Combining the age-male-albumin-bilirubin-platelets score and shear wave elastography stratifies carcinogenic risk in hepatitis C patients after viral clearance

BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect in inhibiting carcinogenesis as IFN therapy.The age-male-albumin-bilirubin-platelets(aMAP)score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients,and the velocity of shear waves(Vs)measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk.Combining these two may improve the prediction of carcinogenic risk.AIM To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.METHODS This retrospective,observational study involved hepatitis C patients treated with DAAs who achieved SVR.Vs was measured before treatment(baseline),at the end of treatment(EOT),and 12 wk(follow-up 12)and 24 wk(follow-up 24)after treatment.The patients were followed for at least six months after EOT to determine whether cancer developed.Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis.The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic(ROC)curve analyses.RESULTS A total of 279 patients(mean age 65.9 years,118 males,161 females)were included in the analysis.Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase,platelets,α-fetoprotein,Vs,and the Fib-4 index as explanatory variables;only Vs was found to be significant(P=0.0296).The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s.Carcinoma developed in 2.0%(3/151)of those with Vs<1.53 m/s and in 10.5%(9/86)of those with Vs≥1.53 m/s.CONCLUSION In hepatitis C patients after SVR,combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.

Comparative analysis of conventional ultrasound and shear wave elastography features in primary breast diffuse large B-cell lymphoma

BACKGROUND Primary breast diffuse large B-cell lymphoma(PB-DLBCL)is a rare subtype of non-Hodgkin lymphoma that accounts for<3%of extranodal lymphomas and 1%of breast tumors.Its diagnosis and management are challenging because of its rarity,heterogeneity,and aggressive behavior.Conventional ultrasound(US)is the first-line imaging modality for breast lesions;however,it has limited specificity and accuracy for PB-DLBCL.Shear wave elastography(SWE)is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.AIM To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.METHODS We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment.We analyzed conventional US features(shape,margin,orientation,echo,posterior acoustic features,calcification,and vascularity)and SWE features(mean elasticity value,standard deviation,minimum elasticity value,maximum elasticity value,and lesion-to-fat ratio)of the PB-DLBCL lesions.Using receiver operating characteristic curve analysis,we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features.We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.RESULTS The results showed that the PB-DLBCL lesions were mostly irregular in shape(84.4%),microlobulated or spiculated in margins(75%),parallel in orientation(65.6%),hypoechoic in echo(87.5%),and had posterior acoustic enhancement(65.6%).Calcification was rare(6.3%)and vascularity was variable(31.3%avascular,37.5%hypovascular,and 31.3%hypervascular).The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions(113.4±46.9 kPa vs 27.8±16.4 kPa,P<0.001).The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa,with a sensitivity of 93.8%,specificity of 92.9%,positive predictive value of 93.8%,negative predictive value of 92.9%,and accuracy of 93.3%.The mean elasticity value was also significantly correlated with Ki-67 expression level(r=0.612,P<0.001),which is a marker of tumor proliferation and aggressiveness.Survival analysis showed that patients with higher mean elasticity values(>54.5 kPa)had worse overall survival(OS)and progression-free survival(PFS)than those with lower mean elasticity values(<54.5 kPa)(P=0.038 for OS and P=0.027 for PFS).CONCLUSION Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL.SWE excels in distinguishing PB-DLBCL from benign breast lesions,reflects tumor proliferation and aggressiveness,and improves disease management.

Real-time Shear Wave Elastography Assessment of Muscle Elasticity in Patients with Renal Failure

Objective:To explore the value of real-time elastic shear wave in evaluating muscle elasticity in patients with renal failure.Methods:50 patients with chronic renal failure from January 2019 to December 2022 were randomly selected as the experimental group,and 50 healthy patients aged 21-61 during the same period were selected as the control group,and the basic information of the patients,including age,gender,body mass index,etc.,were collected.Besides,the Young's modulus of the two groups of patients were observed and analyzed.Results:The Young's modulus values of left and right gastrocnemius muscles in the experimental group were significantly lower than those in the control group(P<0.05),and there was no statistical difference between the left and right sides of the experimental group and the control group(P>0.05).Conclusion:Real-time shear wave elastography provides a non-invasive,real-time and effective tool for the assessment of muscle elasticity in patients with renal failure.Through further research and optimization,real-time shear wave elastography will play a greater role in the prevention and treatment of patients with renal failure,improving the quality of life and prognosis of patients.

