Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules

Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.

Ultrasound elastography for evaluating stiffness of the human lens nucleus with aging:a feasibility study

AIM:To investigate the significance of ultrasound elastography for evaluating stiffness of the human lens nucleus in volunteers with different ages.METHODS:A total of 90 volunteers(lens transparency,uncorrected visual acuity≥0.5,intraocular pressure:14-19 mm Hg)were divided into 3 groups according to age:Group A(30 people,median age:82±3.5 y,mean axial lengths 23.7±0.5 mm);Group B(30 people,median age:46±2.1 y,mean axial lengths 23.9±0.4 mm);and Group C(30 people,median age:22±3.5 y,mean axial lengths 24.0±0.4 mm).Lens nuclear stiffness was measured by Free-hand qualitative elastography by independent operators.Strain gray scale and color-coded elastography maps were recorded.In each case,three consecutive detections were performed and strain ratio was used for statistical analysis.RESULTS:Elastography analysis showed excellent diagnostic performance for lens sclerosis.Lens strain ratio was lowest(0.03±0.01)%in Group A and highest(2.03±0.43)%in Group C.Lens strain ratio was moderate(0.64±0.10)%in Group B.There were significant differences between these three groups(P<0.05).The lens nucleus strain rate changes with age.With aging,the lens nucleus strain rate and resilience decrease,demonstrating harder texture.CONCLUSION:The relationship between human lens stiffness and age is demonstrated by ultrasound elastography.Older age is associated with lower strain ratio and less resilience of the lens.

Application and prospects of AI-based radiomics in ultrasound diagnosis

Artificial intelligence (AI)-based radiomics has attracted considerable research attention in the field of medical imaging, including ultrasound diagnosis. Ultrasound imaging has unique advantages such as high temporal resolution, low cost, and no radiation exposure. This renders it a preferred imaging modality for several clinical scenarios. This review includes a detailed introduction to imaging modalities, including Brightness-mode ultrasound, color Doppler flow imaging, ultrasound elastography, contrast-enhanced ultrasound, and multi-modal fusion analysis. It provides an overview of the current status and prospects of AI-based radiomics in ultrasound diagnosis, highlighting the application of AI-based radiomics to static ultrasound images, dynamic ultrasound videos, and multi-modal ultrasound fusion analysis.

Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasoundelastography

BACKGROUND Endoscopic ultrasound(EUS)and endoscopic ultrasound elastography(EUS-E)simulation lessens the learning curve;however,models lack realism,diminishing competitiveness.AIM To standardize the mechanical properties of polyvinyl alcohol(PVA)hydrogel for simulating organs and digestive lesions.METHODS PVA hydrogel(Sigma Aldrich,degree of hydrolysis 99%)for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México“Dr.Eduardo Liceaga”,Mexico City.We evaluated physical,contrast,elasticity and deformation coefficient characteristics in lesions,applying Kappa’s concordance and satisfaction questionnaire(Likert 4-points).RESULTS PVA hydrogel showed stable mechanical properties.Density depended on molecular weight(MW)and concentration(C).PVA bblocks with the greatest density showed lowest tensile strength(r=-0.8,P=0.01).Lesions were EUSgraphically visible.Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms,exceeding(MW2=146000-186000,C9=15%and C10=20%)with a density under(MW1=85000-124000,C1=7%and C2=9%).We calculated elasticity and deformation parameters of solid(blue)areas,contrasting with the norm(Kappa=0.8;high degree of satisfaction).CONCLUSION PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E,facilitating practice and reducing risk.Repetition amplified skills,while reducing the learning curve.

