Application of real-time shear wave elastography to Achilles tendon hardness evaluation in older adults

BACKGROUND Real-time shear wave elastography(SWE)is a non-invasive imaging technique used to measure tissue stiffness by generating and tracking shear waves in real time.This advanced ultrasound-based method provides quantitative information regarding tissue elasticity,offering valuable insights into the mechanical properties of biological tissues.However,the application of real-time SWE in the musculoskeletal system and sports medicine has not been extensively studied.AIM To explore the practical value of real-time SWE for assessing Achilles tendon hardness in older adults.METHODS A total of 60 participants were enrolled in the present study,and differences in the elastic moduli of the bilateral Achilles tendons were compared among the following categories:(1)Age:55-60,60-65,and 65-70-years-old;(2)Sex:Male and female;(3)Laterality:Left and right sides;(4)Tendon state:Relaxed and tense state;and(5)Tendon segment:Proximal,middle,and distal.RESULTS There were no significant differences in the elastic moduli of the bilateral Achilles tendons when comparing by age or sex(P>0.05).There were,however,significant differences when comparing by tendon side,state,or segment(P<0.05).CONCLUSION Real-time SWE plays a significant role compared to other examination methods in the evaluation of Achilles tendon hardness in older adults.

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 Fibrosis during the Development of Fatty Liver in Rabbits using Real-time Shear-wave Elastography

Nonalcoholic and alcoholic rabbit models of fatty liver were established by feeding on high-fat diet and alcohol, respectively, and fatty liver stiffness at different pathological stages was as- sessed with real-time shear-wave elastography （SWE）, so as to investigate the fibrosis process during the development of fatty liver. The fatty liver stiffness of rabbit in nonalcoholic and alcoholic groups was higher than that in the control group, and that in alcohol group was higher than that in the nonalco- holic group （P〈0.01）. The elasticity modulus of liver in fatty liver rabbits of nonalcoholic and alcoholic groups showed a positive correlation with progression of liver fibrosis （P〈0.01）. Real-time SWE, as a noninvasive diagnostic method, can objectively reflect the liver stiffness change and progression of liver fibrosis during the development of fatty liver.

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.

A Modified Monte Carlo Model of Speckle Tracking of Shear Wave Induced by Acoustic Radiation Force for Acousto-Optic Elasticity Imaging

A modified Monte Carlo model of speckle tracking of shear wave propagation in scattering media is proposed. The established Monte Carlo model mainly concerns the variations of optical electric field and speckle. The two- dimensional intensity distribution and the time evolution of speckles in different probe locations are obtained. The fluctuation of speckle intensity tracks the acoustic-radiation-force shear wave propagation, and especially the reduction of speckle intensity implies attenuation of shear wave. Then, the shear wave velocity is estimated quantitatively on the basis of the time-to-peak algorithm and linear regression processing. The results reveal that a smaller sampling interval yields higher estimation precision and the shear wave velocity is estimated more efficiently by using speckle intensity difference than by using speckle contrast difference according to the estimation error. Hence, the shear wave velocity is estimated to be 2.25 m/s with relatively high accuracy for the estimation error reaches the minimum （0.071）.

Micro-failure process and failure mechanism of brittle rock under uniaxial compression using continuous real-time wave velocity measurement

In this study,the micro-failure process and failure mechanism of a typical brittle rock under uniaxial compression are investigated via continuous real-time measurement of wave velocities.The experimental results indicate that the evolutions of wave velocities became progressively anisotropic under uniaxial loading due to the direction-dependent development of micro-damage.A wave velocity model considering the inner anisotropic crack evolution is proposed to accurately describe the variations of wave velocities during uniaxial compression testing.Based on which,the effective elastic parameters are inferred by a transverse isotropic constitutive model,and the evolutions of the crack density are inversed using a self-consistent damage model.It is found that the propagation of axial cracks dominates the failure process of brittle rock under uniaxial loading and oblique shear cracks develop with the appearance of macrocrack.

