Outcomes in Patients with Macrotrabecular-Massive Subtype Hepatocellular Carcinoma Treated with Yttrium-90 Transarterial Radioembolization.

PURPOSE: To compare the outcomes of yttrium-90 transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC) with and without macrotrabecular-massive (MTM) subtypes. MATERIALS AND METHODS: Forty-one consecutive patients with HCC (male, 90.3%; mean age, 65.3 years [SD ± 10.7]) who underwent yttrium-90 TARE between September 2014 and January 2022 were grouped into the MTM-HCC (n = 17, 41.5%) and non-MTM-HCC (n = 24, 58.5%) groups based on their histopathological subtypes. Demographic, clinical, and radiological characteristics were compared. Survival, univariate, and multivariate analyses were performed, and prognostic factors were evaluated. RESULTS: In MTM-HCC group, the rates of moderately to poorly differentiated tumors were significantly higher (13/17 vs 8/16, P = .007), and new intrahepatic/extrahepatic metastases were detected more frequently (12/17 vs 15/24, P = .038). Median overall survival (OS) in the cohort was 29 months (range, 17.1-40.9 months), whereas patients with MTM-HCC had a significantly shorter median OS (20 vs 44 months, P = .014). In univariate analysis, MTM-HCC subtype (hazard ratio [HR], 2.690; P = .021), the presence of satellite nodules (HR, 3.810; P = .004), and macrovascular invasion (HR, 3.321; P = .012) were identified as significant prognostic factors. In multivariate analysis, MTM-HCC subtype and macrovascular invasion were determined as independent poor prognostic factors (P = .038 and P = .012, respectively). CONCLUSIONS: In patients with HCC treated with yttrium-90 TARE, both the rates of moderately to poorly differentiated histopathological classes and the development of intrahepatic or extrahepatic metastases were significantly higher in the MTM-HCC subtype. OS was worse in patients with MTM-HCC, and macrovascular invasion and MTM-HCC subtype were identified as independent poor prognostic factors.

Factors predicting kidney replacement therapy in pediatric earthquake victims with crush syndrome in the first week following rescue.

Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaras earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31%) of these patients had crush syndrome. Fifty-three (55%) of those with crush syndrome were female. The mean age was 10.9 ± 4.7 years, and the mean time under the rubble was 30.6 ± 23.8 h. Twenty-two patients (23%) required KRT. Hemodialysis was applied to 16 (73%) of them, and hemodiafiltration was applied to the other six (27%) in the pediatric intensive care unit. Regarding creatine kinase (CK) levels, the area under the receiver operating characteristic (ROC) curve (AUC) for predicting KRT was 0.905 (95% confidence interval [CI] 0.848-0.963; p < 0.001). The optimal cut-off value was 40,000 U/L with a sensitivity of 86% and a specificity of 83%. In terms of the percentage of body area crushed, the AUC for predicting KRT was 0.907 (95% CI 0.838-0.976; p < 0.001). The optimal cut-off value was 30% with a sensitivity of 86% and a specificity of 88%. Multiple logistic regression analysis showed that each 10% increase in body area crushed (OR 4.16, 95% CI 1.58-10.93, p = 0.004) and 1 mg/dl increase in the serum phosphorus level (OR 4.19, 95% CI 1.71-10.28, p = 0.002) were significant risk factors for dialysis treatment. CONCLUSIONS: Crush syndrome and kidney problems are common following disasters like earthquakes. Clinical and laboratory findings at admission can predict dialysis requirement in earthquake victims. While CK elevation, body area crushed percentage, and increased phosphorus level were predictive of dialysis treatment, time under the rubble was not. Even if the patients were under the rubble for a short time, acute kidney injury (AKI) may develop as a result of severe hypovolemia due to crush injuries, and patients may need KRT. WHAT IS KNOWN: •Crush syndrome after earthquakes needs to be treated carefully in victims and can cause AKI and mortality when not treated timely and appropriately. WHAT IS NEW: •CK level elevation, body area crushed percentage, and increased phosphorus level are predictive of dialysis treatment. •The time under the rubble may not be predictive of dialysis requirement.

