Emine Caliskan

Evaluation of parotid glands in healthy children and adolescents using shear wave elastography and superb microvascular imaging

ObjectivesWe aim to determine parotid gland elasticity values from healthy children and adolescents using shear wave elastography (SWE). We also define the degree of vascularity using superb microvascular imaging (SMI), power Doppler (PD), and color Doppler (CD) and compare SMI with CD and PD.Materials and methodsA total of 100 cases, comprising 50 girls and 50 boys, with ages ranging from 3 to 17xa0years were included in this prospective study. SWE, SMI, PD, and CD measurements were taken from both parotid glands, and the relationships with sex, age, and body mass index (BMI) were determined. The SMI was compared with the PD and CD.ResultsThe median elasticity values measured with SWE were 8.37u2009±u20092.09xa0kPa and 1.68u2009±u20090.26xa0m/s on the right and 8.33u2009±u20092.04xa0kPa and 1.69u2009±u20090.26xa0m/s on the left. There were significant positive correlations present for those aged below and above 10xa0years and for BMI with elasticity values. The median vascular spot numbers measured using SMI, PD, and CD were 5u2009±u20091.70, 3.5u2009±u20091.45, and 2u2009±u20091.1 on the right and 4u2009±u20091.7, 4u2009±u20091.43, and 2u2009±u20091.05 on the left, respectively. The median values obtained with SMI were significantly higher than the median values obtained with both PD and CD.ConclusionThis study determined the reference SWE, SMI, PD, and CD values for normal parotid glands in healthy children and adolescents. Elasticity values were affected by age and BMI. There was no correlation between vascularity values and age, sex, or BMI. SMI provided more detailed information about vascularity compared with the other methods.

Effects of passive muscle stiffness measured by Shear Wave Elastography, muscle thickness, and body mass index on athletic performance in adolescent female basketball players

AIMSnAthletic performance in basketball comprises the contributions of anaerobic and aerobic performance. The aim wasxa0to investigate the effects of passive muscle stiffness, using shear wave elastography (SWE), as well as muscle thickness, andxa0body mass index (BMI), on both aerobic and anaerobic performances in adolescent female basketball players.Material andxa0methods: Anaerobic and aerobic (VO2max) performance was assessed using the vertical jump and shuttle run tests, respectively,xa0in 24 volunteer adolescent female basketball players. Passive muscle stiffness of the rectus femoris (RF), gastrocnemiusxa0medialis (GM), gastrocnemius lateralis (GL) and soleus muscles were measured by SWE, and the thickness of each musclexa0was assessed by gray scale ultrasound. The BMI of each participant was also calculated. The relationship between verticalxa0jump and VO2max values, and those of muscle stiffness, thickness, and BMI were investigated via Pearsons correlation andxa0multivariate linear regression analysis.nnnRESULTSnNo significant correlation was observed between muscle stiffness and VO2maxxa0or vertical jump (p>0.05). There was significant negative correlation between GL thickness and VO2max (p=0.026), and soleusxa0thickness and VO2max (p=0.046). There was also a significant negative correlation between BMI and VO2max (p=0.001).xa0Conclusions: This preliminary work can be a reference for future research. Although our article indicates that passive musclexa0stiffness measured by SWE is not directly related to athletic performance, future comprehensive studies should be performedxa0in order to illuminate the complex nature of muscles. Thexa0 maintenance of lower muscle thickness and optimal BMI may bexa0associated with better aerobic performance.

Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph nodes categorization: a comparative study

OBJECTIVEnTo determine the diagnostic utility of a vascularity index via superb microvascular imaging in lymph nodes of children with malignant lymphoma and acute lymphadenitis compared to normal lymph nodes.nnnMETHODSnWe performed a retrospective study for multiparametric lymph node (LN) evaluation. Malignant lymphoma diagnosed via histopathological examination and lymph nodes receiving an acute lymphadenitis diagnosis based on clinical and laboratory findings constituted the study subgroups. We calculated a shape index [SIxa0(percent of shortest to longest diameter)] using grayscale ultrasonography and elasticity and velocity values via shear wave elastography (SWE)xa0as well as a vascularity index (VI)xa0using superb microvascular imaging (SMI)xa0for comparison with normal lymph nodes.nnnRESULTSn45xa0lymph nodes diagnosed with malignant lymphoma, 72 lymph nodes diagnosed with acute lymphadenitis and 146 normal lymph nodes were evaluated. For differentiating lymphoma from normal lymph nodes, vascularity index cut-off values higher than 15% represented a diagnostic accuracy of 95%; cut-off elasticity values higher than 17u2009kPa exhibited a diagnostic accuracy of 99%. Optimal VI, elasticity, velocity and SI cut-off values in differentiating lymphoma from lymphadenitis were 15%, 17u2009kPa, 2.45xa0mxa0sn-1 (p < 0.001) and 65% (p < 0.002) with calculated diagnostic accuracies of 83, 87, 88 and 68%, respectively.nnnCONCLUSIONnVascularity index values obtained via superb microvascular imaging and SWExa0would be reasonably useful in differentiating malignant lymphoma and acute lymphadenitis from normal LNs. SWExa0would be more efficient in distinguishing malignant lymph nodes from acute lymphadenitis compared with superb microvascular imaging. Advances in knowledge: Vascularity index by superb microvascular imaging would be a novel Doppler parameter in differentiating both lymphoma from lymphadenitis and also lymphadenitis from normal lymph nodes.