Assessment of Calf Skeletal Muscle Stiffness in Diabetic Nephropathy Patients with Medial Tibial Stress Syndrome by Two-Dimensional Shear Wave Elastography

Objective:To explore the feasibility of two-dimensional shear wave elastography in evaluating calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome.Methods:A total of 48 diabetic nephropathy patients with medial tibial stress syndrome from January 2020 to December 2022 were included as the study group,and 48 patients with diabetic nephropathy during the same period were included as the control group.Both groups were detected by two-dimensional shear wave elastography with ultrasonic equipment,and Young‘s modulus of the tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle were observed and analyzed in the two groups.Results:The Young‘s modulus values of tibialis anterior muscle,tibialis posterior muscle,and gastrocnemius muscle in the study group were significantly lower than those in the control group(P<0.05).Conclusion:Two-dimensional shear wave elastography is feasible for the evaluation of calf skeletal muscle stiffness in diabetic nephropathy patients with medial tibial stress syndrome,and has high accuracy and repeatability.This technique can be used to diagnose,treat and monitor muscle lesions in patients with diabetic nephropathy,and can also be used to assess muscle fatigue and exercise capacity,which has broad application prospects.

Non-invasive assessment of liver fibrosis using twodimensional shear wave elastography in patients with autoimmune liver diseases

AIM To determine the diagnostic accuracy of two-dimensional shear wave elastography(2D-SWE) for the noninvasive assessment of liver fibrosis in patients with autoimmune liver diseases(AILD) using liver biopsy as the reference standard.METHODS Patients with AILD who underwent liver biopsy and 2D-SWE were consecutively enrolled. Receiver operating characteristic(ROC) curves were constructed to assess the overall accuracy and to identify optimal cut-off values.RESULTS The characteristics of the diagnostic performance were determined for 114 patients with AILD. The areas under the ROC curves for significant fibrosis, severe fibrosis, and cirrhosis were 0.85, 0.85, and 0.86, respectively, and the optimal cut-off values associated with significant fibrosis(≥ F2), severe fibrosis(≥ F3), and cirrhosis(F4) were 9.7 k Pa, 13.2 k Pa and 16.3 k Pa, respectively. 2D-SWE showed sensitivity values of 81.7% for significant fibrosis, 83.0% for severe fibrosis,and 87.0% for cirrhosis, and the respective specificity values were 81.3%, 74.6%, and 80.2%. The overall concordance rate of the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages was 53.5%.CONCLUSION2D-SWE showed promising diagnostic performance for assessing liver fibrosis stages and exhibited high cut-off values in patients with AILD. Low overall concordance rate was observed in the liver stiffness measurements obtained using 2D-SWE vs fibrosis stages.

Value of shear wave elastography with maximal elasticity in differentiating benign and malignant solid focal liver lesions

BACKGROUND It is important to differentiate benign and malignant focal liver lesions(FLLs)accurately.Despite the wide use and acceptance of shear wave elastography(SWE),its value for assessing the elasticity of FLLs and differentiating benign and malignant FLLs is still investigational.Previous studies of SWE for FLLs used mean elasticity as the parameter to reflect the stiffness of FLLs.Considering the inhomogeneity of tumor stiffness,maximal elasticity(Emax)might be the suitable parameter to reflect the stiffness of FLLs and to differentiate malignant FLLs from benign ones.AIM To explore the value of SWE with Emax in differential diagnosis of solid FLLs.METHODS We included 104 solid FLLs in 95 patients and 50 healthy volunteers.All the subjects were examined using conventional ultrasound(US)and virtual touch tissue quantification(VTQ)imaging.A diagnosis of benign or malignant FLL was made using conventional US.Ten VTQ values were acquired after 10 consecutive measurements for each FLL and each normal liver,and the largest value was recorded as Emax.RESULTS There were 56 cases of malignant FLLs and 48 cases of benign FLLs in this study.Emax of malignant FLLs(3.29±0.88 m/s)was significantly higher than that of benign FLLs(1.30±0.46 m/s,P<0.01)and that of livers in healthy volunteers(1.15±0.17 m/s,P<0.01).The cut-off point of Emax was 1.945,and the area under the curve was 0.978.The sensitivity and specificity of Emax were 92.9%and 91.7%,respectively,higher(but not significantly)than those of conventional US(80.4%for sensitivity and 81.3%for specificity).Combined diagnosis of conventional US and Emax using parallel testing improved the sensitivity to 100%with specificity of 75%.CONCLUSION SWE is a convenient and easy method to obtain accurate stiffness information of solid FLLs.Emax is useful for differential diagnosis of FLLs,especially in combination with conventional US.

