Evaluation of kidney paranchyma damage using shearwave elastography and superb microvascularimaging methods in pediatric cases vesicoureteralreflux and comparison with scintigraphy results

Vesicoureteral reflux is the abnormal reflux of urine from the bladder into the ureter and pelvicalyceal system, which can lead to the development of recurrent urinary tract infections and pyelonephritis. The inflammation that occurs during pyelonephritis can cause permanent damage to unilateral or bilateral kidneys, called renal parenchymal scarring. Therefore, early diagnosis and treatment of vesicoureteral reflux is important to protect renal function by preventing recurrent urinary tract infection and renal scar development. Dimercaptosuccinic acid scintigraphy is the gold standard method for demonstrating scar tissue, but it involves high radiation exposure. In our study, we investigated the effectiveness of these two methods in predicting the presence of scar tissue by evaluating increased elasticity and decreased blood flow in the kidney parenchyma where scar tissue was observed, using current ultrasonography methods such as superb microvascular imaging and shear wave elastography. In our prospective study, 40 patients were included, 49 kidneys with vesicoureteral reflux and 31 kidneys without vesicoureteral reflux. The vascularity characteristics of all kidneys with superb microvascular imaging and the parenchymal stiffness levels with shear wave elastography were examined by 2 independent radiologists. A statistically significant difference was found in shear wave elastography and superb microvascular imaging values in kidneys with and without scar tissue (p<0.01). There was no significant difference in shear wave elastography and superb microvascular imaging values between kidneys with vesicoureteral reflux but without scar tissue and kidneys without vesicoureteral reflux (p>0.05). When we examine the literatüre, our study appears to be the first study in which both microvascularization of scar tissue and tissue elasticity are effectively evaluated together. Shear wave elastography and superb microvascular imaging can be considered as complementary alternative methods that can be used in the follow-up of the treatment of kidneys with scarring detected by dimercaptosuccinic acid scintigraphy in vesicoureteral reflux patients, as they are inexpensive, radiation-free methods and useful methods in detecting scar tissue.