Real Time Elastografinin Etkinliği: Kortikomedüller Strain Oranı Üriner Obstrüksiyonun Tanı ve Takibinde Kullanılabilir Mi?

Year 2020, Volume: 15 Issue: 1, 27 - 32, 26.02.2020

Soner Çoban , Ünal Kurtoğlu Ali Rıza Türkoğlu , Muhamammet Güzelsoy , Murat Öztürk , Abdullah Gül , Efe Önen , Osman Akyüz , Metin Kılıç

https://doi.org/10.33719/yud.594994

Abstract

Amaç: Üriner obstrüksiyonun tanı ve takibinde kortikomedüller strain oranının (SR)
kullanılabilirliğini araştırmak.

Gereç ve Yöntemler: Hastanemiz
üroloji kliniğine renal kolikle başvuran hastalardan taşa bağlı unilateral
üriner obstrüksiyon tanısı BT ile konulmuş 18-60 yaş arası 40 gönüllü (26
erkek, 14 kadın) hasta çalışmaya alındı. Yine aynı hastaların kontralateral
sağlam böbrekleri kontrol grubu olarak dahil edildi. Bütün hastaların yaşı,
cinsiyeti, ne kadar zamandır renal koliği olduğu, tansiyonu, body mass indexi
(BMI) kaydedildi. Hastalara, abdominal radyolojide 8 yıl deneyimli, tek
radyoloji uzmanı tarafından renal ultrasonografi, doppler ultrasonografi ve Real Time Elastografi (RTE) incelemesi
yapıldı. Bu üç ölçümün ortalaması istatistiksel analizde kullanıldı. Dekompresyon
fazında böbreğin cilde en yakın kesiminden B modda belirlenen medulla ve
korteksteki ilgilenilen bölge işaretlenerek gerinim oranı (SR) ölçüldü.

Bulgular: Gruplar
arasında yaş farkı yoktur. Renal
pelvis çapı ile obstrükte böbrekteki RI arasında pozitif korelasyon bulduk (p=0.006
ve r=0.446). Hidronefrotik
böbreklerin ortalama kortikomedüller SR değerleri (0.38±0.43) ile kontralateral
normal böbreklerin ortalama SR değerleri (0.61±0.69) arasında istatistiksel
olarak anlamlı farklılık saptadık (p=0.025). Hidronefrotik böbreklerin ortalama
arterial doppler değerleri (0.64± 0.06)  ile normal böbreklerin areterial doppler
değerleri (0.60±0.05)  arasında
istatistiksel olarak anlamlı farklılık var (p=0.026).

Sonuç: Noninvaziv
bir yöntem olan RTE ile renal kortikomedüller SR ölçümü üriner obstrüksiyon
tanı ve takibinde kullanılabilir. Bu bulgu literatürde tanımlanmış olan üriner
obstrüksiyondaki artmış arteryel RI verileri ile de desteklenmektedir. 

Keywords

Elastography , Kortikomedüller Strain Oranı (SR) , Üriner Obstrüksiyon

The Effectiveness of Real Time Elastography: May the Corticomedullary Strain Rate Be Used in the Diagnosis and Follow-Up of Urinary Obstruction?

Abstract

Aim: To investigate the utility of
corticomedullary strain ratio (SR) in the diagnosis and follow-up of urinary
obstruction

Material and Methods: Forty
volunteer patients (26 males, 14 females) aged between 18-60 years, who were
admitted to our outpatient urology clinic with renal colic due to stone and diagnosed
as unilateral urinary tract obstruction via CT, were included in the study. Contralateral
intact kidneys of the same patients were accepted as control group. The age,
gender, duration of renal colic, blood pressure and BMI of the all patients
were also recorded. Patients were examined with renal ultrasonography, doppler
ultrasonography and Real Time Elastography (RTE) by a single radiologist with 8
years of experience in abdominal radiology. The average of these three
measurements was used in statistical analysis. Strain ratio (SR) was measured
by marking the region of interest in the medulla and cortex determined in B
mode during the decompression phase.

Results: No
difference was observed in terms of age between the groups. We found a positive
correlation between renal pelvic diameter and RI in obstructed kidney (p=0.006
ve r=0.446). There was a statistically significant difference between mean
corticomedullary SR values of hydronephrotic kidneys (0.38 ± 0.43) and mean SR
values of contralateral intact kidneys (0.61 ± 0.69) (p=0.025). Also, we
observed statistically significant difference between the mean arterial doppler
values of the hydronephrotic kidneys (0.64 ± 0.06) and the arterial doppler
values of intact kidneys (0.60 ± 0.05) (p=0.026).

Conclusion: The
measurement of renal corticomedullary SR by RTE, which is a noninvasive method,
can be used in the diagnosis and follow-up of urinary obstruction. This finding
is supported by increased arterial RI data in urinary obstruction described in the
literature.