Evaluation of internal and shell stiffness in the differential diagnosis of breast non-mass lesions by shear wave elastography

BACKGROUND The diagnostic specificity of conventional ultrasound for breast non-mass lesions(NMLs)is low at approximately 21%-43%.Shear wave elastography(SWE)can distinguish benign from malignant lesions by evaluating the internal and peripheral stiffness.SWE has good reproducibility and high diagnostic efficacy.However,there are very few independent studies on the diagnostic value of SWE in breast NMLs.AIM To determine the value of SWE in the differential diagnosis of breast NMLs.METHODS This study enrolled a total of 118 patients with breast NMLs who underwent SWE examinations in the Beijing Shijitan Hospital Affiliated to Capital Medical University and The Second Hospital of Shandong University from January 2019 to January 2020.The internal elastic parameters of the lesions were recorded,including maximum(Emax),mean(Emean)and minimum elastic values and the standard deviation.The following peripheral parameters were noted:Presence of a“stiff rim”sign;Emax,and Emean elasticity values within 1 mm,1.5 mm,2 mm,2.5 mm and 3 mm from the edge of NMLs.The receiver operating characteristic curve of each parameter was drawn,and the areas under the curve were calculated.RESULTS Emax,Emean and elastic values,and the standard deviation of the internal elastic values in malignant NMLs were significantly higher than those in benign NMLs(P<0.05).The percentage with the“stiff rim”sign in malignant NMLs was significantly higher than that in the benign group(P<0.05),and Emax and Emean at the shell of 1 mm,1.5 mm,2 mm,2.5 mm and 3 mm in the malignant group were all higher than those in the benign group(P<0.05).Of the surrounding elasticity values,Emax of the shell at 2.5 mm in malignant NMLs had maximum areas under the curve of 0.900,and the corresponding sensitivity and specificity were 94.57%and 85.86%,respectively.CONCLUSION The“stiff rim”sign and multiple quantitative elastic values within and around the lesion had good diagnostic performance in the differential diagnosis of breast NMLs.Emax in peripheral tissue had better diagnostic efficiency than other parameters.

Application of Shear Wave Elastography and Contrast-Enhanced Ultrasound in Transrectal Prostate Biopsy

Objective To explore the clinical value of ultrasound shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS)in transrectal prostate biopsy.Methods A total of 54 patients(average age:67.79±12.01 years)in the experimental group underwent transrectal prostate biopsy under the guidance of SWE,while 46 patients(average age:69.22±11.54 years)in the control group underwent transrectal prostate biopsy guided by CEUS.Results There were a total of 451 needles,with an average of 8.35±1.67 needles per patient in the experimental group,and a total of 462 needles,with an average of 10.04±1.33 needles per patient in the control group.The difference in puncture times between the two groups was statistically significant(P<0.05).There was no significant difference in the positive detection rate,sensitivity or specificity between the two groups(P>0.05),but there was a significant difference in the diagnostic accuracy between the two groups(P<0.05).The E_(mean)and E_(max)of prostate cancer were significantly higher in the experimental group than in benign prostatic hyperplasia(P<0.05).The receiver operating characteristic curve(ROC)analysis showed that the area under the ROC curve(AUC)of E_(mean)was 0.752(S.E.=0.072,95%CI=0.611-0.894,P=0.007),and the best cutoff value was 47.005 kPa.Conclusion In summary,both SWE-and CEUS-guided transrectal prostate biopsy can help find the focus and guide the puncture,and improve the positive detection rate.