A Truncus Bicaroticus and an Aberrant Right Subclavian Artery. A Rare Case and Literature Review / Un Tronco Bicarótico y una Arteria Subclavia Derecha Aberrante. Un Caso Raro y Revisión de la Literatura

SUMMARY: An aberrant right subclavian artery described by David Bayford, is rare and one of the aortic arch anomalies. It gives usually incidental findings. We present the case of a 57-year-old woman who was admitted to a neurology outpatient clinic due to a headache and no obvious pathology was detected during a physical examination. In consequence of the brain and chest CT angiography, incidental anomalies of the aortic arch branches were found and asymptomatic aberrant right subclavian artery and bicarotid trunk was diagnosed. The presence of this anomaly is becoming increasingly important in avoiding vascular injuries and cerebral complications in patients undergoing endovascular intervention on the aorta aortic arch surgery, thyroidectomy, or cervicothoracic surgery. So, detailed knowledge of variations of the subclavian artery and bicarotid trunk is paramount for radiologists and surgeons operating on the region of the anterior neck.

Una arteria subclavia derecha aberrante descrita por David Bayford, es rara y es una de las anomalías del arco aórtico. Además, suele ser hallazgos accidentales. Presentamos el caso de una mujer de 57 años que ingresó a una consulta de neurología por dolor de cabeza, sin embargo, no se le detectó patología evidente al examen físico. En el angio-TC de cerebro y tórax, se encontraron anomalías incidentales de las ramas del arco aórtico y se diagnosticó arteria subclavia derecha aberrante asintomática y tronco bicarotídeo. Determinar la presencia de esta anomalía es cada vez más importante, para así evitar lesiones vasculares y complicaciones cerebrales en pacientes sometidos a intervención endovascular de la aorta, cirugía del arco aórtico, tiroidectomía o cirugía cervicotorácica. Por lo tanto, el conocimiento detallado de las variaciones de la arteria subclavia y el tronco bicarotídeo es primordial para los radiólogos y cirujanos que operan en la región anterior del cuello.

Prediction of Local Tumor Progression After Microwave Ablation in Colorectal Carcinoma Liver Metastases Patients by MRI Radiomics and Clinical Characteristics-Based Combined Model: Preliminary Results.

PURPOSE: To investigate the predictability of local tumor progression (LTP) after microwave ablation (MWA) in colorectal carcinoma liver metastases (CRLM) patients by magnetic resonance imaging (MRI) radiomics and clinical characteristics-based combined model. MATERIALS AND METHODS: Forty-two consecutive CRLM patients (67 tumors) with post-MWA complete response at 1st month MRI were included in this retrospective study. One hundred and eleven radiomics features were extracted for each tumor and for each phase by manual segmentation from pre-treatment MRI T2 fat-suppressed (Phase 2) and early arterial phase T1 fat-suppressed sequences (Phase 1). A clinical model was constructed using clinical data, two combined models were created with feature reduction and machine learning by combining clinical data and Phase 2 and Phase 1 radiomics features. The predicting performance for LTP development was investigated. RESULTS: LTP developed in 7 patients (16.6%) and 11 tumors (16.4%). In the clinical model, the presence of extrahepatic metastases before MWA was associated with a high probability of LTP (p < 0.001). The pre-treatment levels of carbohydrate antigen 19-9 and carcinoembryonic antigen were higher in the LTP group (p = 0.010, p = 0.020, respectively). Patients with LTP had statistically significantly higher radiomics scores in both phases (p < 0.001 for Phase 2 and p = 0.001 for Phase 1). The classification performance of the combined model 2, created by using clinical data and Phase 2-based radiomics features, achieved the highest discriminative performance in predicting LTP (p = 0,014; the area under curve (AUC) value 0.981 (95% CI 0.948-0.990). The combined model 1, created using clinical data and Phase 1-based radiomics features (AUC value 0,927 (95% CI 0.860-0.993, p < 0.001)) and the clinical model alone [AUC value of 0.887 (95% CI 0.807-0.967, p < 0.001)] had similar performance. CONCLUSION: Combined models based on clinical data and radiomics features obtained from T2 fat-suppressed and early arterial-phase T1 fat-suppressed MRI are valuable markers in predicting LTP after MWA in CRLM patients. Large-scale studies with internal and external validations are needed to come to a firm conclusion on the predictability of radiomics models in CRLM patients.

Short-term changes of angiogenesis factors after transarterial radioembolization in hepatocellular carcinoma patients.

