition; however, the main imaging finding is diffuse fatty infiltration of the thyroid. Herein, the multimodality imaging features in 3 cases of amyloid goiters secondary to familial Mediterranean fever are presented.