Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication:A systematic review and meta-analysis

BACKGROUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis progression.The assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWE).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with DAAs.AIM To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus(HCV).METHODS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV clearance.In accordance with the study protocol,a qualitative and quantitative analysis of the evidence was planned.RESULTS At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source data.There was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CONCLUSION SWE could be a promising tool for prediction of HCC occurrence in patients treated with DAAs.Further studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

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.

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.

Variations of shear-wave splitting parameters in the source region of the 2023 Türkiye doublet earthquakes

In this study,the shear-wave splitting parameters of local seismic events from the source regions of the 2023 Türkiye MW7.7 and MW7.6 doublet earthquakes(event 1 and event 2,respectively)were measured from June 1,2022,to April 25,2023,and their spatiotemporal characteristics were analyzed.The results revealed clear spatial and temporal differences.Spatially,the dominant fast-wave polarization direction at each station shows a strong correlation with the direction of the maximum horizontal principal compressive stress,as characterized by focal mechanism solutions of seismic events(MW≥3.5)near the station.The dominant fast-wave polarization direction and the regional stress field also showed a strong correlation with the intermovement of the Arabian Plate,African Plate,and Anatolian Block.Along the Nurdagi-Pazarcik fault zone,the seismic fault of event 1,stations closer to the middle of the fault where the mainshock occurred exhibited notably greater delay times than stations located towards the ends of the fault and far from the mainshock.In addition,the stations located to the east of the Nurdagi-Pazarcik fault and to the north of the Sürgüfault also exhibited large delay times.The spatial distribution of shear-wave splitting parameters obtained from each station indicates that the upper-crust anisotropy in the source area is mainly controlled by the regional stress field,which is closely related to the state of the block motion.During the seismogenic process of the MW7.7 earthquake,more stress accumulated in the middle of the Nurdagi-Pazarcik fault than at either end of the fault.Under the influence of the MW7.7 and MW7.6 events,the stress that accumulated during the seismogenic process of the earthquake doublet may have migrated towards some areas outside the aftershock intensive area after the earthquakes,and the crustal stress and its adjustment range near the outer stations increased significantly.With the exception of two stations with few effective events,all stations showed a consistent change in shear-wave splitting parameters over time.In particular,each station showed a decreasing trend in delay times after the doublet earthquakes,reflecting the obvious intensification of crustal stress adjustment in the seismogenic zone after the doublet earthquakes.With the occurrence of the earthquake doublet and a large number of aftershocks,the stress accumulated during the seismogenic process of the doublet earthquakes is gradually released,and then the adjustment range of crustal stress is also gradually reduced.

Radiologic-pathologic correlation of three-dimensional shear-wave elastographic findings in assessing the liver ablation volume after radiofrequency ablation

AIM: To evaluate the usefulness of three-dimensional (3D) shear-wave elastography (SWE) in assessing the liver ablation volume after radiofrequency (RF) ablation.

Novel noninvasive quantification of penile corpus caver no sum lesions in hyperlipidemia-induced erectile dysfunction in rabbits by two-dimensional shear-wave elastography

Structural alterations in fibroelastic compone nts of the penile corpus caver no usum(CC)may impair its compliance,resulting in venous leakage and erectile dysfunction(ED).Our study evaluated the effectiveness of noninvasive two-dimensional shear-wave elastography(2-D SWE)in quantifying penile CC lesions in rabbits with hyperlipidemia-induced ED.A total of 12 New Zealand white rabbits were randomly divided into two groups.Six were fed a high-cholesterol diet containing 2%cholesterol and 8.5%lard for 10 weeks and the other six were fed normal diet as controls.We measured the shear-wave elastic quantitative(SWQ)value of penile CC by 2-D SWE.Erectile function was inv estigated by intracavernous injecti on of pa pa ver i ne,and immunohistochemical(IHC)stain inga nd the wester n blot analysis to determine the penile CC lesions.After 10 weeks,the SWQ values obtained from penile CC were remarkably higher in the high-cholesterol-fed compared with the control group,and the AICP(ICP plateau minus ICP baseline)/MAP(ICP:intracavernous pressure,MAP:mean arterial pressure)was markedly decreased.The IHC staining and western blot revealed extracellular matrix(ECM)accumulation in penile cavernous tissues,and the smooth muscle cell(SMC)phenotypic transition was affected,as indicated by reduced alpha-smooth muscle actin and calponinexpression and increased phospho-myosin light chain?。(p-MLC20)/MLC20 and osteopontin expression.Hyperlipidemia resulted in ECM accumulation accompanied with SMC phenotypic transition in penile CC and impaired the erectile function eventually.These might,in turn,lead to variations in the SWQ values.It suggests that 2-D SWE may be a novel,noninvasive and effective approach that distinguishes penile CC lesions secondary to hyperlipidemia from normal.

