Quantitative Assessment of Muscular Stiffness in Children With Chronic Kidney Disease Using Acoustic Radiation Force Impulse Ultrasound Elastography

Abstract

The aim of this study was to evaluate the feasibility of quantitative analysis of muscle stiffness in the rectus femoris muscle (RFM) by acoustic radiation force impulse (ARFI) ultrasound elastography in children with chronic kidney disease (CKD). Twenty-three children with CKD and 22 healthy children participated in the study in our radiology department. The strength of each CKD group and healthy group participants' tight extensors was assessed by a physiatrist using a handheld dynamometer. Acoustic radiation force impulse was used to measure the shear wave velocities (SWVs) of the RFM. The mean SWV value of the RFM correlated with the strengths of the tight extensors in the CKD and healthy groups. The mean ± SD SWV values of the RFM in the CKD group for the right (n = 23) and left sides (n = 21) were 1.23 ± 0.25 and 1.26 ± 0.30 m/s, respectively. The mean ± SD SWV values of the RFM in the healthy group for the right (n = 23) and left sides (n = 21) were 1.62 ± 0.33 and 1.65 ± 0.35 m/s, respectively. The SWV of the RFM significantly decreased in the patients with CKD when compared with controls (P < 0.001). The SWV values were not correlated to the handheld dynamometry. The interobserver agreement expressed as the interclass correlation coefficient was 0.65 (95% confidence interval, 0.33–0.84; P < 0.001). The acoustic radiation force impulse demonstrates a difference in RFM muscle stiffness between the CKD and healthy groups. This method is a feasible imaging method for the noninvasive assessment of muscle weakness in children with CKD.

Current aspects of renal dysfunction after liver transplantation

“…It has been used mainly in the determination of hepatic fibrosis and cirrhosis in chronic viral hepatitis and displays a good correlation with the degree of liver fibrosis[ 92 , 93 ]. In recent years, the ARFI technique has also been applied to other organs, such as the muscles[ 94 ], prostate[ 95 ], and breast[ 96 ]. Fibrosis is the core process of the progression of CKD and this method has also been evaluated in this scenario.…”

Systematic Review of Instrumented Measures of Skeletal Muscle Mechanical Properties: Evidence for the Application of Shear Wave Elastography with Children

“…One responsiveness study used the Aixplorer on 9 children with CP, revealing decreased shear modulus in gastrocnemius lateralis after botulinum Toxin-A injection (Brandenburg et al 2018). For the Acuson, there are two construct validity studies that report a lower shear wave velocity in the rectus femoris in children with chronic kidney disease (Bekci et al 2019) and a higher shear wave velocity in the gastrocnemius medialis in children with CP, compared with typically developing children (Bilgici and Bekci 2018). One concurrent validity study reported a positive correlation between the shear wave velocity reported by the Acuson and the Modified Ashworth Scale in 16 children with CP (Bilgici and Bekci 2018).…”

“…One concurrent validity study reported a positive correlation between the shear wave velocity reported by the Acuson and the Modified Ashworth Scale in 16 children with CP (Bilgici and Bekci 2018). Use of the Acuson was reported in two negative inter-rater reliability studies in children with chronic kidney disease (Bekci et al 2019) or CP (Bilgici et al 2017). One responsiveness study used the Acuson with 12 children with CP, revealing decreased shear wave velocity in the gastrocnemius medialis after botulinum toxin-A injection (Bilgici et al 2017).…”