Role of shear wave elastography in the evaluation of the treatment and prognosis of supraspinatus tendinitis

BACKGROUND Supraspinatus tendinitis recurs easily after treatment.One of the main reasons is the lack of objective tools for the efficacy evaluation.Shear wave elastography(SWE)can quantitatively analyze the tissue elasticity of region of interest by measuring the Young’s modulus(YM)value.AIM To explore the role of SWE in the efficacy and prognostic evaluation of supraspinatus tendinitis.METHODS Eighty-seven patients with supraspinatus tendinitis treated in Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences were recruited.Another 30 healthy volunteers were enrolled as the control group.The visual analogue scale(VAS)and Constant-Murley Score(CMS)were recorded before treatment.All participants were scanned by SWE scan,and the YM value of the region of interest were recorded.Spearman correlation analysis was performed on YM values with VAS and CMS.Univariate repeated measures analysis of variance was used to calculate the changing trend of VAS,CMS and SWE under different treatment courses.After treatment,the patients were further grouped based on who achieved significantly effective and curative treatment.The patients in the continued treatment group continued to receive treatment according to the YM value,and the remaining patients who stopped receiving treatment were included in the stopped treatment group.All patients were followed up for 1 year,and the difference in recurrence rates between the continued treatment group and the stopped treatment group were compared.RESULTS The SWE images of supraspinatus muscle in healthy volunteers were mainly blue,while those of patients with supraspinatus tendinitis showed regional red and green areas.The average YM value of the supraspinatus muscle in healthy volunteers was 26.12±4.03 kPa.The average YM value of patients with supraspinatus muscle was greater than that of healthy volunteers(average YM=60.61±11.53 kPa,t=26.344,P<0.001).The YM value was positively correlated with VAS(r=0.564,P<0.001)and negatively correlated with CMS(r=-0.411,P<0.001).The changes of VAS and CMS were the most obvious in course 1 and then decreased gradually.The degree of change in YM values was similar in different courses.After a 1-year follow-up,the cumulative relapse-free rate in the continued treatment group was 91.43%,which was significantly higher than that in the stopped treatment group(64.71%,X2=7.379,P=0.007).CONCLUSION SWE can objectively indicate the severity of supraspinatus tendinitis.Using the YM value as a criterion for curative effect may reduce the recurrence rate.

Diagnostic problems in two-dimensional shear wave elastography of the liver

Two-dimensional shear wave elastography(2D-SWE)is used in the clinical setting for observation of the liver.Unfortunately,a wide spectrum of artifactual images are frequently encountered in 2D-SWE,the precise mechanisms of which remain incompletely understood.This review was designed to present many of the artifactual images seen in 2D-SWE of the liver and to analyze them by computer simulation models that support clinical observations.Our computer simulations yielded the following suggestions:(1)When performing 2D-SWE in patients with chronic hepatic disease,especially liver cirrhosis,it is recommended to measure shear wave values through the least irregular hepatic surface;(2)The most useful 2D-SWE in patients with focal lesion will detect lesions that are poorly visible on B-mode ultrasound and will differentiate true tumors from pseudo-tumors(e.g.,irregular fatty change);and(3)Measurement of shear wave values in the area posterior to a focal lesion must be avoided.

The utility of two-dimensional shear wave elastography and texture analysis for monitoring liver fibrosis in rat model