PURPOSE: To analyze changes in angiogenesis factors after transarterial radioembolization (TARE) with Yttrium- 90-loaded resin microspheres in hepatocellular carcinoma (HCC) patients. METHODS: Interleukin-6, interleukin-8, hepatocyte growth factor, platelet-derived growth factor, fibroblast growth factor, vascular endothelial growth factor-A (VEGF-A), and angiopoietin-2 levels in 26 patients were measured before TARE and on day 1, 7, 14, and 30 after TARE and evaluated regarding radiological response. RESULTS: In the sixth month of follow-up, 11 (42.30%) patients had a complete or partial response to treatment, while progressive disease was found in 15 (57.69%) patients. The percentage changes in VEGF-A in the non-responders on day 30 (P = 0.034) after TARE were significantly more obvious. Peak formation rates of VEGF-A were higher in non-responders (P = 0.036). CONCLUSION: Short-term changes in angiogenesis factors in HCC patients after TARE with Yttrium-90-loaded resin microspheres fluctuate with different amplitudes at different times. The upregulation of growth factors has a prognostic capacity. Changes in VEGF-A after TARE may be helpful for the early recognition of non-responders.

Predictability of the radiological response to Yttrium-90 transarterial radioembolization by dynamic magnetic resonance imaging-based radiomics analysis in patients with intrahepatic cholangiocarcinoma

PURPOSE: The study aims to investigate the predictability of the radiological response in intrahepatic cholangiocarcinoma (iCC) patients undergoing Yttrium-90 transarterial radioembolization (TARE) with a combined model built on dynamic magnetic resonance imaging (MRI)-based radiomics and clinical features. METHODS: Thirty-six naive iCC patients who underwent TARE were included in this study. The tumor segmentation was performed on the axial T2-weighted (T2W) without fat suppression, axial T2W with fat suppression, and axial T1-weighted (T1W) contrast-enhanced (CE) sequence in equilibrium phase (Eq). At the sixth month MRI follow-up, all patients were divided into responders and non-responders according to the modified Response Evaluation Criteria in Solid Tumors. Subsequently, a radiomics score (rad-score) and a combined model of the rad-score and clinical features for each sequence were generated and compared between the groups. RESULTS: Thirteen (36.1%) patients were considered responders, and the remaining 23 (63.9%) were non-responders. Responders exhibited significantly lower rad-scores than non-responders (P < 0.050 for all sequences). The radiomics models showed good discriminatory ability with an area under the curve (AUC) of 0.696 [95% confidence interval (CI), 0.522­0.870] for the axial T1W-CE-Eq, AUC of 0.839 (95% CI, 0.709­0.970) for the axial T2W with fat suppression, and AUC of 0.836 (95% CI, 0.678­0.995) for the axial T2W without fat suppression. CONCLUSION: Radiomics models created by pre-treatment MRIs can predict the radiological response to Yttrium- 90 TARE in iCC patients with high accuracy. Combining radiomics with clinical features could increase the power of the test. Large-scale studies of multi-parametric MRIs with internal and external validations are needed to determine the clinical value of radiomics in iCC patients.

A radiomic signature based on magnetic resonance imaging to determine adrenal Cushing's syndrome.

Purpose: The aim of this study was to develop radiomics signature-based magnetic resonance imaging (MRI) to determine adrenal Cushing's syndrome (ACS) in adrenal incidentalomas (AI). Material and methods: A total of 50 patients with AI were included in this study. The patients were grouped as nonfunctional adrenal incidentaloma (NFAI) and ACS. The lesions were segmented on unenhanced T1-weighted (T1W) in-phase (IP) and opposed-phase (OP) as well as on T2-weighted (T2-W) 3-Tesla MRIs. The LASSO regression model was used for the selection of potential predictors from 111 texture features for each sequence. The radiomics scores were compared between the groups. Results: The median radiomics score in T1W-Op for the NFAI and ACS were -1.17 and -0.17, respectively (p < 0.001). Patients with ACS had significantly higher radiomics scores than NFAI patients in all phases (p < 0.001 for all). The AUCs for radiomics scores in T1W-Op, T1W-Ip, and T2W were 0.862 (95% CI: 0.742-0.983), 0.892 (95% CI: 0.774-0.999), and 0.994 (95% CI: 0.982-0.999), respectively. Conclusion: The developed MRI-based radiomic scores can yield high AUCs for prediction of ACS.

A machine learning approach to distinguishing between non-functioning and autonomous cortisol secreting adrenal incidentaloma on magnetic resonance imaging using texture analysis.