Stress-dependent shear wave splitting and permeability in fractured porous rock

It is well known that shear wave propagates slower across than parallel to a fracture, and as a result, a travelling shear wave splits into two directions when it encounters a fracture. Shear wave splitting and permeability of porous rock core samples having single fracture were experimentally investigated using a high-pressure triaxial cell, which can measure seismic shear wave velocities in two directions mutually perpendicular to the sample axis in addition to the longitudinal compressive wave velocity. A single fracture was created in the samples using a modified Brazilian split test device, where the cylindrical sample edges were loaded on two diametrically opposite lines by sharp guillotines along the sample length. Based on tilt tests and fracture surface profilometry, the method of artificially induced tensile fracture in the sample was found to create repeatable fracture surfaces and morphologies. Seismic velocities of the fractured samples were determined under different levels of stress confinement and fracture shear displacement or mismatch. The effective confining stress was varied from 0.5 MPa to55 MPa, while the fractures were mismatched by 0 mm, 0.45 mm and 1 mm. The degree of matching of the fracture surfaces in the core samples was evaluated using the joint matching coefficient(JMC). Shear wave splitting, as measured by the difference in the magnitudes of shear wave velocities parallel(V_(S1))and perpendicular(V_(S2)) to the fracture, is found to be insensitive to the degree of mismatching of the fracture joint surfaces at 2 MPa, and decreased and approached zero as the effective stress was increased.Simple models for the stress-and JMC-dependent shear wave splitting and fractured rock permeability were developed based on the experimental observations. The effects of the joint wall compressive strength(JCS), JMC and stress on the stress dependency of joint aperture were discussed in terms of hydro-mechanical response. Finally, a useful relationship between fractured rock permeability and shear wave splitting was found after normalization by using JMC.

DEVELOPMENT OF A GENERIC ULTRASOUND VIBRO-ACOUSTIC IMAGING PLATFORM FOR TISSUE ELASTICITY AND VISCOSITY

Tissue elasticity and viscosity are always associated with pathological changes.As a new imaging method,ultrasound vibro-acoustic imaging is developed for quantitatively measuring tissue elasticity and viscosity which have important significance in early diagnosis of cancer.This paper developed an ultrasound vibro-acoustic imaging research platform mainly consisting of excitation part and detection part.The excitation transducer was focused at one location within the medium to generate harmonic vibration and shear wave propagation,and the detection transducer was applied to detect shear wave at other locations along shear wave propagation path using pulse-echo method.The received echoes were amplified,filtered,digitized and then processed by Kalman filter to estimate the vibration phase.According to the phase changes between different propagation locations,we estimated the shear wave speed,and then used it to calculate the tissue elasticity and viscosity.Preliminary phantom experiments based on this platform show results of phantom elasticity and viscosity close to literature values.Upcoming experiments are now in progress to obtain quantitative elasticity and viscosity in vitro tissue.

Bulk Waves in the Infinite Electric-Magnetic-Elastic Plate with Mixed Boundary Conditions

A dynamic solution is presented for the propagation of waves in an electric-magneto-elastic plate composed of piezoelectric, piezomagnetic materials and elastic matrix. The electric-magneto-elastic plate is polarized along the thickness direction. The generalized displacements are expressed as the sum of the gradient of a scalar (dilatation wave) and the curl of a vector (shear wave). With the help of dynamic equilibrium equations and geometric equations, we can obtain dynamic equations of the dilatation wave and the shear wave. The conclusion that the types of the dilatation waves and the shear waves remain unchanged after being reflected by the boundary can be obtained through the analysis of these kinetic equations. The dispersion properties and phase velocity surface of the dilatation and shear wave can be obtained by solutions of dynamic equilibrium equations. Influences of the piezoelectric and piezomagnetic parameters on wave characteristics are discussed.

SWE定量评估孕妇胆汁淤积综合征的临床价值

目的 探讨实时剪切波弹性成像(SWE)定量评估孕妇胆汁淤积综合征(CS)的临床价值。方法 选择本院就诊的CS孕妇121例(CS组)及正常孕妇115例(对照组)。比较两组一般资料及胆汁酸、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素水平;ROC分析SWE对孕妇胆汁淤积综合征的诊断效能。结果 CS组孕周、肝脏弹性值、胆汁酸、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素均高于对照组(P<0.05)。控制了年龄、孕周、谷丙转氨酶、谷草转氨酶、总胆红素及直接胆红素之后,肝脏弹性值每增大1 kPa,CS风险增加7.966倍。肝脏弹性值诊断CS的ROC下面积为0.910(0.873,0.946),最佳分界点为肝脏弹性值6.44 kPa,此时的灵敏度和特异度分别为75.7%和96.7%,约登指数为0.724。结论 实时剪切波弹性成像能够在早期准确、无创评估孕妇胆汁淤积综合征的肝脏情况,对CS的早期诊断、治疗和干预有较高的临床价值。