A confounding rib variation: bilateral symmetric aberrant posterior rib articulations and bridgings

IntroductionAlthough mild bone angulation with osseous enlargement often suggests fractures with callus formation, in some cases the diagnosis is synchondrosis.Case ReportWe present a rare variation of the chest wall in a 15-year-old male with a history of lymphoma. Bilateral multi-level posterior rib enlargements revealing mild 18F-fluorodeoxyglucose uptake were detected via positron-emission tomography/computed tomography. The variations were identified as healing fractures, although the more accurate diagnosis was determined to be multi-level posterior rib synchondroses with consecutive bridgings. Although variant bone anatomies are commonly seen in radiological practice, such multiple symmetrical posterior rib synchondroses associated with consecutive bridgings and articulations have not been clearly demonstrated before.ConclusionAwareness of such a rare combination of a well-known variation is crucial for radiologists to exclude malignancies, possibility of fracture and suspicion of child abuse.

Shear wave elastography of parotid glands in pediatric patients with HIV infection

ObjectivesParotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.Materials and methodsThis single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann–Whitney U test were used in statistical analysis.ResultsStiffness of both PGs was significantly higher in patients’ group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.ConclusionsPG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner.

Severe Multisystem Involvement of Chronic Granulomatous Disease in a Pediatric Patient

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disorder identified by recurrent pyogenic and fungal infections infections secondary to defective nicotinamide adenine dinucleotide phosphate oxidase enzyme. In the present study, we demonstrated a case with a history of multiple segmental lung resections because of invasive bronchopulmonary aspergillosis, multifocal hepatic and splenic granulomas, bilateral adnexal calcific foci presumed to be related with old granulomatous infection and finally gastric outlet obstruction secondary to the involvement of the stomach wall thickening with granulomatous tissue. This is an extremely severe case of CGD with multiorgan involvement within a 10-year period after the diagnosis. Gastric antral involvement may mimic inflammatory bowel diseases in such cases, and intestinal involvement can reliably be demonstrated via ultrasonography. Spontaneous resolution of the antral involvement was observed in the follow-up.

Shear wave elastography evaluation in pediatric testicular microlithiasis: a comparative study

PurposeThe aim of this study was to evaluate the testicular parenchyma in pediatric patients with testicular microlithiasis by shear wave elastography (SWE) and compare the values with normal control subjects.MethodsTwenty-three patients previously diagnosed with testicular microlithiasis under follow-up for 20xa0±xa011xa0months were included in the study group. In the control group, 31 patients with no medical history that could affect testicular tissue were prospectively included. Forty-six testes in the study group and 62 testes in the control group were evaluated with gray-scale ultrasound and SWE.ResultsThere were no differences in age and testes volume between the study and control groups. The mean SWE values of all testes based on elasticity and speed parameters in the study group were 8.84xa0±xa02.86xa0kPa and 1.66xa0±xa00.26xa0m/s, respectively. In the control group, mean SWE values were 5.26xa0±xa01.17xa0kPa and 1.31xa0±xa00.14xa0m/s, respectively. Elasticity values were significantly higher in testes with microlithiasis as compared with the control group (pxa0<xa00.001).ConclusionsSWE evaluation demonstrates the effects of ultrastructural changes in elasticity that are not detected on gray-scale ultrasound. SWE is a more reliable method in follow-up examinations for pediatric testicular microlithiasis.