PURPOSE: To investigate the possibility of distinguishing between nonfunctioning adrenal incidentalomas (NFAI) and autonomous cortisol secreting adrenal incidentalomas (ACSAI) with a model created with magnetic resonance imaging (MRI)-based radiomics and clinical features. METHODS: In this study, 100 adrenal lesions were evaluated. The lesions were segmented on unenhanced T1-weighted in-phase (IP) and opposed-phase (OP) as well as on T2-weighted (T2-W) 3Tesla MRIs. The LASSO regression model was used to select potential predictors from 108 texture features for each sequence. Subsequently, a combined radiomics score and clinical features were created and compared. RESULTS: A significant difference was found between median rad-scores for ACSAI and NFAI in training and test sets (p < 0.05 for all sequences). Multivariate logistic regression analysis revealed that the length of the tumor (OR = 1.09, p = 0.007) was an independent risk factor related to ACSAI. Multivariate logistic regression analysis was used for building clinical-radiomics (combined) models. The Op, IP, and IP plus T2-W model had a higher performance with area under curve (AUC) 0.758, 0.746, and 0.721 on the test dataset, respectively. CONCLUSION: ACSAI can be distinguished from NFAI with high accuracy on unenhanced MRI. Radiomics analysis and the model constructed by machine learning algorithms seem superior to another radiologic assessment method. The inclusion of chemical shift MRI and the length of the tumor in the radiomics model could increase the power of the test.

Efficacy of the endovascular ovarian vein embolization technique in pelvic venous congestion syndrome.

Purpose: Pelvic pain, either related or unrelated to menstruation, is especially common in women of reproductive age. Thirty-nine per cent of all women suffer from chronic pelvic pain at some point in their lives, and pelvic venous congestion syndrome (PVCS) is the cause of this pain in 30% of cases. The aim of this study was to determine factors affecting the success of endovascular venous embolization used in the treatment of PVCS, and to present the long-term treatment results. Material and methods: The data of 144 female patients who underwent endovascular ovarian vein embolization for PVCS between January 2012 and July 2020 were retrospectively analysed. Results: Pain management was determined to be very successful in 37 (25.6%) patients, successful in 55 (38.1%), and unsuccessful in 52 (35.3%). Treatments using a coil alone were significantly more successful in pain management than those involving the use of different materials in addition to the coil (p = 0.036). In addition, patients with unilateral insufficiency before the procedure were found to have more successful pain management than those with bilateral insufficiency (p = 0.041). Reproductive/postmenopausal state and parity did not have a statistically significant effect on treatment efficacy (p = 0.250 and p = 0.573, respectively). Conclusions: Endovascular pelvic venous embolization is an important option in the treatment of PVCS due its less invasive and reproducible nature.

Reduction of Hepatopulmonary and Intrahepatic Shunts after Treatment with Sorafenib in Hepatocellular Carcinoma Patients.

PURPOSE: To investigate the reduction of elevated shunts after treatment with sorafenib in hepatocellular carcinoma (HCC) patients planned for transarterial radioembolization (TARE). MATERIALS AND METHODS: Sixteen HCC patients treated with sorafenib were investigated. Shunts were evaluated by SPECT/CT after Technetium-99 m Tc-macroaggregated albumin injection. RESULTS: All patients had high LSF (median 43.5%, range 28-86), and two (12.5%) of them had widespread intrahepatic shunts with concomitants elevated (36%) and acceptable (18%) lung shunt fraction (LSF). The mean duration of the sorafenib use was 134.4 ± 59.2 days. While one patient (6.25%) developed hand-foot syndrome, minor side effects were seen in all patients. After sorafenib use, LSF fell below 20% in eight patients, and TARE was applied to all of them. There was strong negative correlation between the failure of shunt reduction and presence of macrovascular invasion (ρ = - 0.775) and infiltrative tumour type (ρ = - 0.775). CONCLUSION: Sorafenib use may be beneficial in some selected HCC patients with elevated shunts. Expected results may not be obtained in patients with infiltrative tumour type or macrovascular invasion, but patients with nodular tumour type with the absence of macrovascular invasion may be appropriate candidates for shunt reduction with ensuring subsequent TARE. Further investigations with sufficient patient population and standardized protocols of follow-up periods are needed to clarify the values for sorafenib use in HCC patients with evaluated shunts.

An Alternative Central Venous Access Route for Pediatric Patients with Chronic Critical Illness: The Transhepatic Approach.