基于声辐射力脉冲成像的诊断模型对胆道闭锁患儿肝纤维化的应用价值

目的分析基于声辐射力脉冲成像(ARFI)定量参数建立的无创诊断模型对胆道闭锁患儿肝纤维化的诊断价值。方法回顾性收集100例接受ARFI检查并行肝门-空肠吻合术(Kasai’s)治疗及肝组织活检的胆道闭锁患儿,男42例,女58例,平均年龄(68.79±8.79)d。根据活检病理结果分为肝纤维化组(71例)和非肝纤维化组(29例)。依据Metavir分级标准将肝纤维化分为5级:F0(29例)、F1(31例)、F2(24例)、F3(11例)、F4(5例)。2组临床资料和ARFI定量参数的比较采用t检验或χ^(2)检验;采用单因素方差分析比较肝纤维化不同分级间的剪切波速度(SWV)。采用多因素Logistic回归分析影响胆道闭锁患儿发生肝纤维化的独立危险因素,并构建基于ARFI定量参数的无创诊断模型。采用受试者操作特征(ROC)曲线评价模型的诊断效能,计算其曲线下面积(AUC)。结果肝纤维化组血清中性粒细胞(NEUT)、总胆红素(TBIL)、层黏蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-Col)浓度,以及SWV均高于非肝纤维化组(均P<0.05)。多因素Logistic回归分析结果显示,SWV、血清TBIL及LN、HA、PCⅢ、Ⅳ-Col浓度高是影响胆道闭锁患儿发生肝纤维化的危险因素(均P<0.05)。基于SWV的无创诊断模型诊断胆道闭锁患儿发生肝纤维化的最佳临界值为1.75 m/s,敏感度、特异度、准确度、阳性预测值、AUC分别为93.15%、70.09%、90.25%、88.80%、0.922。结论基于ARFI定量参数建立的无创诊断模型,可较为准确地诊断出胆道闭锁患儿是否存在肝纤维化,且具有较高的应用价值。

二维超声剪切波弹性成像技术肝脏硬度测量在非酒精性脂肪性肝病疾病严重程度预测中的应用价值

目的 研究二维超声剪切波弹性成像技术(2D-SWE)肝脏硬度测量在非酒精性脂肪性肝病(NAFLD)疾病严重程度预测中的应用价值。方法 研究方法为回顾性分析,观察对象为2019年9月至2023年10月皖南医学院附属宣城市医院(宣城市人民医院)收治入院的122例NAFLD患者,设为研究组,并选取同一时期入院的122例健康体检者,设为对照组。两组研究对象均接受2D-SWE检查,比较肝硬度值。同时,参考脂肪性病变程度将研究组122例患者分为轻度组(n=63)与中重度组(n=59)。比较两组患者体重指数、生化指标[总胆红素、空腹血糖、高密度脂蛋白(HDL)、糖化血红蛋白(HbA1c)、甘油三酯、总胆固醇、低密度脂蛋白(LDL)],分析研究组2D-SWE硬度值与体重指数、生化指标的相关性,并分析2D-SWE硬度值对NAFLD严重程度的预测价值。结果 研究组患者的肝硬度值为(12.08±3.04) kPa,高于对照组[(6.98±2.93) kPa],差异有统计学意义(P<0.05)。中重度组肝硬度值为(12.28±3.07) kPa,高于轻度组[(8.39±2.76) kPa],轻度组、中重度组肝硬度值均高于对照组[(6.98±2.93) kPa],差异均有统计学意义(P<0.05)。中重度组患者的体重指数、空腹血糖、HbA1c、甘油三酯、总胆固醇、LDL水平分别为(31.12±4.34) kg/m^(2)、(6.24±0.76)μmol/L、(6.18±0.53) mmol/L、(3.16±0.58) mmol/L、(0.79±0.14) mmol/L、(3.26±0.75) mmol/L,均高于轻度组[(27.48±2.19) kg/m^(2)、(5.36±0.58)μmol/L、(5.27±0.36) mmol/L、(2.08±0.47) mmol/L、(0.61±0.13)mmol/L、(2.77±0.89) mmol/L],差异均有统计学意义(P<0.05)。经Pearson分析,研究组患者肝硬度与体重指数、空腹血糖、HbA1c、甘油三酯、总胆固醇、LDL均呈正相关(r=0.270、0.219、0.215、0.234、0.233、0.264,均P<0.05)。NAFLD程度预测中肝硬度值的受试者工作特征(ROC)曲线下面积为0.908,标准差0.025,P<0.01,95%置信区间(CI)为0.857~0.959。结论 NAFLD检查中2D-SWE肝脏硬度测量效果显著,肝脏硬度值与NAFLD密切相关,且可辅助预测患者疾病严重程度。

