To compare sonographic parameters of the pancreas between healthy children and pediatric cystic fibrosis (CF) patients with pancreatic involvement using shear wave elastography (SWE) and to investigate the efficacy of SWE in the diagnosis of pancreatic involvement in pediatric CF patients.
The pancreas was evaluated in 38 patients with CF and 38 healthy children using conventional B-mode ultrasonography (US) and two-dimensional (2D)-SWE.
The pancreatic 2D-SWE values of the CF group were significantly lower than those of the healthy control group (1.01 ± 0.16 vs. 1.31 ± 0.01 m/s for the head, 1.03 ± 0.05 vs. 1.28 ± 0.08 m/s for the pancreatic body, and 1.02 ± 0.05 vs. 1.30 ± 0.10 m/s for the tail; p < 0.005 for all the comparisons). When the threshold values were obtained for the pancreatic head, body, and tail segments for the differentiation of the CF patients and healthy controls, the sensitivity of the test was determined as 81.5%, 76.3%, and 73.3%, respectively, and the specificity as 97.3%, 100%, and 100%, respectively. When the patients were divided into two groups based on the presence of B-mode US characteristics (homogeneity, sharp demarcation, and hyperechoic pancreas), there was a significant difference in the 2D-SWE values of the pancreatic head between the patients with and the patients without these characteristics (p = 0.048 for homogeneity, p = 0.021 for sharp demarcation, and p = 0.006 for hyperechoic pancreas).
The measurement of 2D-SWE values was found to be an easily applicable non-invasive test with high sensitivity and specificity for the demonstration of changes in the pancreas of pediatric CF patients.
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Andersen D (1938) Cystic fibrosis disease of the pancreas and its relation to celiac disease. Am J Dis Child 56:344–399
Spoonhower KA, Davis PB (2016) Epidemiology of cystic fibrosis. Clin Chest Med 37:1–8
Sheppard MN, Nicholson AG (2002) The pathology of cystic fibrosis. Curr Diagn Pathol 8:50–59
Gibson-Corley KN, Meyerholz DK, Engelhardt JF (2016) Pancreatic pathophysiology in cystic fibrosis. J Pathol 238:311–320
Yen EH, Quinton H, Borowitz D (2013) Better nutritional status in early childhood is associated with improved clinical outcomes and survival in patients with cystic fibrosis. J Pediatr 162:530–535.e1
Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H, Clinical Practice Guidelines on Growth, and Nutrition Subcommittee, Ad Hoc Working Group (2008) Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review. J Am Diet Assoc 108:832–839
Mauch RM, Kmit AH, Marson FA, Levy CE, Barros-Filho AA, Ribeiro JD (2016) Association of growth and nutritional parameters with pulmonary function in cystic fibrosis: a literature review. Rev Paul Pediatr 34:503–509
Chaudry G, Navarro OM, Levine DS, Oudjhane K (2006) Abdominal manifestations of cystic fibrosis in children. Pediatr Radiol 36:233–240
Di Serafino M, Vitale V, Severino R, Barbuto L, Vezzali N, Ferro F, Rossi E, Caprio MG, Raia V, Vallone G (2019) Pediatric ultrasonography of the pancreas: normal and abnormal findings. J Ultrasound 22:261–272
Haber HP (2007) Cystic fibrosis in children and young adults: findings on routine abdominal sonography. Am J Roentgenol 189:89–99
Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK (2017) Ultrasound elastography: review of techniques and clinical applications. Theranostics 7:1303–1329
Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography part 1: basic principles and technology. Ultraschall Med 34:169–184
Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F, Zoppo A (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18:523–531