The value of ultrasound elastography in differential diagnosisof superficial lymph nodes

The study evaluated the value of ultrasound elastography in differentiating the benign and malignant superficial lymph nodes.A total of 112 subjects,including 82 patients with enlarged lymph nodes and 30 healthy volunteers,were recruited.All the subjects were examined by B-mode ultrasonography,power Doppler ultrasonogra-phy and elastography.Most of the patients were histo-pathologically confirmed by needle aspiration cytology and some patients were diagnosed by clinical data combined with follow-upfindings.The sensitivity,speci-ficity and accuracy of B-mode ultrasonography were 59.8%,76.5%and 67.1%,those of the bloodflow classification by power Doppler ultrasonography 77.0%,82.3%and 79.4%and those of elastographic classification 74.7%,97.1%and 84.5%,respectively.The elasticity of the lymph nodes was quantitatively measured and defined as stiffness value.When the stiffness value of 2.395 was taken as the cutoff point,the sensitivity and specificity of elastography were 78.41%and 98.51%,and the Youden index reached the highest,with the value being 0.7692.The stiffness values of two indeterminate benign lymph nodes,the elastrographicfindings of which were rated as patterns 2 and 3,were below the cutoff point.The elastographicfindings of 10 malignant lymph nodes were also classified as pattern 2 or 3.Only one of them had the stiffness values below the cutoff point.It was concluded that ultrasound elastography is a novel,noninvasive and convenient tool for the differentiation of the nature of the superficial lymph nodes in clinical practice.

Enhanced endoscopic ultrasound imaging for pancreatic lesions: The road to artificial intelligence

Early detection of pancreatic cancer has long eluded clinicians because of its insidious nature and onset.Often metastatic or locally invasive when symptomatic,most patients are deemed inoperable.In those who are symptomatic,multi-modal imaging modalities evaluate and confirm pancreatic ductal adenocarcinoma.In asymptomatic patients,detected pancreatic lesions can be either solid or cystic.The clinical implications of identifying small asymptomatic solid pancreatic lesions(SPLs)of<2 cm are tantamount to a better outcome.The accurate detection of SPLs undoubtedly promotes higher life expectancy when resected early,driving the development of existing imaging tools while promoting more comprehensive screening programs.An imaging tool that has matured in its reiterations and received many image-enhancing adjuncts is endoscopic ultrasound(EUS).It carries significant importance when risk stratifying cystic lesions and has substantial diagnostic value when combined with fine needle aspiration/biopsy(FNA/FNB).Adjuncts to EUS imaging include contrast-enhanced harmonic EUS and EUS-elastography,both having improved the specificity of FNA and FNB.This review intends to compile all existing enhancement modalities and explore ongoing research around the most promising of all adjuncts in the field of EUS imaging,artificial intelligence.

The Effect of Hamstring Stretching on Muscle Hardness and Isokinetic Muscle Performance

The purpose of this study was to clarify the effects and the time course of moderate hamstring stretching on the hardness and strength of the knee flexor muscles. Thirteen young adults performed static stretching of their hamstrings （2 minx 3 repetitions）. Before and after the static stretching, muscle hardness and concentric isokinetic torque of the knee flexors （180~/s） was determined. The hardness of the long head of the BF （biceps femoris） muscle was measured by using shear wave ultrasound elastography images. To follow the time course of the stretching effects, we determined the above parameters before, immediately after, and every 10 min for torque and every 5 min for muscle hardness until 30 min after stretching. Muscle hardness of the BF significantly decreased when compared with before the stretching （P 〈 0.001）, and remained significantly reduced until 25 min. However, the knee flexion torque did not show any change at any timing. As seen in this experiment, moderate stretching decreased the muscle hardness of the BF without a decline in the knee flexion torque. Thus, these findings suggest that moderate stretching is useful as a warm-up maneuver.

Assessment of diaphragmatic function by ultrasonography:Current approach and perspectives

This article reports the various methods used to assess diaphragmatic function by ultrasonography.The excursions of the two hemidiaphragms can be measured using two-dimensional or M-mode ultrasonography,during respiratory maneuvers such as quiet breathing,voluntary sniffing and deep inspiration.On the zone of apposition to the rib cage for both hemidiaphragms,it is possible to measure the thickness on expiration and during deep breathing to assess the percentage of thickening during inspiration.These two approaches make it possible to assess the quality of the diaphragmatic function and the diagnosis of diaphragmatic paralysis or dysfunction.These methods are particularly useful in circumstances where there is a high risk of phrenic nerve injury or in diseases affecting the contractility or the motion of the diaphragm such as neuro-muscular diseases.Recent methods such as speckle tracking imaging and ultrasound shear wave elastography should provide more detailed information for better assessment of diaphragmatic function.