Journal of Ultrasonography最新文献

{"title":"Ultrasound-guided therapeutic injection of the surgically transposed ulnar nerve at the elbow: sonographic appearances, technique and clinical follow-up.","authors":"Christopher John Burke, Vinh Tran, Allison Weinstock, Dhruv Shankar, Ronald Adler","doi":"10.15557/jou.2026.0011","DOIUrl":"10.15557/jou.2026.0011","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the therapeutic efficacy of ultrasound-guided injection of the transposed ulnar nerve at the elbow.</p><p><strong>Methods: </strong>Fifteen patients who underwent injection of a transposed ulnar nerve between 2014-2024 were identified. Sonographic appearances of the injected segment were scored using a Likert grading system for abnormality, and the cross-sectional area (mm²) was measured. Follow-up with respect to clinical response, need for subsequent therapeutic injection or decompressive surgery was recorded.</p><p><strong>Results: </strong>The grade of abnormality was mild (<i>n</i> = 4), moderate (<i>n</i> = 5), and severe (<i>n</i> = 3), with the remainder morphologically normal (<i>n</i> = 3). Interrater agreement was 0.91 (95% CI 0.80-1.00) with <i>p</i> <0.001. Cross-sectional area ranged from 8-18 mm². Fourteen of fifteen patients (93%) experienced relief at the time of injection, decreasing to 12/15 (80%) at short-term follow-up <3 months, and further falling to 7/15 (47%) >3 months. Five patients (33%) underwent subsequent therapeutic injections, and three (20%) proceeded to revision surgery. There were no significant differences in grade between patients who experienced relief at any of the three time-points (<i>p</i> >0.05), nor differences in deformity or cross-sectional area between those who underwent subsequent injection (<i>p</i> >0.05) or surgery (<i>p</i> >0.05).</p><p><strong>Conclusion: </strong>Ultrasound-guided injection is a viable option for refractory neuropathic symptoms, although relief was often temporary, and 20% eventually required revision surgery.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260011"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragm thickening fraction as a predictor of the need for ventilatory support in the emergency department: an observational pilot study.","authors":"Carmine Cristiano Di Gioia, Alice Alame, Maria Lucrezia Grisan, Gianmarco Sicuranza, Eli Ollari, Filippo Orlando, Daniele Orso","doi":"10.15557/jou.2026.0013","DOIUrl":"https://doi.org/10.15557/jou.2026.0013","url":null,"abstract":"<p><strong>Aim: </strong>Early identification of patients likely to require ventilatory support is a key emergency department priority. Bedside diaphragm ultrasound provides a rapid assessment of respiratory muscle function, and the diaphragm thickening fraction quantifies diaphragmatic contraction during tidal breathing.</p><p><strong>Material and methods: </strong>In this prospective observational pilot study, adults with acute respiratory failure in a single emergency department underwent diaphragm ultrasound within 6 hours of presentation. The primary outcome was initiation of non-invasive ventilation or invasive mechanical ventilation from emergency department presentation through hospitalization.</p><p><strong>Results: </strong>Among 56 patients, 22 (39%) required ventilatory support. Diaphragm thickening fraction was lower in those requiring support (median 20.93% vs 29.8%; <i>p</i> = 0.006). Higher diaphragm thickening fraction was associated with lower odds of ventilatory support (OR 0.93 per 1% increase, 95% CI 0.88-0.98; <i>p</i> = 0.008). Discriminative ability was moderate (AUC 0.72, 95% CI 0.58-0.87), and the optimal cutoff was 22.1% (sensitivity 59%, specificity 71%).</p><p><strong>Conclusions: </strong>Early emergency department assessment of diaphragm thickening fraction may help identify patients at increased risk of requiring ventilatory support.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260013"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound assessment of cerebrovascular risk via breath-holding index in migraine patients treated with anti-CGRP monoclonal antibodies: a pilot study.","authors":"Gianvito Barbella, Pietro Antenucci, Vittorio Govoni, Ilaria Casetta, Maurizio Paciaroni, Marina Padroni","doi":"10.15557/jou.2026.0016","DOIUrl":"https://doi.org/10.15557/jou.2026.0016","url":null,"abstract":"<p><strong>Aim: </strong>Migraine is the second most disabling condition worldwide. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway represent an effective prophylactic treatment; however, their impact on cerebral hemodynamics remains unclear. The aim of this pilot study was to evaluate cerebrovascular risk in patients with migraine without aura treated with these therapies, by calculating the breath-holding index (BHI) of the anterior cerebral circulation using transcranial color-coded Doppler (TCCD) ultrasonography.</p><p><strong>Material and methods: </strong>Cerebral vasomotor reactivity to hypercapnia was assessed using the breath-holding test combined with TCCD ultrasonography in 40 patients with migraine without aura undergoing treatment with anti-CGRP monoclonal antibodies and 40 healthy subjects. BHI values and other key cerebrovascular parameters were compared between the groups.</p><p><strong>Results: </strong>The BHI values in patients with migraine without aura were not below the threshold predictive of increased cerebrovascular risk (less than 0.69% per second, as referenced in the general population). No significant differences were observed in major cerebrovascular parameters between cases and controls. Additionally, a subanalysis revealed no significant differences based on the specific monoclonal antibody (erenumab, fremanezumab, or galcanezumab) or clinical response status (responders versus non-responders).</p><p><strong>Conclusions: </strong>Our findings suggest that treatment with anti-CGRP monoclonal antibodies is not associated with a BHI indicative of increased cerebrovascular risk. Notably, this is the first study to include galcanezumab and fremanezumab in the evaluation of cerebrovascular risk using ultrasound, highlighting TCCD ultrasonography as a practical and non-invasive tool for the assessment of cerebrovascular reactivity in migraine.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260016"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photopic (tint) ultrasound in musculoskeletal radiology - a pilot visual-grading/acceptability study.","authors":"Sarah Lim, Hasaam Uldin, Neel Raja, Ankit Shah, Christopher Speers, Rajesh Botchu","doi":"10.15557/jou.2026.0012","DOIUrl":"https://doi.org/10.15557/jou.2026.0012","url":null,"abstract":"<p><strong>Background: </strong>While grayscale ultrasound is the standard in musculoskeletal imaging, photopic imaging, where the entire image is colorized, may enhance visual perception by leveraging human color discrimination. Despite its theoretical benefits, its clinical value remains underexplored.</p><p><strong>Objective: </strong>To assess the perceived interpretability/helpfulness, image quality, and visual appeal of photopic (tint) ultrasound imaging compared to conventional grayscale (B-mode) imaging in musculoskeletal radiology.</p><p><strong>Methods: </strong>A retrospective analysis reviewed 20 musculoskeletal cases sequentially collected from two centers. B-mode images were recolored using various tints on Siemens Acuson S2000 and GE Logiq Fortis equipment. Two final-year residents specializing in musculoskeletal radiology independently rated image quality, visual appeal, and diagnostic value on a 5-point Likert scale. Inter-rater agreement was assessed using Cohen's Kappa.</p><p><strong>Results: </strong>Tint images received consistently high scores, with a minimum rating of 4 across all categories. The images were rated a mean score of 4 for quality, visual appeal, and diagnostic value by both readers. Median and mode scores were 4 or 5 in all subcategories. High inter-rater reliability (Cohen's Kappa: 0.8) indicated strong agreement between reviewers.</p><p><strong>Conclusion: </strong>Photopic ultrasound imaging demonstrates high image quality, visual appeal, and perceived interpretability/helpfulness in musculoskeletal applications. The technique shows promise as a complementary tool to grayscale imaging, with potential benefits in teaching as well as clinical interpretation, particularly for trainees. Further research with larger cohorts and experienced radiologists is warranted.