Background:Liver fibrosis is a common pathological change caused by a variety of etiologies.Early diagnosis and timely treatment can reverse or delay disease progression and improve the prognosis.This study aimed to assess the potential utility of two-dimensional shear wave elastography and texture analysis in dynamic monitoring of the progression of liver fibrosis in rat model.Methods:Twenty rats were divided into control group(n=4)and experimental groups(n=4 per group)with carbon tetrachloride administration for 2,3,4,and 6 weeks.The liver stiffness measurement was performed by two-dimensional shear wave elastography,while the optimal texture analysis subsets to distinguish fibrosis stage were generated by MaZda.The results of elastography and texture analysis were validated through comparing with histopathology.Results:Liver stiffness measurement was 6.09±0.31 kPa in the control group and 7.10±0.41 kPa,7.80±0.93 kPa,8.64±0.93 kPa,9.91±1.13 kPa in the carbon tetrachloride induced groups for 2,3,4,6 weeks,respectively(P<0.05).By texture analysis,histogram and co-occurrence matrix had the most frequency texture parameters in staging liver fibrosis.Receiver operating characteristic curve of liver elasticity showed that the sensitivity and specificity were 95.0%and 92.5%to discriminate liver fibrosis and non-fibrosis,respectively.In texture analysis,five optimal parameters were selected to classify liver fibrosis and non-fibrosis.Conclusions:Two-dimensional shear wave elastography showed potential applications for noninvasive monitoring of the progression of hepatic fibrosis,even in mild fibrosis.Texture analysis can further extract and quantify the texture features in ultrasonic image,which was a supplementary to further visual information and acquired high diagnostic accuracy for severe fibrosis.

Differential diagnosis of different types of solid focal liver lesions using two-dimensional shear wave elastography

BACKGROUND The clinical management and prognosis differ between benign and malignant solid focal liver lesions(FLLs),as well as among different pathological types of malignant FLLs.Accurate diagnosis of the possible types of solid FLLs is important.Our previous study confirmed the value of shear wave elastography(SWE)using maximal elasticity(Emax)as the parameter in the differential diagnosis between benign and malignant FLLs.However,the value of SWE in the differential diagnosis among different pathological types of malignant FLLs has not been proved.AIM To explore the value of two-dimensional SWE(2D-SWE)using Emax in the differential diagnosis of FLLs,especially among different pathological types of malignant FLLs.METHODS All the patients enrolled in this study were diagnosed as benign,malignant or undetermined FLLs by conventional ultrasound.Emax of FLLs and the periphery of FLLs was measured using 2D-SWE and compared between benign and malignant FLLs or among different pathological types of malignant FLLs.RESULTS The study included 32 benign FLLs in 31 patients and 100 malignant FLLs in 96 patients,including 16 cholangiocellular carcinomas(CCCs),72 hepatocellular carcinomas(HCCs)and 12 liver metastases.Thirty-five FLLs were diagnosed as undetermined by conventional ultrasound.There were significant differences between Emax of malignant(2.21±0.57 m/s)and benign(1.59±0.37 m/s)FLLs(P=0.000),and between Emax of the periphery of malignant(1.52±0.39 m/s)and benign(1.36±0.44 m/s)FLLs(P=0.040).Emax of liver metastases(2.73±0.99 m/s)was significantly higher than that of CCCs(2.14±0.34 m/s)and HCCs(2.14±0.46 m/s)(P=0.002).The sensitivity,specificity and accuracy were 71.00%,84.38%and 74.24%respectively,using Emax>1.905 m/s(AUC 0.843)to diagnose as malignant and 23 of 35(65.74%)FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly.CONCLUSION Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas.2D-SWE with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.

Shear Wave Elastography of Invasive Ductal Carcinoma:Correlations between Shear Wave Velocity and Histological Prognostic Factors

The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of 76 breast tumors histologically confirmed as invasive ductal carcinomas were included in this study.SWV values were measured by VTIQ for each lesion preoperatively or prior to breast biopsy.The maximum values were recorded for statistical analysis.Medical records were reviewed to determine tumor size,histological grade,lymph node status and immunohistochemical results.Tumor subtypes were categorized as luminal A,luminal B,human epidermal growth factor receptor 2(HER2)positive and triple negative.The correlations between SWV and histological prognostic factors were analyzed.It was found that tumor size showed positive association with SWV(r=0.465,P<0.001).Larger tumors had significantly higher SWV than smaller ones(P=0.001).Histological grade 1 tumors had significantly lower SWV values than those with higher histological grade(P=0.015).The Ki67 expression,tumor subtypes and lymph node status showed no statistically significant correlations with SWV,although triple negative tumors and lymph node-positive tumors showed higher SWV values.It was concluded that tumor size was significantly associated with SWV.Higher histological grade was associated with increased SWV.There was no statistically significant correlations between SWV and other histological prognostic factors.

