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.

Evaluation of lymphocytic thyroiditis in children with quantitative gray-scale ultrasound echo intensity using a PACS-based tool.

PURPOSE: To evaluate diagnostic performance of PACS-based quantitative gray-scale ultrasound as an objective method in evaluation of pediatric thyroiditis. METHODS: Quantitative measurements of the echo-intensity level of the thyroid were obtained from ultrasound images, retrospectively using a PACS-based tool in 37 children with the tissue-proven diagnosis. Thyroid/muscle ratio was calculated by dividing the mean echo intensity of thyroid by that of adjacent strap muscle. Heterogeneity index (HI) was calculated by dividing thyroid standard deviation (SD) by thyroid mean values. For qualitative evaluation, two radiologists independently reviewed ultrasounds twice for the presence of thyroiditis. A consensus session was performed for patients for whom there was disagreement. Intra- and inter-observer reliability were assessed. Thyroid/muscle ratio and HI were correlated with final pathology. RESULTS: Lymphocytic thyroiditis was found by histopathology in 19/37 (51%). No significant difference between thyroiditis and normal thyroid groups was found for either thyroid/muscle ratio (1.51 and 1.62, respectively, p = .82) or HI (0.23 and.23, respectively, p = .37). A larger proportion of patients for whom the consensus review indicated thyroiditis were confirmed by histopathology than would be expected by chance alone (12/19 (63%), p = .03). There was fair inter-observer agreement (κ with 95% confidence intervals of 0.36 (0.14-0.57), p = .004) and slight intra-observer agreement for each radiologist (κ with 95% confidence intervals of 0.13 (0.17-0.43), p = .39 and 0.17 (0.15-0.49), p = .31). CONCLUSION: Quantitative gray-scale echo intensity analysis of US was not sufficient to diagnose thyroiditis in a pediatric population. Consensus qualitative analysis of ultrasound was more consistent with pathological diagnosis.

The Role of Real-Time Tissue Elastography and Gray-Scale Ultrasound Histogram Analysis in the Diagnosis of Patients With Sjögren's Syndrome.

OBJECTIVES: This study aims to evaluate gray-scale histogram analysis of B-mode ultrasound (US) images and US elastographic features of the parotid glands in patients with Sjögren's syndrome (SS) and to explore relationships with the ultrasonographic and disease activity scores in the light of histopathological findings. PATIENTS AND METHODS: A total of 57 consecutive female patients (mean age 47.9±10.4 years; range 25 to 76 years) with a diagnosis of SS and 48 healthy female individuals (mean age 51.1±10.8 years; range 20 to 70 years) underwent parotid ultrasonography and real-time tissue elastography imaging. Quantitative measurements of gray-scale US images were performed using the histogram software of the scanner. The histogram ratios of the parotid glands from both sides were obtained (histogram ratio; mean gray-scale histogram parotid/mean gray-scale histogram fat). Strain ratio (SR; ratio of fat to gland parenchyma) was calculated from the color-coded images. Subjective B-mode US scoring of electronically recorded gray- scale US images was performed by two radiologists independently for intra- and inter-observer agreement. Subjective assessments, quantitative measurements, and clinical parameters were compared. RESULTS: The SR of the patient group (1.4±0.8 right side, 1.5±0.9 left side) was significantly higher than that of the control group (1.0±0.3 right side, 1.1±0.3 left side) (p<0.05). The gray-scale histogram ratio of the patient group (1.3±0.5 right side, 1.4±0.9 left side) was lower than that of the control group (1.8±0.7 right side, 1.9±0.7 left side) (p<0.05). Receiver-operating-characteristics curve yielded 66% sensitivity for both sides and 50% and 52% specificity for the right and left sides, respectively, for a cut-off SR of 1.02; 76% and 86% sensitivity for the right and left sides, respectively, and 63% specificity for both sides for a cut-off histogram ratio of 1.35. The quantitative histogram ratio method had a higher positivity rate for the diagnosis of abnormal parotid glands than subjective assessments of US images. CONCLUSION: Sonoelastography and gray-scale histogram analysis of the parotid glands may be used as auxiliary tools to detect parotid gland sonographic abnormalities in patients with SS.

Atypically presenting kaposiform hemangioendothelioma of the knee: ultrasound findings.

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of early childhood and infancy. Kasabach-Merritt phenomenon, a common complication of KHE, is characterized by life-threatening thrombocytopenia, hemolytic anemia, and consumption coagulopathy. There may be atypical cases that do not present with Kasabach-Merritt phenomenon and do have atypical imaging findings. Knowledge of atypical imaging features may assist radiologists in identifying KHE. In this report, we present a 4-year-old case of KHE with atypical ultrasound findings.

A Practical Approach to Quantitative Grayscale Ultrasound Analysis of Hepatic Steatosis in Pediatric Patients Using a Picture Archiving and Communication System-Based Tool.