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260012"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic shear wave elastography beyond portal hypertension: a narrative review of non-portal applications.","authors":"Mattia Paratore, Silvia Andaloro, Maria Sandrina Leone, Sara Miliani, Giulia D'Acunzo, Elena Melita, Nicholas Viceconti, Fabrizio di Prisco, Fabrizio Mancuso, Francesca Romana Ponziani, Francesco Santopaolo, Antonio Gasbarrini, Laura Riccardi, Matteo Garcovich","doi":"10.15557/jou.2026.0020","DOIUrl":"https://doi.org/10.15557/jou.2026.0020","url":null,"abstract":"<p><p>Shear wave elastography is a non-invasive ultrasound technique that quantifies tissue stiffness with high reproducibility. While its role in assessing portal hypertension is well established, the spleen has recently gained attention as a potential biomarker in non-portal conditions. As a vascular and immune organ, the spleen undergoes structural and functional changes in various systemic diseases, making splenic shear wave elastography a promising diagnostic and prognostic tool. This review summarizes current evidence regarding splenic shear wave elastography in healthy individuals and in diseases beyond portal hypertension. In hematologic disorders, particularly myeloproliferative neoplasms, splenic stiffness correlates with bone marrow fibrosis, extramedullary hematopoiesis, and thrombotic complications. In cardiovascular conditions, splenic congestion reflects systemic venous pressure and has been studied in acute and chronic heart failure, as well as in congenital circulatory alterations such as Fontan physiology. Research in inherited storage diseases, transfusion-dependent anemias, and autoinflammatory syndromes suggests a role for shear wave elastography in detecting parenchymal infiltration and monitoring disease progression. Infectious diseases including brucellosis, schistosomiasis, and HIV-related vasculopathy, further highlight its sensitivity to microvascular and inflammatory changes. Pediatric studies have expanded normative reference ranges and explored applications in systemic infections and splenomegaly. Despite encouraging findings, methodological heterogeneity, variability among ultrasound platforms, and physiological confounders limit comparability across studies. Current evidence remains predominantly based on small, single-center cohorts, and disease-specific cutoff values have yet to be established. In conclusion, splenic shear wave elastography shows potential for broad clinical applicability, but standardization of protocols, multicenter validation, and integration into multiparametric ultrasound frameworks are needed before implementation in routine practice.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260020"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound in trauma: a systematic review of recent literature.","authors":"Azizul Fadzli Jusoh, Rosliza Yahaya, Mohd Hashairi Fauzi, Shaik Farid Abdull Wahab","doi":"10.15557/jou.2026.0018","DOIUrl":"https://doi.org/10.15557/jou.2026.0018","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) is a vital diagnostic tool in trauma care, providing rapid bedside imaging to improve critical decision-making. Despite its growing use, a comprehensive understanding of its efficacy remains limited compared with traditional imaging methods, particularly in resource-constrained settings. This systematic literature review aims to synthesize recent research evaluating the diagnostic accuracy and clinical utility of POCUS, and the impact of training and advancements in POCUS technology, highlighting their role in enhancing trauma care practices. Following PRISMA guidelines, a thorough search of databases such as Scopus and Web of Science was conducted, identifying peer-reviewed articles published between 2020 and 2024. A total of 110 studies were selected based on their relevance to trauma applications of POCUS. Data were extracted, analyzed, and categorized into five themes: POCUS in (1) thoracic trauma, (2) abdominal trauma, (3) musculoskeletal trauma, (4) neurological and head trauma, (5) training and technological advances. The findings indicate that POCUS significantly improves diagnostic speed and supports earlier interventions, particularly in settings with limited access to advanced imaging. Furthermore, the review highlights the potential of POCUS to reduce reliance on more invasive procedures, thereby minimizing patient risk. Despite these advantages, challenges remain in standardizing training and ensuring consistent application across varied clinical environments. This review concludes that while POCUS is an effective adjunct to traditional imaging in trauma care, its full potential can be realized only through ongoing training and continued technological advancement. These insights underscore the need for further research to optimize POCUS protocols and expand their adoption in diverse healthcare settings.