Mehmet ÖNCÜ, Samet ŞİMŞEK, Süleyman ÖNCÜ, Zeynep Fatma ARSLAN, Ahmet Tan CİMİLLİ, Mehmet KARAGÜLLE

Pediatrik yaş popülasyonunda testiküler kan akımının mikro V Doppler ile değerlendirilmesi: prepubertal torsiyonun değerlendirilmesinde kıdemli rehberlik ihtiyacını azaltabilir

Amaç: Pediatrik popülasyonda testis vaskülaritesini MicroV Doppler (MVD) ve Q pack incelemesi ile değerlendirdik ve deneyimsiz ile kıdemli radyologlar arasındaki interobserver variabiliteyi inceledik. Ayrıca çocuklarda testis kanlanmasını göstermede MVD ve Q pack incelemesini renkli ve power Doppler ile karşılaştırdık. Gereç ve Yöntemler: Çalışmaya 114 testis (4-14 yaş arası) dahil edildi. Testis mikrodamar yapısı renk, power, MicroV Doppler ve Q-pack inceleme teknikleri kullanılarak incelendi. Testis parankiminin vaskülaritesini görsel olarak puanlamak için renk, Power ve MicroV Doppler için bir gruplama sistemi oluşturuldu. Bulgular: Çalışmamızda tüm çocuklarda MVD ile testis kan akımının varlığını doğruladık. Renkli, power Doppler ve MVD'de gözlemciler arasında anlamlı bir fark olmadığını ve MVD'de tutarlılık değerinin renkli ve power Doppler'e göre daha yüksek olduğunu bulduk. Q-pack değerleri ile hasta yaşı arasında anlamlı bir pozitif korelasyon gözlemledik. Bu çalışmadan elde edilen Qpac değerleri yaşla birlikte arttı. İstatistiksel olarak anlamlı yanlılığın olmaması, yöntemin yararlı olduğunu gösterir. Sonuç: MVD, gözlemciler arası önemli bir değişkenlik olmaması ve çalışma hayatının ilk yıllarında daha az deneyimli radyologlar için prepubertal torsiyon gibi akut skrotal patolojileri kolaylıkla tespit edebilmesi nedeniyle tekrarlanabilir bir yöntemdir. Böylece çocuklarda acil vakaların değerlendirilmesinde radyoloji asistanına eşlik eden kıdemli rehberliğe duyulan ihtiyaç azalabilir.

Anahtar Kelimeler:

Testis, Doppler, Pediatric

Micro V Doppler assessment of testicular blood supply in the pediatric age population: may reduce the need for senior guidance in the evaluation of prepubertal torsion

Objective: We evaluated the testis vascularity in pediatric population with MicroV Doppler (MVD) and Q pack examination and to detect differences between a limited experience and a experienced senior radiologists. The inter-observer agreement in MVD and Q pack examination is evaluated. We also compared MVD and Q pack examination with color and power Doppler in demonstrating testicular blood supply in children.Material and Methods: 114 testis (between the ages of 4-14) were included in the study. Testicular microvessel structure was examined by using color, power, MicroV Doppler and Q-pack examination techniques. A grouping system was created for color, Power and MicroV Doppler to score the vascularity of the testicular parenchyma visually.Results: In our study, we confirmed the presence of testicular blood flow with MVD in all children. We found that there was no significant difference between the observers in color, power Doppler and MVD and the consistency value was higher in MVD compared to color and power Doppler. We observed a significant positive correlation between Q-pack values and patient age. Q-pac values obtained from this study increased with age. The lack of statistically significant bias indicates that the method is useful.Conclusion: MVD is a reproducible method since there is no significant interobserver variability and can easily detect acute scrotal pathologies such as prepubertal torsion for the less experienced radiologists in the early years of working life. Thus, the need for senior guidance accompanying radiology resident in the evaluation of emergency cases in children may decrease.

Keywords:

blood supply, micro V doppler, pediatric age population,

PDF

___

1. Pearl MS, Hill MC. Ultrasound of the scrotum. Semin Ultrasound CT MR. 2007 Aug;28(4):225-48. doi: 10.1053/j.sult.2007.05.001. PMID: 17874648.
2. Atkinson GO Jr, Patrick LE, Ball TI Jr, Stephenson CA, Broecker BH, Woodard JR. The normal and abnormal scrotum in children: evaluation with color Doppler sonography. AJR Am J Roentgenol. 1992 Mar;158(3):613-7. doi: 10.2214/ajr.158.3.1739005. PMID: 1739005.
3. Ingram S, Hollman AS. Colour Doppler sonography of the normal paediatric testis. Clin Radiol. 1994 Apr;49(4):266-7. doi: 10.1016/s0009-9260(05)81854-9. PMID: 8162685.
4. Karaca L, Oral A, Kantarci M, Sade R, Ogul H, Bayraktutan U, Okur A, Yüce I. Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children's testicular blood flow. Eur Rev Med Pharmacol Sci. 2016 May;20(10):1947-53. PMID: 27249591.).
5. Middleton WD, Siegel BA, Melson GL, Yates CK, Andriole GL. Acute scrotal disorders: prospective comparison of color Doppler US and testicular scintigraphy. Radiology. 1990 Oct;177(1):177-81. doi: 10.1148/radiology.177.1.2204963. PMID: 2204963.
6. Burks DD, Markey BJ, Burkhard TK, Balsara ZN, Haluszka MM, Canning DA. Suspected testicular torsion and ischemia: evaluation with color Doppler sonography. Radiology. 1990 Jun;175(3):815-21. doi: 10.1148/radiology.175.3.2188301. PMID: 2188301.
7. Lee YS, Kim MJ, Han SW, Lee HS, Im YJ, Shin HJ, Lee MJ. Superb microvascular imaging for the detection of parenchymal perfusion in normal and undescended testes in young children. Eur J Radiol. 2016 Mar;85(3):649-56. doi: 10.1016/j.ejrad.2015.12.023. Epub 2015 Dec 30. PMID: 26860680.
8. Ayaz E, Ayaz M, Önal C, Yıkılmaz A. Seeing the Unseen: Evaluating Testicular Vascularity in Neonates by Using the Superb Microvascular Imaging Ultrasound Technique. J Ultrasound Med. 2019 Jul;38(7):1847-1854. doi: 10.1002/jum.14882. Epub 2018 Dec 13. PMID: 30548880.
9. ERIKCI VS. Çocukluk çağı akut skrotum olgularında tedavi yaklaşımı: 5 yıllık deneyim. 2013.
10. Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care 2005; 21: 165-169.
11. Kurt G, Cerrah Celayir A, Şahin C, Pelin K. Testis torsiyonlu olgularda 4.5 yıllık deneyimlerimiz. Zeynep Kamil Tıp Bülteni 2017; 48: 94-98. .
12. Murphy FL, Fletcher L, Pease P. Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum. Pediatr Surg Int. 2006 May;22(5):413-6. doi: 10.1007/s00383-006-1681-0. Epub 2006 Apr 7. PMID: 16602024.
13. Lewis AG, Bukowski TP, Jarvis PD, Wacksman J, Sheldon CA. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. 1995 Feb;30(2):277-81; discussion 281-2. doi: 10.1016/0022-3468(95)90574-x. PMID: 7738751.
14. Ingram S, Hollman AS, Azmy A. Testicular torsion: missed diagnosis on colour Doppler sonography. Pediatr Radiol 1993; 23: 483-.
15. Jiang ZZ, Huang YH, Shen HL, Liu XT. Clinical Applications of Superb Microvascular Imaging in the Liver, Breast, Thyroid, Skeletal Muscle, and Carotid Plaques. J Ultrasound Med. 2019 Nov;38(11):2811-2820. doi: 10.1002/jum.15008. Epub 2019 Apr 5. PMID: 30953387.
16. Tao YK, Kennedy KM, Izatt JA. Velocity-resolved 3D retinal microvessel imaging using single-pass flow imaging spectral domain optical coherence tomography. Opt Express. 2009 Mar 2;17(5):4177-88. doi: 10.1364/oe.17.004177. PMID: 19259254; PMCID: PMC2723161.
17. Ohno Y, Fujimoto T, Shibata Y. A New Era in Diagnostic Ultrasound, Superb Microvascular Imaging: Preliminary Results in Pediatric Hepato-Gastrointestinal Disorders. Eur J Pediatr Surg. 2017 Feb;27(1):20-25. doi: 10.1055/s-0036-1593381. Epub 2016 Oct 3. PMID: 27699732.
18. Arslan FZ, Altunkeser A, Körez MK, Aksoy N, Bayramoğlu Z, Karagülle M. The Importance of Superb Microvascular Imaging for the Differentiation of Malignant Breast Lesions from Benign Lesions. Eur J Breast Health. 2021 Dec 30;18(1):48-54.
19. Barth RA, Shortliffe LD. Normal pediatric testis: comparison of power Doppler and color Doppler US in the detection of blood flow. Radiology. 1997 Aug;204(2):389-93. doi: 10.1148/radiology.204.2.9240525. PMID: 9240525.
20. Agrawal AM, Tripathi PS, Shankhwar A, Naveen C. Role of ultrasound with color Doppler in acute scrotum management. J Family Med Prim Care. 2014 Oct-Dec;3(4):409-12. doi: 10.4103/2249-4863.148130. PMID: 25657954; PMCID: PMC4311353.
21. McDowall J. "The ultrasonographic “whirlpool sign” in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis." Emergency radiology 25.3 (2018): 281-292.
22. Karaca L, Oral A, Kantarci M, Sade R, Ogul H, Bayraktutan U, Okur A, Yüce I. Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children's testicular blood flow. Eur Rev Med Pharmacol Sci. 2016 May;20(10):1947-53. PMID: 27249591.
23. Ayaz E, Ayaz M, Önal C, Yıkılmaz A. Seeing the Unseen: Evaluating Testicular Vascularity in Neonates by Using the Superb Microvascular Imaging Ultrasound Technique. J Ultrasound Med. 2019 Jul;38(7):1847-1854. doi: 10.1002/jum.14882. Epub 2018 Dec 13. PMID: 30548880.
24. Durmaz MS, Sivri M. Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow. J Med Ultrason (2001). 2018 Jul;45(3):443-452. doi: 10.1007/s10396-017-0847-9. Epub 2017 Dec 16. PMID: 29248966.
25. Ayaz E, Aslan A, İnan İ, Yıkılmaz A. Evaluation of Ovarian Vascularity in Children by Using the "Superb Microvascular Imaging" Ultrasound Technique in Comparison With Conventional Doppler Ultrasound Techniques. J Ultrasound Med. 2019 Oct;38(10):2751-2760. doi: 10.1002/jum.14983. Epub 2019 Mar 28. PMID: 30919993.