Ferraioli G, Tinelli C, Zicchetti M, Above E, Poma G, Di Gregorio M, Filice C (2012) Reproducibility of real-time shear wave elastography in the evaluation of liver elasticity. Eur J Radiol 81:3102–3106
Cosgrove DO, Berg WA, Dore CJ, Skyba DM, Henry JP, Gay J, Cohen-Bacrie C, BE1 Study Group (2012) Shear wave elastography for breast masses is highly reproducible. Eur Radiol 22:1023–1032
Gallotti A, D'Onofrio M, Pozzi Mucelli R (2010) Acoustic radiation force impulse (ARFI) technique in ultrasound with virtual touch tissue quantification of the upper abdomen. Radiol Med 115:889–897
Kawada N, Tanaka S, Uehara H, Ohkawa K, Yamai T, Takada R, Shiroeda H, Arisawa T, Tomita Y (2014) Potential use of point shear wave elastography for the pancreas: a single center prospective study. Eur J Radiol 83:620–624
Zaro R, Lupsor-Platon M, Cheviet A, Badea R (2016) The pursuit of normal reference values of pancreas stiffness by using acoustic radiation force impulse (ARFI) elastography. Med Ultrason 18:425–430
Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, Howenstine M, McColley SA, Rock M, Rosenfeld M, Sermet-Gaudelus I, Southern KW, Marshall BC, Sosnay PR (2017) Diagnosis of cystic fibrosis: consensus guidelines from the cystic fibrosis foundation. J Pediatr 181:4–15
Yashima Y, Sasahira N, Isayama H, Kogure H, Ikeda H, Hirano K, Mizuno S, Yagioka H, Kawakubo K, Sasaki T, Nakai Y, Tada M, Yoshida H, Omata M, Koike K (2012) Acoustic radiation force impulse elastography for noninvasive assessment of chronic pancreatitis. J Gastroenterol 47:427–432
Stumpf S, Jaeger H, Graeter T, Oeztuerk S, Schmidberger J, Haenle MM, Kratzer W, Elasto-Study Group Ulm (2016) Influence of age, sex, body mass index, alcohol, and smoking on shear wave velocity (p-SWE) of the pancreas. Abdom Radiol (NY) 41:1310–1316
Saglam D, Bilgici MC, Kara C, Yılmaz GC, Çamlıdağ İ (2017) Acoustic radiation force impulse elastography in determining the effects of type 1 diabetes on pancreas and kidney elasticity in children. Am J Roentgenol 209:1143–1149
Pfahler MHC, Kratzer W, Leichsenring M, Graeter T, Schmidt SA, Wendlik I, Lormes E, Schmidberger J, Fabricius D (2018) Point shear wave elastography of the pancreas in patients with cystic fibrosis: a comparison with healthy controls. Abdom Radiol (NY) 43:2384–2390
Friedrich-Rust M, Schlueter N, Smaczny C, Eickmeier O, Rosewich M, Feifel K, Herrmann E, Poynard T, Gleiber W, Lais C, Zielen S, Wagner TO, Zeuzem S, Bojunga J (2013) Non-invasive measurement of liver and pancreas fibrosis in patients with cystic fibrosis. J Cyst Fibros 12:431–439
Freeman AJ, Ooi CY (2017) Pancreatitis and pancreatic cytosis in cystic fibrosis. J Cyst Fibros 16:79–86
The authors thank Professor Derya Ufuk Altintas, Department of Pediatric Allergy and Immunology, Balcali Hospital, Medical Faculty Cukurova University, Adana, Turkey for her assistance in the preparation of this manuscript.
The authors received no financial support for the research, authorship, and/or publication of this article.
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The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
This study was conducted in accordance with the principles of the Declaration of Helsinki after obtaining the approval of the local ethics committee (No. 305201988/28).
Written informed consent was obtained from the parents of the participants.
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Piskin, F.C., Yavuz, S., Kose, S. et al. A comparative study of the pancreas in pediatric patients with cystic fibrosis and healthy children using two-dimensional shear wave elastography. J Ultrasound (2020). https://doi.org/10.1007/s40477-020-00432-3
- Shear wave elastography
- B-mode ultrasonography
- Cystic fibrosis