VTIQ实时剪切波弹性成像技术、 CDFI在甲状腺癌诊疗评估中的应用观察

目的 探讨声触诊组织成像与定量技术(VTIQ)实时剪切波弹性成像技术、彩色多普勒超声(CDFI)在甲状腺癌诊疗评估中的应用效果。方法 选取2021年11月—2023年6月大同市第五人民医院甲状腺癌患者91例设为恶性组,另选取同期收治的甲状腺良性结节患者91例设为良性组,两组均分别接受VTIQ实时剪切波弹性成像技术、CDFI检查。统计恶性组与良性组、恶性组不同病理特征(淋巴结转移情况、疾病分期)患者、不同预后患者VTIQ[病灶组织剪切波速度(SMV)]及CDFI参数[舒张末期血流速度(EDV)、收缩期峰值流速(PSV)、血流阻力指数(RI)],分析VTIQ及CDFI参数与甲状腺癌淋巴结转移及疾病分期的关联性。结果 恶性组SMV平均值、PSV、RI高于良性组,EDV低于良性组(P<0.05)。淋巴结转移、Ⅲ~Ⅳ期甲状腺癌患者SMV平均值、PSV、RI高于无淋巴结转移、Ⅰ~Ⅱ期患者;EDV低于无淋巴结转移、Ⅰ~Ⅱ期患者(P<0.05)。检验可知,SMV平均值、PSV、RI与甲状腺癌淋巴结转移、疾病分期呈显著正相关,EDV与甲状腺癌淋巴结转移、疾病分期呈显著负相关(P<0.05)。预后不良组SMV平均值、PSV、RI高于预后良好组,EDV低于预后良好组(P<0.05)。结论 通过VTIQ实时剪切波弹性成像技术、CDFI检查,可明确甲状腺癌病灶信息,在疾病诊疗评估中具有较高应用价值。

多模态超声定量评价涎腺与增龄的相关临床研究

目的:高分辨率超声多模态成像定量评价涎腺与增龄的相关临床研究。方法:选用对不同年龄阶段(20~80岁)涎腺350例,按青年组(18~40岁)、中年A组(41~50岁)、中年B组(51~65)、老年组(>65岁)分组,采用15MHZ高频超声,进行2D、彩色多普勒及剪切波弹性成像超声检查。总结收集腮腺、颌下腺的大小、血管内径、血供状态及腺体组织的杨氏模量值。观察各个定量测值与增龄之间的相关性。结果:增龄过程中,腮腺、颌下腺在中年期左右径、厚径均增大,到老年期腮腺左右径变化不明显,但厚径变薄,颌下腺到老年期左右径、厚径均变小;增龄过程中,腮腺、颌下腺血管内径变化不明显,颌下腺最大血液流速中年B组VMAX减低,阻力指数增高,老年期有低阻力变成高阻力,腮腺内血流及阻力指数变化不大;增龄过程中,腮腺杨氏模量测值变化都不明显,颌下腺青年期男女性别间有差异,女性较男性硬,青年组、中年A、B组间变化不明显,而老年组变低。结论:多模态超声可定量评价涎腺相关数据。

基于超声剪切波弹性成像与红热外成像技术探讨浮针治疗子宫腺肌病痛经的研究

目的基于超声剪切波弹性成像与红热外成像技术探讨浮针治疗子宫腺肌病痛经的效果。方法选取2021年1月至2022年12月广州中医药大学第一附属医院收治的84例子宫腺肌病痛经患者作为研究对象,按照随机数字表法分为对照组和观察组,每组42例。对照组予以常规药物治疗,观察组在此基础上予以浮针治疗。比较两组患者临床疗效、视觉模拟评分法(VAS)评分、COX痛经症状量表(CMSS)评分、弹性特征量测值及红外线热成像分布图。结果观察组患者总有效率(95.24%)高于对照组(78.57%),差异有统计学意义(P<0.05)。治疗前,两组患者VAS评分比较,差异无统计学意义(P>0.05);治疗第1个月经周期,观察组VAS评分低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者痛经症状持续时间、严重程度评分比较,差异无统计学意义(P>0.05);治疗第1个月经周期,观察组痛经症状持续时间、严重程度评分均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组标准偏差、应变均值、均等性、对比度低于对照组,观察组复杂度、蓝色区域所占百分比、峰度、偏度、杂乱性、相关性、一致性高于对照组,差异有统计学意义(P<0.05)。红外线热成像分布图显示,观察组高温区及分布减少程度优于对照组。结论浮针可以有效缓解子宫腺肌病痛经时间及严重程度,减轻患者疼痛,临床疗效及安全性较高。

