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

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

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