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260018"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macrocystic lymphatic malformation of the gluteal region complicated by abscess formation: the crucial role of multimodal imaging in pediatric emergency care - case report and literature review.","authors":"Chiara Locorotondo, Manuela Montatore, Federica Masino, Roberto Maresca, Andrea Torrente, Giuseppe Guglielmi, Eluisa Muscogiuri","doi":"10.15557/jou.2026.0017","DOIUrl":"https://doi.org/10.15557/jou.2026.0017","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the sequential imaging findings and diagnostic utility of ultrasound and contrast-enhanced magnetic resonance imaging in a rare pediatric case of superinfected macrocystic lymphatic malformation of the gluteal region following minor trauma.</p><p><strong>Materials and methods: </strong>A 2-year-old girl with a pre-existing diagnosis of macrocystic lymphatic malformation in the gluteal region presented with acute onset of severe localized pain, fever, and erythema after sustaining blunt trauma. Laboratory tests demonstrated leukocytosis and elevated C-reactive protein, supporting the clinical suspicion of secondary infection. Initial ultrasound evaluation revealed multiple cystic lesions without internal vascularity, accompanied by surrounding soft-tissue edema. Given the concern for secondary infection, a follow-up ultrasound was performed 72 hours later, demonstrating increased vascularity of the cyst walls and internal echogenic debris consistent with superinfection. Subsequently, contrast-enhanced magnetic resonance imaging confirmed abscess formation, characterized by peripheral contrast enhancement, restricted diffusion, and extensive inflammatory changes in the surrounding soft tissues.</p><p><strong>Results: </strong>Integration of sequential imaging findings enabled early and accurate diagnosis of abscess formation within the macrocystic lymphatic malformation. This facilitated prompt initiation of targeted conservative treatment, including intravenous antibiotics and image-guided percutaneous drainage, effectively avoiding emergency surgical intervention and its potential complications.</p><p><strong>Conclusion: </strong>In pediatric patients with macrocystic lymphatic malformations, minor trauma may precipitate secondary infection and abscess development. A stepwise imaging strategy, beginning with ultrasound and supplemented by contrast-enhanced magnetic resonance imaging, is critical for early detection, precise lesion characterization, and guidance of appropriate management to minimize morbidity and improve clinical outcomes.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260017"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genicular nerves: ultrasound anatomy, scanning techniques, and clinical implications.","authors":"Stanzin Spalkit, Shashank Chapala, Kapil Shirodkar, Ankit Shah, Bipin Shah, Rajesh Botchu","doi":"10.15557/jou.2026.0019","DOIUrl":"https://doi.org/10.15557/jou.2026.0019","url":null,"abstract":"<p><p>The genicular nerves are sensory nerves that innervate the knee joint, playing a crucial role in pain transmission. Because of their small size, they are frequently underappreciated and overlooked during routine ultrasound examinations. With the advent of high-resolution ultrasound, these nerves can be visualized directly, facilitating targeted interventions. A detailed understanding of genicular nerve anatomy, ultrasound landmarks, and characteristic imaging appearances has significant clinical implications for managing knee pain. Given the high prevalence of chronic knee pain due to osteoarthritis and post-operative conditions, ultrasound-guided genicular nerve blocks and radiofrequency ablation are increasingly utilized. Traditionally, genicular nerve procedures, targeting three nerves (the superomedial, superolateral, and inferomedial genicular nerves), were performed under fluoroscopic guidance. However, ultrasound offers distinct advantages, including real-time visualization of soft tissues, the absence of radiation exposure, and precise targeting of anatomical locations using revised landmarks and Doppler signal. These advancements have enabled more comprehensive targeting of five nerves: the superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve, recurrent peroneal genicular nerve, and the infrapatellar branch of the saphenous nerve. Although ablation of the recurrent peroneal genicular nerve carries a risk of injury to the common peroneal nerve, potentially resulting in foot drop, precise localization through ultrasound-guidance may help mitigate this complication. This article provides a comprehensive review of genicular nerve anatomy, ultrasound techniques, and interventional approaches, emphasizing the clinical relevance of ultrasound-guided procedures for managing knee pain and diagnosing nerve pathologies.