Acoustic radiation force impulse (ARFI) in the evaluation of the renal parenchymal stiffness in paediatric patients with vesicoureteral reflux: preliminary results

Bruno, Costanza; Caliari, Giuliana; Zaffanello, Marco; Brugnara, Milena; Zuffante, Michele; Cecchetto, Mariangela; Minniti, Salvatore; Pedot, Alice; Talamini, Giorgio; Pozzi-Mucelli, Roberto
December 2013
European Radiology;Dec2013, Vol. 23 Issue 12, p3477
Academic Journal
Objectives: To prospectively evaluate acoustic radiation force impulse (ARFI) imaging of the kidneys in children with and without chronic renal disease. Methods: Twenty-eight children (age range 9–16 years) with primary or secondary vesicoureteral reflux (≥ grade III) underwent scintigraphy and ultrasound with ARFI. Kidneys were divided—according to scintigraphy—into “affected” and “contralateral”; the results were compared with 16 age-matched healthy subjects. An ARFI value, expressed as speed (m/s) of wave propagation through the tissue, was calculated for each kidney through the mean of the values obtained at the upper, middle and lower third. The Wilcoxon test was used; P values <0.05 were considered statistically significant. Results: The mean ARFI values obtained in the “affected” kidneys (5.70 ± 1.71 m/s) were significantly higher than those measured in both “contralateral” (4.09 ± 0.97, P < 0.0001) and “healthy” kidneys (3.13 ± 0.09, P < 0.0001). The difference between values in the “contralateral” kidneys and “healthy” ones was significant ( P < 0.0001). The “affected” kidneys with secondary reflux had mean ARFI values (6.59 ± 1.45) significantly higher than those with primary reflux (5.35 ± 1.72). Conclusions: ARFI values decrease from kidneys with secondary vesicoureteral reflux to kidneys with primary reflux to unaffected kidneys contralateral to reflux to normal kidneys. Key points: • Acoustic radiation force impulse (ARFI) can quantify tissue elasticity during ultrasound examinations.• Kidneys are highly heterogeneous and difficult to evaluate with ARFI.• Kidneys damaged by vesicoureteral reflux are stiffer than normal.• ARFI can identify initial damage in macroscopically normal kidneys.


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