Shear wave elastography may be sensitive and more precise than transient elastography in predicting significant fibrosis

BACKGROUND Noninvasive measurements including transient elastography(TE)and twodimensional shear wave elastography(SWE)have been used clinically instead of liver biopsy for regular assessment of liver fibrosis in chronic hepatitis B(CHB)patients.AIM To investigate the diagnostic efficiency of SWE compared to TE by assessing independent influencing factors and performance for diagnosing significant fibrosis based on our cohort of treatment-naive CHB patients.METHODS Fifty-four treatment-naive CHB patients who underwent liver biopsy to determine whether to initiate antiviral therapy were enrolled.SWE,TE,serum tests and liver biopsy were performed for all participants.The fibrosis-4 and aspartate aminotransferase to platelet ratio index scores were also calculated.Potential independent influencing factors on SWE and TE values were analyzed.Based on liver pathology results,the agreement and correlation were determined,and a comparison of the two methods was performed.RESULTS There were 27 cases(50%)of mild fibrosis(F0-F2)and 27(50%)cases of significant fibrosis(F3-F6);fibrosis was assessed with the Ishak scoring system.Multivariate linear regression analyses revealed that the fibrosis stage was the only factor that affected the SWE values(P<0.001),whereas the total bilirubin level(P=0.013)and fibrosis stage(P=0.037)were independent factors that affected TE values.Orthogonal partial least squares discriminant analysis showed that the number of independent factors(VIP>1)was higher for TE than SWE.Bland-Altman analysis showed satisfactory agreement between liver stiffness measurements(LSMs)of SWE and TE.Both SWE and TE could significantly discriminate significant fibrosis from mild fibrosis(P<0.001).SWE exhibited a higher correlation with LSMs of liver fibrosis than TE(r=0.65 and 0.50,P<0.001).The diagnostic performance of SWE was better than that of TE for significant fibrosis(F>2).The areas under the receiver operating characteristic curves of SWE and TE were 0.786 and 0.714,respectively.The optimal LSM cutoff values of SWE and TE were 9.05 kPa and 8.15 kPa,respectively.CONCLUSION Compared to the TE value,the SWE value was less affected by other factors.SWE may be more sensitive and precise than TE in predicting significant fibrosis(>F2)in CHB patients.

Model for liver hardness using two-dimensional shear wave elastography,durometer,and preoperative biomarkers

BACKGROUND Post-hepatectomy liver failure(PHLF)increases morbidity and mortality after liver resection for patients with advanced liver fibrosis and cirrhosis.Preoperative liver stiffness using two-dimensional shear wave elastography(2D-SWE)is widely used to evaluate the degree of fibrosis.However,the 2D-SWE results were not accurate.A durometer measures hardness by quantifying the ability of a material to locally resist the intrusion of hard objects into its surface.However,the durometer score can only be obtained during surgery.To measure correlations among 2D-SWE,palpation by surgeons,and durometermeasured objective liver hardness and to construct a liver hardness regression model.METHODS We enrolled 74 hepatectomy patients with liver hardness in a derivation cohort.Tactile-based liver hardness scores(0-100)were determined through palpation of the liver tissue by surgeons.Additionally,liver hardness was measured using a durometer.Correlation coefficients for durometer-measured hardness and preoperative parameters were calculated.Multiple linear regression models were constructed to select the best predictive durometer scale.Receiver operating characteristic(ROC)curves and univariate and multivariate analyses were used to calculate the best model’s prediction of PHLF and risk factors for PHLF,respectively.A separate validation cohort(n=162)was used to evaluate the model.RESULTS The stiffness measured using 2D-SWE and palpation scale had good linear correlation with durometer-measured hardness(Pearson rank correlation coefficient 0.704 and 0.729,respectively,P<0.001).The best model for the durometer scale(hardness scale model)was based on stiffness,hepatitis B virus surface antigen,and albumin level and had an R2 value of 0.580.The area under the ROC for the durometer and hardness scale for PHLF prediction were 0.807(P=0.002)and 0.785(P=0.005),respectively.The optimal cutoff value of the durometer and hardness scale was 27.38(sensitivity=0.900,specificity=0.660)and 27.87(sensitivity=0.700,specificity=0.787),respectively.Patients with a hardness scale score of>27.87 were at a significantly higher risk of PHLF with hazard ratios of 7.835(P=0.015).The model’s PHLF predictive ability was confirmed in the validation cohort.CONCLUSION Liver stiffness assessed by 2D-SWE and palpation correlated well with durometer hardness values.The multiple linear regression model predicted durometer hardness values and PHLF.