Quantitative assessment of thyroid gland elasticity with shear-wave elastography in pediatric patients with Hashimoto’s thyroiditis

ObjectiveHashimoto’s thyroiditis is the most common autoimmune thyroid disorder in the pediatric age range. Measurement of thyroid gland size is an essential component in evaluation and follow-up of thyroid pathologies. Along with size, tissue elasticity is becoming a more commonly used parameter in evaluation of parenchyma in inflammatory diseases. The aim of the current study was to assess thyroid parenchyma elasticity by shear-wave elastography in pediatric patients with Hashimoto’s thyroiditis; and compare the elasticity values to a normal control group.Materials and methodsIn this study; thyroid glands of 59 patients with a diagnosis of Hashimoto’s thyroiditis based on ultrasonographic and biochemical features, and 26 healthy volunteers without autoimmune thyroid disease and thyroid function disorders, were evaluated with shear-wave elastography. Patients with Hashimoto thyroiditis were further subdivided into three categories based on gray-scale ultrasonography findings as focal thyroiditis (grade 1), diffuse thyroiditis (grade 2), and fibrotic thyroid gland (grade 3).ResultsPatients with Hashimoto’s thyroiditis (nxa0=xa059) had significantly higher elasticity values (14. 9xa0kPa; IQR 12.9–17.8xa0kPa) than control subjects (10.6xa0kPa; IQR 9.0–11.3xa0kPa) (pxa0<xa00.001). Of the 59 patients with Hashimoto’s thyroiditis, 23 patients had focal thyroiditis involving less than 50% of the gland categorized as grade 1, 24 patients had diffuse involvement of the thyroid gland categorized as grade 2, and 12 patients had marked hyperechoic septations and pseudonodular appearance categorized as grade 3 on gray-scale ultrasound. Based on elastography, grade 3 patients had significantly higher elasticity values (19.7xa0kPa; IQR 17.8–21.5xa0kPa) than patients with grade 2 (15.5xa0kPa; IQR 14.5–17.8xa0kPa) and grade 1 thyroiditis (12.8xa0kPa; IQR 11.9–13.1xa0kPa) (pxa0<xa00.05). Patients with grade 2 thyroiditis had significantly higher elasticity values than those with grade 1 thyroiditis (pxa0<xa00.05).ConclusionGray-scale ultrasound findings of heterogeneous echotexture and hypoechoic echogenicity reflect a longer duration of inflammation and may not be found in the initial stages of thyroiditis. Our results indicate that shear-wave elastography could be used to evaluate the degree of fibrosis in Hashimoto’s thyroiditis.

Assessment of paediatric Hashimoto's thyroiditis using superb microvascular imaging

AIMnTo evaluate the role of superb microvascular imaging along with greyscale and Doppler imaging for thyroid gland evaluation in Hashimotos thyroiditis (HT) versus control subjects.nnnMATERIALS AND METHODSnThe study included 33 healthy volunteers with normal ultrasound and laboratory findings and 70 patients with HT based on laboratory and sonographic findings who were undergoing follow-up and receiving medical treatment. HT patients were classified based on the modification of the scheme proposed by Sostre and Reyes that incorporates the extent of hypoechoic foci or patchy infiltration as grade A (foci involving <50% of the gland) and B (foci involving >50% of the gland). Thyroid volume, mean resistive indices, peak-systolic and end-diastolic velocities based on Doppler imaging, and vascularity index via superb microvascular imaging were obtained using a Canon Aplio 500 ultrasound device using a linear 10-14 MHz transducer.nnnRESULTSnPatients with HT had significantly higher median thyroid volume and peak-systolic velocities (7.32 ml and 19 cm/s, respectively) compared to control subjects (4.62 ml and 16 cm/s, respectively). HT patients had significantly higher median vascularity index (VI; 13.5%) compared to control subjects (7.95%). A significant fair positive correlation with VI and anti-thyroglobulin antibody levels (r=0.356, p<0.05) and significant moderate positive correlation with VI and anti-thyroid peroxidase antibody levels (r=0.503, p<0.05) were found. In HT diagnosis, the optimal VI cut-off value was 10.58% with a sensitivity and specificity of 67.1% and 90%, respectively.nnnCONCLUSIONnSuperb microvascular imaging appears to allow assessment of subtle vascularity changes in early HT stages that cannot be detected by Doppler parameters. This technique demonstrates excellent visualization of the microvascular structures and quantitative assessment based on a novel parameter such as VI.

Utility of lung radiodensity ratios in diagnosis of radiolucent foreign body aspiration in children: a practical approach

OBJECTIVEnTo evaluate the utility of radiodensity ratio between lungs on chest X-ray for the diagnosis of radiolucent foreign body aspiration (FBA) in children.nnnMETHODSnX-rays of 33 patients with confirmed diagnosis of FBA by bronchoscopy were compared to 66 control patients. We divided the study group into three subgroups: symmetric (13-patients), right-oblique (RO;12-patients) and left-oblique (LO;8-patients).nnnRESULTSnWhen we compared FBA-symmetric-subgroup to symmetric-control-group, FBA-RO-subgroup to RO-control-group and FBA-LO-subgroup to LO-control-group, radiodensity ratios were significantly higher in the FBA subgroups.nnnCONCLUSIONnThe calculated radiodensity ratio between lungs on X-ray would be a useful and practical tool for the diagnosis of radiolucent FBA in children.