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260019"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratesticular varicocele: sonographic diagnosis and clinical impact.","authors":"Ashraf Talaat Youssef","doi":"10.15557/jou.2026.0014","DOIUrl":"https://doi.org/10.15557/jou.2026.0014","url":null,"abstract":"<p><p>Intratesticular varicocele is an uncommon sonographic finding that often coexists with extratesticular varicocele. Its clinical significance remains uncertain, with limited evidence regarding its effect on fertility or testicular function. This commentary discusses the peer-reviewed literature, focusing on the diagnostic features, clinical associations, and management considerations of intratesticular varicocele. Current evidence indicates that isolated intratesticular varicocele is rare and has no proven effect on semen quality or testicular volume. Management should be guided by the presence of concurrent extratesticular varicocele, as there is no established indication for direct treatment of isolated intratesticular varicocele. Further prospective studies may help clarify whether isolated intratesticular varicocele has any independent clinical significance; however, current evidence supports a cautious, observation-based approach when it is encountered in isolation.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260014"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing renal shear wave elastography: effects of probe orientation, respiration, corticomedullary differentiation, and hydration.","authors":"Andrzej Materniak, Grzegorz Jędrzejewski, Andrzej Paweł Wieczorek, Magdalena Woźniak","doi":"10.15557/jou.2026.0015","DOIUrl":"https://doi.org/10.15557/jou.2026.0015","url":null,"abstract":"<p><strong>Aim: </strong>To assess how probe orientation, respiratory phase, hydration, and corticomedullary differentiation affect renal two-dimensional shear wave elastography.</p><p><strong>Material and methods: </strong>Prospective single-center study with four independent sub-studies: (1) probe orientation (long vs. short axis; children, <i>n</i> = 35), (2) respiration (quiet breathing vs. brief mid-expiratory breath-hold; children, <i>n</i> = 20), (3) hydration (adults, <i>n</i> = 12; 700 mL water intake; stiffness at baseline, +20, +40 min), and (4) corticomedullary differentiation with depth assessment (children, <i>n</i> = 29). Shear wave elastography was acquired as five-frame series using 5-mm regions of interest. Sub-studies 1-3 sampled the cortex, whereas sub-study 4 sampled the cortex and renal pyramids at matched depths. Outcomes included per-subject median stiffness (kPa) and interquartile-range-to-median ratio (IQR/M). A quality filter (IQR/M ≤0.30) was applied to all sub-studies except the orientation sub-study. Statistical analysis included the Wilcoxon signed-rank test, Friedman test (hydration), and Spearman's ρ (depth).</p><p><strong>Results: </strong>Long-axis orientation reduced variability within measurement series (lower IQR/M) compared with short-axis orientation (<i>p</i> <0.05). Stiffness during quiet breathing and mid-expiratory breath-hold was comparable. After water intake, stiffness increased (Friedman <i>p</i> <0.05). The cortex was consistently stiffer than the renal pyramids in the same subjects (<i>p</i> <0.05), and no depth-related effect was detected (Spearman's ρ -0.24 to +0.25; all <i>p</i> ≥0.19).</p><p><strong>Conclusions: </strong>Among the four evaluated factors, probe orientation and hydration influenced renal shear wave elastography, whereas respiratory phase within the tested range did not. Corticomedullary differences should be explicitly reported when standardizing pediatric renal shear wave elastography.</p>","PeriodicalId":45612,"journal":{"name":"Journal of Ultrasonography","volume":"26 105","pages":"20260015"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}