Advertisement

Acoustic shadowing in pediatric kidney stone ultrasound: a retrospective study with non-enhanced computed tomography as reference standard

  • Martijn V. VerhagenEmail author
  • Tom A. Watson
  • Melissa Hickson
  • Naima Smeulders
  • Paul D. Humphries
Original Article

Abstract

Background

The usefulness of acoustic shadowing as a feature of pediatric kidney stone ultrasound (US) may be underestimated.

Objective

The hypothesis was that the majority of stones in children have acoustic shadowing and that its specificity is high (>90%) in pediatric kidney stones.

Materials and methods

Our retrospective observational study included children who had undergone abdominal non-enhanced computed tomography (CT) for kidney stones in a pediatric renal stone referral centre between 2015 and 2016. US examinations prior to CT were retrospectively assessed for US features such as acoustic shadowing, twinkle artifact and stone size. These features were compared to CT as reference standard.

Results

Thirty-one patients (median age: 13 years, range: 1–17 years) with 77 suspected kidney stones were included. The median stone size was 5 mm (interquartile range [IQR]: 5 mm). For acoustic shadowing, sensitivity was 70% (95% confidence interval [CI] 56–80%) and specificity was 100% (95% CI 56–100%). All kidney stones with a diameter ≥9 mm demonstrated shadowing. Sensitivity for twinkle artifact was 88% (95% CI 72–96%), but specificity for twinkle artifact could not be calculated due to the lack of true negatives. All false-positive stones on US demonstrated twinkle artifact, but none showed shadowing.

Conclusion

Acoustic shadowing was demonstrated in the majority of pediatric kidney stones. Specificity was high, but this was not significant. Twinkle artifact is a sensitive US tool for detecting (pediatric) kidney calculi, but with a risk of false-positive findings.