OBJECTIVE: To evaluate the safety and functionality of the transhepatic approach as an alternative route for central venous catheterization in pediatric patients with chronic critical illness. METHODS: The study included data of 12 chronic critically ill pediatric patients who underwent central venous catheterization with transhepatic approach. The indications, procedure details, mean patency time, and catheter-related complications were retrospectively analyzed. RESULTS: A total of 16 central venous catheters were placed through the transhepatic approach. A 5F port catheter was used in eight attempts, a 5F PICC in two attempts, and an 8-14F Hickman-Broviac catheter in six attempts. All procedures were performed with technical success. The mean patency time of the catheters was 132.1 d (range: 12-540 d). In the long-term follow-up, catheter-related sepsis was detected in a patient, and six catheters lost functionality due to malposition. CONCLUSION: The transhepatic approach is a safe and functional alternative route for central venous access in chronic critically ill pediatric patients requiring long-term vascular access. The procedure using ultrasonography and fluoroscopy can be performed with high technical success. In the long-term follow-up, Dacron felt cuff tunneled catheters placed in the subcostal space with a transhepatic approach remained functional for a long time.

Evaluation of the Liver and Pancreas by 2D Shear Wave Elastography in Pediatric Wilson's Disease.

BACKGROUND: The primary aim of the study was to demonstrate parenchymal changes in the liver and pancreas related to copper accumulation using ultrasound in pediatric patients with Wilson's disease and secondly, to investigate the effectiveness of two-dimensional shear wave elastography in the diagnosis of involvement of these organs. METHODS: Patients with Wilson's disease (n = 25) who were treated and followed at our center were evaluated prospectively. In addition to routine clinical assessments, eye examination, laboratory analyses, and abdominal ultrasound imaging, all patients underwent tissue stiffness measurements from the liver and pancreas (head, body and tail) by two-dimensional shear wave elastography. The data obtained from the WD patients were compared with those of age- and sex-matched healthy controls (n = 37). RESULTS: Liver elastography measurements showed significantly increased tissue stiffness in the patient group than in control subjects (P < .001). While there was no significant difference between the groups in the tissue thickness of pancreatic head, body, and tail, tissue stiffness was significantly reduced in the patient group (P < .001). Disease duration was significantly associated and moderately correlated with liver tissue stiffness (r = 0.417, P = .038) but not significantly associated with pancreatic tissue stiffness. CONCLUSION: In the early stages of Wilson's disease, parenchymal changes occur in the liver and pancreas, which cannot be detected by conventional ultrasonography imaging but may be demonstrated by two-dimensional shear wave elastography. Ultrasound elastography is an easy to use, non-invasive, and promising method that provides numerical data on the early changes in tissue stiffness, allowing for objective monitoring of Wilson's disease patients who require lifelong follow-up.

Trans-Arterial Radioembolization with Yttrium-90 of Unresectable and Systemic Chemotherapy Resistant Hepatoblastoma in Three Toddlers.

The aim of this short communication was to report the results of transarterial radioembolization (TARE) with Yttrium-90 (Y90) loaded resin microspheres in three toddlers with unresectable and systemic chemotherapy-resistant HB hepatoblastoma (HB). Six TARE procedures were performed on the patients. The dose required for treatment was calculated using partition model. Administered doses of Y90 were 1.369, 0.851, and 1.147 GBq. Complete radiological response in two patients and partial response enabling liver resection in one patient were achieved. Neither life-threatening nor minor complications developed after the treatment. These results demonstrates that HB is a radiosensitive neoplasm, and TARE-Y90 can be used as the primary, neoadjuvant and palliative treatment method in patients with unresectable and systemic chemotherapy-resistant HBs. However, studies with higher number of patients and long-term results are required.

Whole tumor volumetric ADC analysis: relationships with histopathological differentiation of hepatocellular carcinoma.

