Aplicaciones de la técnica de elastografía cuantitativa-ARFI (Acoustic Radiation Force Impulse) en la evaluación del parénquima renal en edad pediátrica

Abstract

Chronic kidney disease (CKD) represents a serious public health problem in developed countries with a high and increasing prevalence. Pediatric CKD is an entity with its own specific clinical characteristics, such as the impact of the disease on growth, so early identification of those children at increased risk may be beneficial. Imaging tests play a fundamental role in the early diagnosis of parenchymal fibrosis. Elastography is an advanced non-invasive imaging technique that objectively assesses elasticity and thus early detection of tissue fibrosis. ARFI (Acoustic Radiation Force Impulse) elastosonography is a modality integrated into the latest generation of ultrasound devices, and complements any B-mode and Color Doppler examination in the same act. In the case of CKD, it could be useful for the early detection of renal fibrosis in early stages, before the diagnosis in analytical markers or other invasive tests such as biopsy, which, although it is still the "gold-standard" technique in the detection of renal fibrosis, it is not free of complications and sometimes fatal risks. In this work we have proposed a reproducible and safe renal elastography examination protocol in children, comparing the elasticity values of healthy and diseased pediatric renal tissue, as well as whether there are differences between disease stages or according to age and other anthropometric and analytical parameters, in addition to comparing the velocities obtained with two different transducers. The results obtained revealed an examination protocol with moderate interobserver reproducibility, as well as lower velocities when using the linear transducer with respect to the convex probe. Mean elasticity values have also been recorded both in kidneys of healthy children (without finding differences according to age or sex groups) and with CKD, with a lower mean Vc in the healthy group and a progressive decrease in Vc as the disease progresses to more advanced stages. These findings indicate that the ARFI technique is an emerging non-invasive diagnostic method with a high potential in the pediatric population to detect early renal fibrosis , avoiding other invasive tests, in addition to being able to perform the conventional ultrasound study at the same time without added risks for the child.