Evaluation of kidney parenchyma by elastography in pediatric patients with vesico-ureteral reflux disease

The most important complication in vesico-ureteral reflux disease (VUR) is the presence of scarring in the kidney and DMSA is used in its detection. We aimed to contribute to the diagnosis with elastography in detecting the presence of scarring in patients with VUR. 50 pediatric VUR patients with DMSA examinations reported in the last year and 21 healthy volunteers were included in the study. In the patient and control groups, the kidneys were included in the study with the name "kidney unit".Kidneys with stage 3, 4 and 5 reflux in the patient group were defined as "advanced stage renal unit". "Advanced stage renal units" were divided into two in themselves as scarred and unscarred. The kidneys with stage 1 and 2 reflux in the patient population were defined as the "early stage kidney unit", and the kidneys on the non-reflux side were defined as the "contralateral kidney unit" in patient with unilateral reflux. 42 kidney units in the 21 people control group were defined as "control kidney units". Solitary kidney structure was present in 3 patients and a total of 139 kidney units were studied. Elastography evaluation was performed on upper, middle and lower zona of kidneys. Three ROIs were placed in each zona for cortex evaluation, avoiding the capsule and the medulla as much as possible. A total of 9 measurements were performed with three of the zones in each kidney unit, and the average elastography value of the parenchyma was recorded in m/sec. In the comparison, SWE rates of advanced scarring kidney units were found to be significantly higher than the other groups (p<0.05). In the "Receiver Operating Characteristic" (ROC) analysis made for this comparison, the sensitivity of 2.06 m/s for the SWE velocity in distinguishing the scarred kidney units from the unscarred advanced kidney units was calculated as 83.7% and the specificity as 76.5%. Shearwave elastography technique is a promising, reproducible, easily applicable, non-invasive diagnostic imaging method in the evaluation of the renal parenchyma. We think that our study will shed light on more comprehensive and controlled studies on this subject, and that the SWE examination is a promising method that can be used as an alternative to DMSA in the detection of scar formation.