基于主动超声激励的岩石节理刚度分布测量研究

Goodman提出采用节理刚度表征复杂岩石节理面的拓扑行为并为其提供定量值,而无需对节理面的粗糙度、接触面积等参数进行详细测量分析。然而目前对岩石节理刚度的测量仍存在局限,因此,在试验室环境下采用压电陶瓷换能器对完整平板试件和含节理平板试件进行弹性波激励,同时采用三维扫描激光多普测振仪监测平板内弹性波的传播数据。将采集的波场信号数据进行滤波、插值、积分等一系列处理,并基于Schoenberg线性滑移模型计算节理刚度分布,实现岩石节理接触行为的全局参数表征,同时进一步验证了岩石节理全场超声表征的可行性。全场波形数据清晰地揭示了岩石节理界面接触行为,为后续深入探索岩石节理几何形状、孔径、界面性质及其地震特征之间的相互关系奠定了基础。

多模态超声检查特征对乳腺癌Ki-67、CMTM6表达的预测价值

目的 探讨多模态超声检查特征对乳腺癌Ki-67、趋化素样因子MARVEL跨膜结构域包含6(CMTM6)表达的预测价值。方法 选取接受手术治疗及病理证实的145例乳腺癌患者,术前进行常规超声检查、剪切波弹性成像(SWE)和超声造影(CEUS)检查,免疫组织化学法检测Ki-67、CMTM6的表达。多因素logistic回归分析多模态超声检查特征对Ki-67、CMTM6表达的预测价值。结果 乳腺癌组织Ki-67、CMTM6表达阳性率分别为90.34%(131/145)、88.97%(129/145),均高于癌旁正常乳腺组织9.66%(14/145)、11.03%(16/145),差异有统计学意义(χ^(2)=198.7、199.1,P均<0.001)。常规超声检查肿块形态、肿块边界和有无微钙化与乳腺癌Ki-67、CMTM6表达差异均有统计学意义(P均<0.05)。SWE征象中硬环征、黑洞征与乳腺癌Ki-67、CMTM6表达差异均有统计学意义(P均<0.05)。CEUS特征以早增强、晚消退灌注与乳腺癌Ki-67、CMTM6表达差异均有统计学意义(P均<0.05)。logistic回归分析显示,肿块形态不规则、边界不清楚、微钙化、硬环征、黑洞征及早增强、晚消退灌注是乳腺癌Ki-67、CMTM6阳性表达的独立预测因素。结论 多模态超声检查特征可用于预测乳腺癌Ki-67、CMTM6的表达,从而为乳腺癌的诊治提供依据。