PURPOSE: The aim of this study was to investigate the relationships between values obtained from whole tumor volumetric apparent diffusion coefficient (ADC) measurements and histopathological grade in patients with hepatocellular carcinoma (HCC). METHODS: Fifty-one naïve patients with HCC were included in the study. The tumors were classified according to the Edmondson-Steiner grade and separated as well-differentiated and non-well-differentiated (moderately and poorly differentiated). The ADC parameters of groups were compared by applying Mann-Whitney U test. The correlation between tumors' histopathological stage and whole tumor ADC parameters was investigated using Spearman's Rank Correlation Coefficient. The receiver operating characteristic curve analysis (ROC) was applied to calculate the area under curve (AUC) with intersection point of ADC parameters and curve. RESULTS: Mean and percentile ADC values of well-differentiated tumors were significantly higher than those of non-well-differentiated tumors (p < 0.05). The strongest correlation between histopathological grade and ADC parameters was 75th percentile ADC (r = - 0.501), 50th percentile ADC (r = - 0.476) and mean ADC (r = - 0.465). Mean, 75th and 50th percentile ADC values used for the distinction of groups gave the highest AUC at ROC analysis (0.781, 0.781, 0.767, respectively). When threshold values of mean, 75th and 50th percentile ADC values were applied (1516 mm2/s, 1194 mm2/s, and 1035 mm2/s) sensitivity was calculated as 0.73, 0.91, 0.83, respectively, and specificity was calculated as 0.82, 0.61, and 0.68, respectively. CONCLUSIONS: A correlation between whole tumor volumetric ADC values and HCCs' histopathological grade was detected in this study. 75th percentile, 50th percentile and mean ADC values are determined as highly sensitive and specific tests when the threshold values are applied for distinguishing between well-differentiated tumors and moderately/poorly differentiated tumors. When all these findings are evaluated together, HCCs' volumetric ADC values might be a useful noninvasive predictive parameters for histopathological grade in patients with HCC.

Pre-Pulseless Takayasu Arteritis in a Child Represented With Prolonged Fever of Unknown Origin and Successful Management With Concomitant Mycophenolate Mofetil and Infliximab.

Takayasu arteritis (TA) is classified as a large vessel vasculitis of predominantly aorta and its main branches, resulting in fibrosis and stenosis. Only a minority of TA patients are diagnosed in pre-stenosis phase when constitutional symptoms including fever, arthralgia, weight loss, headache, abdominal pain, and elevated acute phase reactants are dominant insidious characteristics. In this article, we present a 12-year-old female patient, who was referred to our department with a one-year history of low-grade fever, fatigue, and myalgia. Physical examination did not reveal pulse and blood pressure discrepancies between any extremities. Acute phase reactants were markedly elevated, and autoantibodies were negative. Magnetic resonance angiography (MRA) findings have confirmed TA diagnosis with prominent vessel wall thickening in the ascendant and abdominal aorta, focal ectasias and a thoracoabdominal fusiform aneurysm. As methotrexate and methylprednisolone treatment during three months was unsuccessful, infliximab was induced. During the next 12 months, patient had clinical improvement, but worsening of MRA findings and new onset of carotidynia forced us to switch methotrexate to mycophenolate mofetil. Six months later, laboratory and radiological remission were achieved. In conclusion, we report a challenge to diagnose pre-pulseless childhood-TA (c-TA) in the state of prolonged fever with no signs of vascular stenosis, systemic hypertension, pulses and blood pressure discrepancies, bruits and claudication. Therefore, we wish to discourse the importance of early diagnosis of TA since, to our knowledge, there are no studies investigating treatment success only in the early phases of c-TA.

A comparative study of the pancreas in pediatric patients with cystic fibrosis and healthy children using two-dimensional shear wave elastography.

PURPOSE: To compare sonographic parameters of the pancreas between healthy children and pediatric cystic fibrosis (CF) patients with pancreatic involvement using shear wave elastography (SWE) and to investigate the efficacy of SWE in the diagnosis of pancreatic involvement in pediatric CF patients. METHODS: The pancreas was evaluated in 38 patients with CF and 38 healthy children using conventional B-mode ultrasonography (US) and two-dimensional (2D)-SWE. RESULTS: The pancreatic 2D-SWE values of the CF group were significantly lower than those of the healthy control group (1.01 ± 0.16 vs. 1.31 ± 0.01 m/s for the head, 1.03 ± 0.05 vs. 1.28 ± 0.08 m/s for the pancreatic body, and 1.02 ± 0.05 vs. 1.30 ± 0.10 m/s for the tail; p < 0.005 for all the comparisons). When the threshold values were obtained for the pancreatic head, body, and tail segments for the differentiation of the CF patients and healthy controls, the sensitivity of the test was determined as 81.5%, 76.3%, and 73.3%, respectively, and the specificity as 97.3%, 100%, and 100%, respectively. When the patients were divided into two groups based on the presence of B-mode US characteristics (homogeneity, sharp demarcation, and hyperechoic pancreas), there was a significant difference in the 2D-SWE values of the pancreatic head between the patients with and the patients without these characteristics (p = 0.048 for homogeneity, p = 0.021 for sharp demarcation, and p = 0.006 for hyperechoic pancreas). CONCLUSION: The measurement of 2D-SWE values was found to be an easily applicable non-invasive test with high sensitivity and specificity for the demonstration of changes in the pancreas of pediatric CF patients.