Comparison of point and two-dimensional shear wave elastography of the spleen in healthy subjects

BACKGROUND Few systematic comparative studies of the different methods of physical elastography of the spleen are currently available.AIM To compare point shear wave and two-dimensional elastography of the spleen considering the anatomical location(upper,hilar,and lower pole).METHODS As part of a prospective clinical study,healthy volunteers were examined for splenic elasticity using four different ultrasound devices between May 2015 and April 2017.The devices used for point shear wave elastography were from Siemens(S 3000)and Philips(Epiq 7),and those used for two-dimensional shear wave elastography were from GE(Logiq E9)and Toshiba(Aplio 500).In addition,two different software versions(5.0 and 6.0)were evaluated for the Toshiba ultrasound device(Aplio 500).The study consisted of three arms:A,B,and C.RESULTS In study arm A,200 subjects were evaluated(78 males and 122 females,mean age 27.9±8.1 years).In study arm B,113 subjects were evaluated(38 men and 75 women,mean age 26.0±6.3 years).In study arm C,44 subjects were enrolled.A significant correlation of the shear wave velocities at the upper third of the spleen(r=0.33088,P<0.0001)was demonstrated only for the Philips Epiq 7 device compared to the Siemens Acuson S 3000.In comparisons of the other ultrasound devices(GE,Siemens,Toshiba),no comparable results could be obtained for any anatomical position of the spleen.The influencing factors age,gender,and body mass index did not show a clear correlation with the measured shear wave velocities.CONCLUSION The absolute values of the shear wave elastography measurements of the spleen and the two different elastography methods are not comparable between different manufacturers or models.

Diagnostic value of ACR TI-RADS combined with three-dimensional shear wave elastography in ACR TI-RADS 4 and 5 thyroid nodules

Background:Three-dimensional shear wave elastography(3D-SWE)is a promising method in distinguishing benign and malignant thyroid nodules.By combining with conventional method,it may further improve the diagnostic value.The study aimed to assess the diagnostic value of American College of Radiology(ACR)thyroid imaging reporting and data system(TI-RADS)combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.Methods:All nodules were examined by conventional ultrasonography,ACR TI-RADS classification,and 3D-SWE examination.Conventional ultrasonography was used to observe the location,size,shape,margin,echogenicity,taller-than-wide sign,microcalcification,and blood flow of thyroid nodules,and then ACR TI-RADS classification was performed.The Young’s modulus values(3D-C-Emax,3D-C-Emean,and elastography standard deviation[3D-C-Esd])were measured on the reconstructed coronal plane images.According to the receiver operating characteristic(ROC)curve,the best diagnostic efficiency among 3D-C-Emax,3D-C-Emean,and 3D-C-Esd was selected and the cut-off threshold was calculated.According to the surgical pathology,they were divided into benign group and malignant group.And appropriate statistical methods such as t-test and Mann-Whitney U test were used to compare the difference between the two groups.On this basis,3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.Results:Of the 112 thyroid nodules,62 were malignant and 50 were benign.The optimal cut-off value of three-dimensional maximum Young’s modulus in coronal plane(3D-C-Emax)was 51.5 kPa and the area under the curve(AUC)was 0.798.The AUC,sensitivity,specificity,and accuracy of conventional ACR TI-RADS were 0.828,83.9%,66.0%,and 75.9%,respectively.The AUC,sensitivity,specificity,and accuracy of combined ACR TI-RADS were 0.845,90.3%,66.0%,and 79.5%,respectively.The difference between the two AUC values was statistically significant.Conclusions:Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS.The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements.It can be used as an effective method in the diagnosis of thyroid nodules.