超声E成像无创定量评价慢性肝病肝纤维化临床研究

目的应用超声E成像(即剪切波弹性成像,SWE)技术对慢性肝病患者进行检测和分析,探讨该技术在无创定量评价慢性肝病肝纤维化程度中临床应用价值。方法选择2019年8月至2021年7月在南京中医药大学附属医院就诊的慢性肝病患者148例,其中男性56例,女性92例;年龄17~75岁,平均年龄48.9岁;身高1.47~1.87 m,平均身高1.65 m;体质量44~106 kg,平均体质量65.50 kg;身体质量指数(BMI)17.51~35.85 kg/m^(2),平均BMI 24.00 kg/m^(2);疾病类型,病毒性肝炎44例,代谢相关脂肪性肝病36例,自身免疫性肝炎22例,药物性肝炎20例,原发性胆汁性胆管炎26例。对所有患者肝脏均应用SWE技术进行检测并行超声引导下肝脏组织穿刺活检,以病理诊断为金标准,对肝脏SWE弹性测值与肝脏纤维化分期关系进行统计学分析。结果经病理诊断,慢性肝病有肝纤维化患者130例,无纤维化患者18例。两者SWE弹性测值、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBiL)、直接胆红素(DBiL)及高密度脂蛋白胆固醇(HDL-C)比较,差异均有统计学意义[(9.34±4.73)kPa vs(6.24±1.46)kPa,(147.89±62.79)U/L vs(73.32±34.78)U/L,(270.56±60.95)U/L vs(105.94±52.97)U/L,(57.12±10.82)μmol/L vs(20.57±5.01)μmol/L,(38.41±7.95)μmol/L vs(9.35±4.88)μmol/L,(1.35±0.36)mmol/L vs(1.39±0.84)mmol/L。t=2.755、1.972、2.615、3.898、3.957、0.359,P<0.05]。对慢性肝病肝纤维化组患者SWE弹性测值与各项指标间进行相关分析显示,SWE弹性测值与年龄(r=0.338)、纤维化分期(r=0.736)、血糖(GLU)(r=0.174)及凝血酶原时间(PT)(r=0.424)呈正相关(P<0.05)。SWE技术对慢性肝病肝纤维化诊断效能分析,受试者工作特性(ROC)曲线分析结果显示,应用SWE技术诊断慢性肝病肝纤维化S0/S1期、S1/S2期、S2/S3期及S3/S4期SWE弹性测值截断值分别为6.35 kPa、7.65 kPa、8.35 kPa、17.30 kPa,其曲线下面积(AUC)分别为0.736[95%可信区间(CI)0.628~0.844]、0.751(95%CI 0.657~0.845)、0.803(95%CI 0.680~0.927)及0.752(95%CI 0.566~0.939)。结论SWE技术作为一种实时超声弹性成像技术,操作简便、无创,患者接受度高,其弹性测值可用来无创定量评价慢性肝病肝纤维化及其分期,具有良好的临床应用前景。

实时二维超声剪切波弹性成像在慢性乙型肝炎肝纤维化分期中的临床应用

目的探讨实时二维超声剪切波弹性(2D shear wave elasticity,2D-SWE)成像检测杨氏模量在慢性乙型肝炎(chronic hepatitis b,CHB)肝纤维化分期中的应用价值。方法选取我院2019年1月至2022年12月诊治为CHB肝纤维化分期患者117例,分别行二维超声检查及2D-SWE检查,二维超声以M0、M1为阴性,以M2、M3、M4为阳性组,SWE以E1级为阴性组,以E2、E3、E4级为阳性组,进行对比研究,并观察SWE杨氏模量值与病理分期的相关性。结果2D-SWE与二维超声评估CHB肝纤维化相比,诊断效能明显提高,ROC曲线下面积分别为:0.915、0.752,P值均<0.05,具有统计学意义;SWE弹性模量与病理分期成正相关,r值0.903。结论2D-SWE在评价慢性乙型肝炎肝纤维化中,与临床病理分期具有高度相关性,且比二维超声具有更可靠的诊断价值。

基于剪切波弹性成像评价颈肩痛与斜角肌的关系

背景:在临床工作中,医疗人员主要以触诊的方法评估颈肩痛患者颈部软组织的僵硬程度,主观性强,缺乏客观依据。实时剪切波弹性成像是一种定量弹性超声技术,能够客观评估肌肉组织弹性值,评价肌肉状态。目的:应用实时剪切波弹性成像评估颈肩痛患者斜角肌的僵硬程度,观察颈肩痛患者双侧前斜角肌与中后斜角肌的肌肉硬度变化特征。方法:于2021年12月至2022年6月在广州中医药大学深圳医院(福田)招募健康者受试者(对照组)36例和颈肩痛患者(试验组)36例,在颈部中立位及侧屈位时,应用实时剪切波弹性成像测量两组双侧前、中后斜角肌弹性模量平均值及横截面积。结果与结论:①在相同体位下,两组组内左侧与右侧前斜角肌的弹性模量平均值、左侧与右侧中后斜角肌的弹性模量平均值比较差异均无显著性意义(P>0.05),两组组内左侧与右侧前斜角肌的横截面积、左侧与右侧中后斜角肌的横截面积比较差异均无显著性意义(P>0.05),两组组内中后斜角肌的弹性模量平均值与横截面积均高于前斜角肌(P<0.01,P<0.001);②在颈部中立位及侧屈位时,试验组前斜角肌、中后斜角肌的弹性模量平均值高于对照组(P<0.001),前斜角肌、中后斜角肌的横截面积均低于对照组(P<0.01,P<0.001);③结果表明,应用实时剪切波弹性成像技术能直观地评价颈肩痛患者前、中后斜角肌在颈部肌肉不同状态下弹性模量的差异,颈肩痛患者的双侧斜角肌处于劳损、僵硬状态。