OBJECTIVES: To evaluate the efficacy of a picture archiving and communication system (PACS)-based ultrasound (US) quantification technique for diagnosis of hepatic steatosis in a pediatric population. METHODS: Abdominal US images of 49 pediatric patients (≤18 years) with histopathologically proven diagnoses of hepatic steatosis (n = 17), nonsteatotic liver disease (n = 19), and a normal liver (n = 13) were retrospectively reviewed. Patient demographics, the fibrosis stage, and the steatosis grade were obtained from the database. Quantitative grayscale measurements of the echo intensity level of the liver and kidneys were performed on the US images using the PACS measuring tool. The hepatorenal ratio was obtained by dividing mean liver by mean kidney values. The heterogeneity index for the liver was calculated by dividing the liver standard deviation by mean liver values. Hepatorenal ratio and heterogeneity index values of the 3 groups were correlated with pathologic results and compared by a 1-way analysis of variance. A receiver operating characteristic curve analysis was performed, and cutoff values were determined. RESULTS: The hepatorenal ratio of the hepatic steatosis group was significantly greater than those of the control and nonsteatotic liver disease groups (P < .001). The heterogeneity index of the hepatic steatosis group was significantly greater than that of the control group (P = .046). For a hepatorenal ratio cutoff value of 1.5, 88.2% sensitivity, 91.4% specificity, 88.3% positive predictive value, and 94.1% negative predictive value were obtained for predicting hepatic steatosis. CONCLUSIONS: PACS-based quantitative grayscale US quantification is a safe, accurate, and easily applicable objective method for the diagnosis of hepatic steatosis in children. A hepatorenal ratio of greater than 1.5 can be used as a conservative parameter, permitting increased confidence in discriminating hepatic steatosis from other conditions.

Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer.

BACKGROUND: The 2015 American Thyroid Association (ATA) Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer provides selection criteria for nodules prior to ultrasound-guided fine-needle aspiration biopsy. OBJECTIVE: To evaluate the diagnostic performance of pediatric thyroid nodule risk stratification for predicting malignancy when applying the ultrasound (US) criteria recommended. MATERIALS AND METHODS: US characteristics of 39 thyroid nodules in 33 pediatric patients who underwent US fine-needle aspiration biopsy were reviewed by two radiologists. Based on the aggregated US criteria from the ATA Guidelines, each nodule was assigned a level of malignancy risk. Kappa coefficients were estimated to assess intra- and interobserver reliability. Using each patient's largest nodule observation (n = 33), univariable exact logistic regression analyses of US parameters were then conducted to estimate the odds of a malignant pathology diagnosis. A penalized Firth correction was employed in the univariable models analyzing composition, shape and level of suspicion due to quasi-complete data separation. RESULTS: Twenty-seven nodules in 21 patients (median age: 16 years; 17 female) were benign and 12 nodules in 12 patients (median age: 16.5 years; 11 female) were malignant. Intraobserver agreement was substantial to almost perfect for composition, echogenicity, shape and margins. Interobserver agreement was almost perfect for composite level of suspicion. High level of suspicion was assigned to all 12 malignant nodules versus 9/21 (43%) of the benign nodules. Level of suspicion, solid/predominantly solid composition, irregular margins and echogenic foci emerged as significant predictors of malignancy with odds ratios (OR) of 8.5 (95% confidence interval [CI]: 1.7-1,130, P = 0.001), 10.5 (95% CI: 1.1-1,417, P = 0.04), 53.2 (95% CI: 5.1-2,988, P < 0.0001) and 3.5 (95% CI: 1.1-23.2, P = 0.03), respectively. CONCLUSION: The composite, US-based risk stratification criteria from the 2015 ATA Guidelines may provide an appropriate and reproducible method for estimating risk of malignancy for pediatric thyroid nodules.

Is the unaffected eye really unaffected? Color Doppler ultrasound findings in unilaterally active central serous chorioretinopathy.

PURPOSE: To evaluate ocular hemodynamic changes using color Doppler ultrasonography imaging (CDI) with an emphasis on unaffected eyes of patients with central serous chorioretinopathy (CSC). METHODS: Twenty-seven patients with active CSC and 25 controls were analyzed using spectral domain-optical coherence tomography (SD-OCT) and CDI for choroidal imaging and evaluation of retrobulbar vessels, respectively. RESULTS: Resistive index (RI), pulsatility index (PI), and peak systolic velocity (PSV) of the ophthalmic artery (OA) and PSV, end-diastolic velocity (EDV), and mean velocity (Vmean) of the central retinal artery (CRA) in the patient group were less than those in the control group. RI and PI of the CRA were greater in the patient group compared to the control group. RI, PI, PSV, and Vmean of the OA and PSV, EDV, and Vmean of the CRA in the patients' unaffected eyes were less than those in the control group. OCT measurements of central choroidal thickness (CCT) of the affected eyes in the patient group were significantly greater than those of the unaffected eyes in the patient and control groups; that of the unaffected eyes was greater than that in the control group. CONCLUSIONS: Hemodynamic changes in OA reflect choroidal hyperperfusion. Hemodynamic and OCT changes in the unaffected eyes of the patient group suggest CSC as a bilateral disorder and the systemic nature of the disease. Further investigations may aid in the evaluation of treatment response and the follow-up of disease, providing a new insight into management strategies.

Incidence and follow-up outcomes of developmental hip dysplasia of newborns in the Western Mediterranean Region.

The aim of our study was to determine the incidence of developmental hip dysplasia (DHD) in the Western Mediterranean Region of Turkey and evaluate follow-up results of physiologically immature hips classified as type 2 according to Graf classification. Ultrasononographic examinations of the hips were performed using Graf's technique on 1162 infants (2324 hips) referred to our clinic for hip ultrasounds between March 2013 and March 2014. DHD was detected in 1.36% of 1162 infants. Among infants who were brought into repetitive follow-ups, 191 out of type 2a hip displasias of 201 infants were improved to type 1 and 10 type 2a hip dysplasias worsened. Sonographically worsened tip 2a group consisted of 4 type 2b, 6 type 2c DHDs. Hip ultrasound performed during neonatal period and infancy in the detection of developmental hip dysplasias and follow-up of hip dysplasias diagnosed as type 2a convey importance because of sonographically detected potential deterioration.