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.

Diagnostic accuracy of real-time tissue elastography for breast cancer:a meta-analysis

Objective The present study aimed to determine the accuracy of real-time tissue elastography （RTE） for the diagnosis of breast cancer. Methods The search was conducted in the PubMed, Web of Science, Cochrane Library, and China Biology Medicine databases from inception through December 31, 2014, without language restrictions. The meta-analysis was conducted using STATA version 12.0 and Meta-Disc version 1.4. We calculated the summary statistics for sensitivity （Sen）, specificity （Spe）, positive and negative likelihood ratio （LR＋/LR–）, diagnostic odds ratio （DOR）, and summary receiver operating characteristic （SROC） curve. Results Ten studies that met al inclusion criteria were included in the meta-analysis. A total of 608 ma-lignant breast lesions and 1292 benign breast tumors were assessed. Al breast lesions were histological y confirmed after RTE. The pooled Sen was 0.83 （95% CI = 0.79–0.86）; the pooled Spe was 0.86 （95% CI = 0.84–0.88）. The pooled LR＋ was 9.87 （95% CI = 2.66–36.71）; the pooled LR– was 0.20 （95% CI = 0.17–0.23）. The pooled DOR of RTE for the diagnosis of breast cancer was 62.21 （95% CI = 33.88–114.24）. The area under the SROC curve was 0.9334 （standard error = 0.00125）. We found no evidence of publica-tion bias （t = –0.57, P = 0.582）. Conclusion RTE may have high diagnostic accuracy for the dif erential diagnosis of benign and malig-nant breast tumors. RTE may be a good tool for breast cancer diagnosis.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Current use of intraoperative ultrasound in modern liver surgery

Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries.

Non-invasive diagnosis of hepatitis B virus-related cirrhosis

Chronic hepatitis B(CHB)infection is a major public health problem associated with significant morbidity and mortality worldwide.Twenty-three percent of patients with CHB progress naturally to liver cirrhosis,which was earlier thought to be irreversible.However,it is now known that cirrhosis can in fact be reversed by treatment with oral anti-nucleotide drugs.Thus,early and accurate diagnosis of cirrhosis is important to allow an appropriate treatment strategy to be chosen and to predict the prognosis of patients with CHB.Liver biopsy is the reference standard for assessment of liver fibrosis.However,the method is invasive,and is associated with pain and complications that can be fatal.In addition,intra-and inter-observer variability compromises the accuracy of liver biopsy data.Only small tissue samples are obtained and fibrosis is heterogeneous in such samples.This confounds the two types of observer variability mentioned above.Such limitations have encouraged development of non-invasive methods for assessment of fibrosis.These include measurements of serum biomarkers of fibrosis;and assessment of liver stiffness via transient elastography,acoustic radiation force impulse imaging,real-time elastography,or magnetic resonance elastography.Although significant advances have been made,most work to date has addressed the diagnostic utility of these techniques in the context of cirrhosis caused by chronic hepatitis C infection.In the present review,we examine the advantages afforded by use of non-invasive methods to diagnose cirrhosis in patients with CHB infections and the utility of such methods in clinical practice.

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

BACKGROUND Esophageal varices(EV)are the most fatal complication of chronic hepatitis B(CHB)related cirrhosis.The prognosis is poor,especially after the first upper gastrointestinal hemorrhage.AIM To construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis.METHODS Between 2016 and 2018,the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University.Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses,and integrated into two nomograms,respectively.Both nomograms were internally and externally validated by calibration,concordance index(C-index),receiver operating characteristic curve,and decision curve analyses(DCA).RESULTS A total of 307 patients with CHB related cirrhosis were recruited.The independent risk factors for EV included Child-Pugh class[odds ratio(OR)=7.705,95%confidence interval(CI)=2.169-27.370,P=0.002],platelet count(OR=0.992,95%CI=0.984-1.000,P=0.044),splenic portal index(SPI)(OR=3.895,95%CI=1.630-9.308,P=0.002),and liver fibrosis index(LFI)(OR=3.603,95%CI=1.336-9.719,P=0.011);those of EV severity included Child-Pugh class(OR=5.436,95%CI=2.112-13.990,P<0.001),mean portal vein velocity(OR=1.479,95%CI=1.043-2.098,P=0.028),portal vein diameter(OR=1.397,95%CI=1.021-1.912,P=0.037),SPI(OR=1.463,95%CI=1.030-2.079,P=0.034),and LFI(OR=3.089,95%CI=1.442-6.617,P=0.004).Two nomograms(predicting EV risk and severity,respectively)were well-calibrated and had a favorable discriminative ability,with C-indexes of 0.916 and 0.846 in the training cohort,respectively,higher than those of other predictive indexes,like LFI(C-indexes=0.781 and 0.738),SPI(C-indexes=0.805 and 0.714),ratio of platelet count to spleen diameter(PSR)(C-indexes=0.822 and 0.726),King’s score(C-indexes=0.694 and 0.609),and Lok index(C-indexes=0.788 and 0.700).The areas under the curves(AUCs)of the two nomograms were 0.916 and 0.846 in the training cohort,respectively,higher than those of LFI(AUCs=0.781 and 0.738),SPI(AUCs=0.805 and 0.714),PSR(AUCs=0.822 and 0.726),King’s score(AUCs=0.694 and 0.609),and Lok index(AUCs=0.788 and 0.700).Better net benefits were shown in the DCA.The results were validated in the validation cohort.CONCLUSION Nomograms incorporating clinical and ultrasonic variables are efficient in noninvasively predicting the risk and severity of EV.

实时超声弹性成像参数、血清CA153、IGF1及HE4水平与早期宫颈癌临床病理特征的关系及其预测价值分析

目的:探讨实时超声弹性成像参数、血清糖类抗原153(CA153)、胰岛素生长因子1(IGF1)及人附睾分泌蛋白4(HE4)水平与早期宫颈癌临床病理特征的关系及其预测价值。方法:选取2022年1月~2023年6月本院收治的85例早期宫颈癌患者为宫颈癌组,另取同期收治的85例宫颈癌前病变患者为宫颈癌前病变组。两组均进行实时超声弹性成像检查,并测定血清CA153、IGF1及HE4水平。探讨实时超声成像、血清CA153、IGF1及HE4与宫颈癌患者临床病理特征的关系。采用受试者工作特征曲线(ROC)分析实时超声弹性成像参数、血清CA153、IGF1及HE4对早期宫颈癌患者的诊断价值。结果:相较于宫颈癌前病变组,宫颈癌组弹性应变比值和弹性图像压放指数均明显升高(P<0.05),血清CA153、IGF1及HE4水平均明显升高(P<0.05);FIGO分期Ⅱ期、低分化程度患者实时超声成像参数、血清CA153、IGF1及HE4水平均明显高于FIGO分期Ⅰ期、中高分化程度患者(P<0.05);ROC曲线显示,弹性应变比值、弹性图像压放指数、CA153、IGF1、HE4诊断早期宫颈癌的曲线下面积(AUC)分别为0.811、0.807、0.760、0.649、0.764,联合诊断的AUC最大,为0.944。结论:实时超声弹性成像参数、血清CA153、IGF1及HE4与早期宫颈癌的分期和分化程度有关,且对诊断早期宫颈癌均具有一定的临床价值,以联合诊断的价值更高。