Quantitative Ultrasound Elastography of Breast: A Review and Update with Emphasis on Shear Wave Imaging (ARFI)

Elastography is a method which determines the stiffness of tissues with the help of ultrasound technology and exhibits more quantitative data according to palpation that made during physical examination. Elastography has relatively entered to routine use in the breast evaluation with imaging techniques. Although palpation has a very long history, elastography has been used since 1990s. Elastography is used as an adjunct to conventional gray scale ultrasound and can identify the stiffness of the tissues non-invasively. Today, it is used as two separate technological modalities: strain elastography and shear wave elastography. The aims of these modalities are to increase the sensitivity of the separation between malignant and benign lesions, reduce the unnecessary biopsy processes and to provide a more accurate Breast Imaging Reporting and Data System (BIRADS) categorization of the breast lesions. In this article, we aimed to review the clinical utilization and benefits of elastography in differantial diagnosis of breast lesions, BIRADS categorization, and biopsy decision making in the light of current literature.

Quantitative assessment of the aging corpus cavernosum by shear wave elastography

We wanted to determine whether shear wave elastography(SwE)could be used to evaluate the aging degree of the corpus cavernosum(CC)and to identify the histological basis of changes in SWE measurements during the aging process.We performed a crosssectional study enrolling healthy participants of different ages.We measured the Young's modulus(YM)of the penile CCs by SWE and assessed erectile function using the International Index of Erectile Function-5(IIEF-5).Histological investigation was performed in surgically resected penile specimens from a separate group of patients to examine the smooth muscle and collagen content of the CCs.Furthermore,we measured the YM,erectile function,smooth muscle,and collagen content of the CCs in different age groups of rats.Finally,we enrolled 210 male volunteers in this study.The YM of the CC(CCYM)was positively correlated with age(r=0.949,P<0.01)and negatively correlated with erectile function(r=-0.843,P<0.01).Histological examinations showed that cCs had increased collagen content but decreased smooth muscle content with increased age.The same positive correlation between CcYM and age was also observed in the animal study.In addition,the animal study showed that older rats,with increased CcYM and decreased erectile function,had lower smooth muscle content and higher collagen content.SwE can noninvasively and quantitatively evaluate the aging degree of the Cc.Increased collagen content and decreased smooth muscle content might be the histological basis for the effect of aging on the CC and the increase in its YM.

Noninvasive Assessment of Liver Fibrosis and Inflammation in Chronic Hepatitis B:A Dual-task Convolutional Neural Network(DtCNN)Model Based on Ultrasound Shear Wave Elastography

Background and Aims:Liver stiffness(LS)measured by shear wave elastography(SWE)is often influenced by hepat-ic inflammation.The aim was to develop a dual-task convo-lutional neural network(DtCNN)model for the simultaneous staging of liver fibrosis and inflammation activity using 2D-SWE.Methods:A total of 532 patients with chronic hepatitis B(CHB)were included to develop and validate the DtCNN model.An additional 180 consecutive patients between De-cember 2019 and April 2021 were prospectively included for further validation.All patients underwent 2D-SWE examina-tion and serum biomarker assessment.A DtCNN model con-taining two pathways for the staging of fibrosis and inflam-mation was used to improve the classification of significant fibrosis(≥F2),advanced fibrosis(≥F3)as well as cirrhosis(F4).Results:Both fibrosis and inflammation affected LS measurements by 2D-SWE.The proposed DtCNN performed the best among all the classification models for fibrosis stage[significant fibrosis AUC=0.89(95%CI:0.87-0.92),ad-vanced fibrosis AUC=0.87(95%CI:0.84-0.90),liver cirrho-sis AUC=0.85(95%CI:0.81-0.89)].The DtCNN-based pre-diction of inflammation activity achieved AUCs of 0.82(95%CI:0.78-0.86)for grade≥A1,0.88(95%CI:0.85-0.90)grade≥A2 and 0.78(95%CI:0.75-0.81)for grade≥A3,which were significantly higher than the AUCs of the single-task groups.Similar findings were observed in the prospec-tive study.Conclusions:The proposed DtCNN improved di-agnostic performance compared with existing fibrosis staging models by including inflammation in the model,which sup-ports its potential clinical application.