Keywords

Elastography , corticomedullary strain ratio , urinary tract obstruction

References

• 1. Lee VS, Kaur M, Bokacheva L, et al. What causes diminished corticomedullary differentiation in renal insufficiency? J Magn Reson Imaging 2007; 25: 790–95.
• 2. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Retrieved December 03-2015.
• 3. Correas JM, Anglicheau D, Gennisson JL, Tanter M: Renal elastography. Nephrol Ther 2016;12: 25-34.
• 4. Inci MF, Kalayci TO, Tan S.,et al. Diagnostic value of strain elastography for differentiation between renal cell carcinoma and transitional cell carcinoma of kidney. Abdom Radiol (NY) 2016;41: 1152-59.
• 5. Sarıca K., Renal fizyoloji ve üst üriner sistem obstrüksiyonun patofizyolojisi, TÜYK, 2004.
• 6. Yokoyama H., Tsuji Y., Diuretic doppler US in chronic unilateral parsial ureteric obstruction in dogs. BJU İnternational 2002; 90:100-104
• 7. Anafarta K., Göğüş O., A. Nihat, Bedük Y., Temel Üroloji, Güneş Kitabevi 1998.
• 8. Metin MR, Aydın H, Ünal Ö, et al. Differentiation between endometrial carcinoma and atypical endometrial hyperplasia with transvaginal sonographic elastography. Diagn Interv Imaging. 2016; 97: 425-31.
• 9. Onur MR, Göya C. Ultrasound elastography: abdominal appli-cations. Turkiye Klinikleri J Radiol Special Topics. 2013; 6: 59-69.
• 10. Wang Z, Yang H, Suo C, Wei J, Tan R, Gu M. Application of ultrasound elastography for chronic allograft dysfunction in kidney transplantation. J Ultrasound Med. 2017; 36: 1759-69.
• 11. Wang Y, Yao B, Li H, et al. Assessment of tumor stiffness with shear wave elastography in a human prostate cancer xenograft implantation model. J Ultrasound Med 2017; 36: 955-63.
• 12. Yağcı B, Erdem Toslak I, Çekiç B, et al. Differentiation between idiopathic granulomatous mastitis and malignant breast lesions using strain ratio on ultrasonic elastography. Diagn Interv Imaging. 2017; 98: 685-91.
• 13. You J, Chen J, Xiang F, et al. The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules. J Med Ultrason (2001) 2017 Sep 13. doi: 10.1007/s10396-017-0819-0. [Epub ahead of print]
• 14. Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW. Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med. 2010; 29: 551-63.
• 15. Hong Y, Liu X, Li Z, Zhang X, Chen M, Luo Z. Real-time ultra-sound elastography in the differential diagnosis of benign and malignan thyroid nodules. J Ultrasound Med. 2009 ;28: 861-7.
• 16. Lim S, Kim SH, Kim Y, et al. Coefficient of variance as quality criterion for evaluation of advanced hepatic fibrosis using 2D shear-wave elastography. J Ultrasound Med 2017 Aug 14. doi: 10.1002/jum.14341. [Epub ahead of print]
• 17. Zeng J, Huang ZP, Zheng J, Wu T, Zheng RQ. Non-invasive assessment of liver fibrosis using two-dimensional shear wave elastography in patients with autoimmune liver diseases. World J Gastroenterol 2017; 23: 4839-46.
• 18. Gersak MM, Lupșor-Platon M, Badea R, Ciurea A, Dudea SM. Strain Elastography (SE) for liver fibrosis estimation - which elastic score to calculate? Med Ultrason. 2016;18: 481-87
• 19. Gao J, Min R, Hamilton J, et al. Corticomedullary strain ratio: a quantitative marker for assessment of renal allograft cortical fibrosis. J Ultrasound Med. 2013; 32: 1769-75.
• 20. Gao J, Weitzel W, Rubin JM, et al. Renal transplant elasticity ultrasound imaging: correlation between normalized strain and renal cortical fibrosis. Ultrasound Med Biol 2013; 39: 1536-42.
• 21. Orlacchio A, Chegai F, Del Giudice C, et al. Kidney transplant: usefulness of real-time elastography (RTE) in the diagnosis of graft interstitial fibrosis. Ultrasound Med Biol. 2014;40: 2564-72.
• 22. Menzilcioglu MS, Duymus M, Citil S, et al. Strain wave elastography for evaluation of renal parenchyma in chronic kidney disease. Br J Radiol 2015; 88: 20140714.
• 23. Tublin M. E., Bude R. O., Plat J. F. The resistive index in renal Doppler sonography: Where do we stand? AJR 2003;180: 885-92.
• 24. Webb J.A.W. US and Doppler studies in the diagnosis of renal obstruction BJU International (2000), 86 Suppl. 1, 25-32.
• 25. Kim K. M., Bogaert G. A., Nguyen H. T.; Borirakchanyavat S., Kogan B. A. Renal hemodynamic Changes After Complete Unilateral Ureteral Obstruction in the Young Lamb. The Journal of Urology, 1997;158: 1090-93.
• 26. Nguyen H. T., Kogan B. A. Upper urinary tract obstuction :experimental and clinical aspects BJU 1998; 81: 13-21.
• 27. Platt J. F. Advances in ultrasonography of urinary tract obstruction Abdom Imaging 1998 23:3–9.
• 28. Mustonen S. , Ala-Houhala I.O., Vehkalahti P. , Laippala P. , Tammela T.L.J. Kidney ultrasound and Doppler ultrasound findings during and after acute urinary retention. European Journal of Ultrasound 12 (2001) 189–96.