Keywords

Calculus Children Computed tomography Diagnostic accuracy Kidney Ultrasonography 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Issler N, Dufek S, Kleta R et al (2017) Epidemiology of paediatric renal stone disease: a 22-year single centre experience in the UK. BMC Nephrol 18:136CrossRefGoogle Scholar
  2. 2.
    VanDervoort K, Wiesen J, Frank R et al (2007) Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 177:2300–2305CrossRefGoogle Scholar
  3. 3.
    Sas DJ (2011) An update on the changing epidemiology and metabolic risk factors in pediatric kidney stone disease. Clin J Am Soc Nephrol 6:2062–2068CrossRefGoogle Scholar
  4. 4.
    Erotocritou P, Smeulders N, Green JSA (2015) Paediatric stones: an overview. J Clin Urol 8:347–356CrossRefGoogle Scholar
  5. 5.
    Copelovitch L (2012) Urolithiasis in children: medical approach. Pediatr Clin N Am 59:885–896CrossRefGoogle Scholar
  6. 6.
    Ahmad NA, Ather MH, Rees J (2003) Unenhanced helical computed tomography in the evaluation of acute flank pain. Int J Urol 10:287–292CrossRefGoogle Scholar
  7. 7.
    Cheng PM, Moin P, Dunn MD et al (2012) What the radiologist needs to know about urolithiasis: part 1— pathogenesis, types, assessment, and variant anatomy. AJR Am J Roentgenol 198:540–547CrossRefGoogle Scholar
  8. 8.
    Tasian GE, Pulido JE, Keren R et al (2014) Use of and regional variation in initial CT imaging for kidney stones. Pediatrics 134:909–915CrossRefGoogle Scholar
  9. 9.
    Riccabona M, Avni FE, Blickman JG et al (2009) Imaging recommendations in paediatric uroradiology: minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR annual congress, Edinburgh, UK, June 2008. Pediatr Radiol 39:891–898CrossRefGoogle Scholar
  10. 10.
    Yavuz A, Ceken K, Alimoglu E, Kabaalioglu A (2015) The reliability of color doppler “twinkling” artifact for diagnosing millimetrical nephrolithiasis: comparison with B-mode US and CT scanning results. J Med Ultrason 42:215–222CrossRefGoogle Scholar
  11. 11.
    Masch WR, Cohan RH, Ellis JH et al (2016) Clinical effectiveness of prospectively reported sonographic twinkling artifact for the diagnosis of renal calculus in patients without known urolithiasis. AJR Am J Roentgenol 206:326–331CrossRefGoogle Scholar
  12. 12.
    Dillman JR, Kappil M, Weadock WJ et al (2011) Sonographic twinkling artifact for renal calculus detection: correlation with CT. Radiology 259:911–916CrossRefGoogle Scholar
  13. 13.
    Palmer JS, Donaher ER, O’Riordan MA, Dell KM (2005) Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol 174:1413–1416CrossRefGoogle Scholar
  14. 14.
    Roberson NP, Dillman JR, O’Hara SM et al (2018) Comparison of ultrasound versus computed tomography for the detection of kidney stones in the pediatric population: a clinical effectiveness study. Pediatr Radiol 48:962–972CrossRefGoogle Scholar
  15. 15.
    Rahmouni A, Bargoin R, Herment A et al (1996) Color Doppler twinkling artifact in hyperechoic regions. Radiology 199:269–271CrossRefGoogle Scholar
  16. 16.
    Mishra SK, Ganpule A, Manohar T, Desai MR (2007) Surgical management of pediatric urolithiasis. Indian J Urol 23:428–434CrossRefGoogle Scholar
  17. 17.
    Vrtiska TJ, Hattery RR, King BF et al (1992) Role of ultrasound in medical management of patients with renal stone disease. Urol Radiol 14:131–138CrossRefGoogle Scholar
  18. 18.
    Oner S, Oto A, Tekgul S et al (2004) Comparison of spiral CT and US in the evaluation of pediatric urolithiasis. JBR-BTR 87:219–223Google Scholar
  19. 19.
    Johnson EK, Faerber GJ, Roberts WW et al (2011) Are stone protocol computed tomography scans mandatory for children with suspected urinary calculi? Urology 78:662–666CrossRefGoogle Scholar
  20. 20.
    Afshar K, McLorie G, Papanikolaou F et al (2004) Outcome of small residual stone fragments following shock wave lithotripsy in children. J Urol 172:1600–1603CrossRefGoogle Scholar
  21. 21.
    Nijman RJM, Ackaert K, Scholtmeijer RJ et al (1989) Long-term results of extracorporeal shock wave lithotripsy in children. J Urol 142:609–611CrossRefGoogle Scholar
  22. 22.
    Claudon M, Tranquart F, Evans DH et al (2002) Advances in ultrasound. Eur Radiol 12:7–18CrossRefGoogle Scholar
  23. 23.
    Cunitz BW, Dunmire B, Sorensen MD et al (2017) Quantification of renal stone contrast with ultrasound in human subjects. J Endourol 31:1123–1130CrossRefGoogle Scholar
  24. 24.
    Shabana W, Bude RO, Rubin JM (2009) Comparison between color Doppler twinkling artifact and acoustic shadowing for renal calculus detection: an in vitro study. Ultrasound Med Biol 35:339–350CrossRefGoogle Scholar
  25. 25.
    Hassani H, Raynal G, Spie R et al (2012) Imaging-based assessment of the mineral composition of urinary stones: an in vitro study of the combination of hounsfield unit measurement in noncontrast helical computerized tomography and the twinkling artifact in color Doppler ultrasound. Ultrasound Med Biol 38:803–810CrossRefGoogle Scholar
  26. 26.
    Lee JY, Kim SH, Cho JY, Han D (2001) Color and power Doppler twinkling artifacts from urinary stones: clinical observations and phantom studies. AJR Am J Roentgenol 176:1441–1445CrossRefGoogle Scholar
  27. 27.
    Chelfouh N, Grenier N, Higueret D et al (1998) Characterization of urinary calculi: in vitro study of “twinkling artifact” revealed by color-flow sonography. AJR Am J Roentgenol 171:1055–1060CrossRefGoogle Scholar
  28. 28.
    Lu W, Sapozhnikov OA, Bailey MR et al (2013) Evidence for trapped surface bubbles as the cause for the twinkling artifact in ultrasound imaging. Ultrasound Med Biol 39:1026–1038CrossRefGoogle Scholar
  29. 29.
    Dunmire B, Lee FC, Hsi RS et al (2015) Tools to improve the accuracy of kidney stone sizing with ultrasound. J Endourol 29:147–152CrossRefGoogle Scholar
  30. 30.
    Turrin A, Minola P, Costa F et al (2007) Diagnostic value of colour Doppler twinkling artefact in sites negative for stones on B mode renal sonography. Urol Res 35:313–317CrossRefGoogle Scholar
  31. 31.
    Ather MH, Jafri AH, Sulaiman MN (2004) Diagnostic accuracy of ultrasonography compared to unenhanced CT for stone and obstruction in patients with renal failure. BMC Med Imaging 4:2CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Paediatric RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
  2. 2.Department of Paediatric UrologyGreat Ormond Street Hospital for ChildrenLondonUK

Personalised recommendations