Ultrafast shear-wave elastography for pediatric deep vein thrombosis: a prospective feasibility study

Area of Science:

• Pediatric imaging
• Biomaterials science
• Medical ultrasound technology

Background:

• Deep vein thrombosis (DVT) in children presents unique diagnostic and management challenges.
• Quantifying thrombus characteristics non-invasively is crucial for understanding DVT progression and treatment response.
• Current methods for assessing thrombus properties in pediatric DVT are limited.

Purpose of the Study:

• To determine the feasibility of ultrafast shear-wave elastography (SWE) for quantifying thrombus stiffness in pediatric deep vein thrombosis (DVT).
• To explore the changes in thrombus stiffness over time using SWE.
• To establish SWE as a potential non-invasive biomarker for thrombus maturation in pediatric DVT.

Main Methods:

• A prospective, single-center study enrolled pediatric patients (<18 years) with confirmed DVT.
• Bedside ultrafast SWE ultrasound was performed using a research platform with a linear transducer.
• Mean shear-wave velocity (SWV) was computed using MATLAB, with measurements planned at three time points (0-5 days, 6 days-6 weeks, 6-16 weeks post-diagnosis).

Main Results:

• Feasibility of SWE was achieved in 19 out of 35 enrolled pediatric DVT patients, with higher success rates in older children and occlusive DVTs.
• Fifteen patients had at least two successful SWE measurements, revealing a significant increase in SWV over time (0.012 m/s per day, P<0.001).
• Increased SWV was associated with older age at DVT diagnosis and female sex, independent of time.

Conclusions:

• Ultrafast SWE is a feasible technique for evaluating thrombus stiffness in pediatric DVT, particularly in older children and those with occlusive thrombi.
• Exploratory longitudinal analysis demonstrated increasing SWV over time, indicating thrombus maturation.
• Ultrafast SWE shows promise as a non-invasive quantitative biomarker for monitoring thrombus development in pediatric DVT.