Photoacoustic elastography based on laser-excited shear wave

Elastography can be used as a diagnostic method for quantitative characterization of tissue hardness information and thus,differential changes in pathophysiological states of tissues.In this study,we propose a new method for shear wave elastography(SWE)based on laser-excited shear wave,called photoacoustic shear wave elastography(PASWE),which combines photoacoustic(PA)technology with ultrafast ultrasound imaging.By using a focused laser to excite shear waves and ultrafast ultrasonic imaging for detection,high-frequency excitation of shear waves and noncontact elastic imaging can be realized.The laser can stimulate the tissue with the light absorption characteristic to produce the thermal expansion,thus producing the shear wave.The frequency of shear wave induced by laser is higher and the frequency band is wider.By tracking the propagation of shear wave,Young’s modulus of tissue is reconstructed in the whole shear wave propagation region to further evaluate the elastic information of tissue.The feasibility of the method is verified by experiments.Compared with the experimental results of supersonic shear imaging(SSI),it is proved that the method can be used for quantitative elastic imaging of the phantoms.In addition,compared with the SSI method,this method can realize the noncontact excitation of the shear wave,and the frequency of the shear wave excited by the laser is higher than that of the acoustic radiation force(ARF),so the spatial resolution is higher.Compared to the traditional PA elastic imaging method,this method can obtain a larger imaging depth under the premise of ensuring the imaging resolution,and it has potential application value in the clinical diagnosis of diseases requiring noncontact quantitative elasticity.

Quantitative Assessment of Liver Fibrosis by Elastography in Patients with Chronic Liver Disease: A Cross-Sectional Study in Lomé (Togo)

Aim: To describe the two-dimensional elastographic profile according to the Shearwave (2D-SWE) technique in patients with chronic liver disease in Lom. Materials and method: Cross-sectional, descriptive study conducted over seven month at the Autel dElie Clinic in Lom, from January to August 2022, on adult patients with chronic liver disease who underwent abdominal ultrasound coupled with two-dimensional elastography. Results: The sample size was 54 patients. The mean age of the patients was 33 12 years, with extremes of 18 and 66 years. Patients aged 30 years or less accounted for 48.1% (n = 26). All patients (n = 54) had at least one transaminase assay with a mean of 69.3 78.3 IU/l (AST) and 59.3 82.8 IU/l (ALT). There was no statistically significant association between the biological parameters and the presence of fibrosis. Viral liver disease was the main cause, accounting for 81.5% (n = 44) of cases, with no significant association with the degree of fibrosis. Ultrasound revealed a dysmorphic liver (57.4%;n = 31) and portal hypertension (18.5%, n = 10). Fibrosis stages F1, F2 and F4 accounted for (48.1%, n = 26), (24.1%, n = 13) and (13%, n = 7) of cases respectively. Liver dysmorphia was significantly associated with the presence of fibrosis (p = 0.012) and portal hypertension was significantly associated with the degree of fibrosis (p = 0.0063). Conclusion: Assessment of liver fibrosis in patients with chronic liver disease using 2D-SWE elastography is essential for patient follow-up.

Predicting hepatocellular carcinoma: A new non-invasive model based on shear wave elastography

BACKGROUND Integrating conventional ultrasound features with 2D shear wave elastography(2D-SWE)can potentially enhance preoperative hepatocellular carcinoma(HCC)predictions.AIM To develop a 2D-SWE-based predictive model for preoperative identification of HCC.METHODS A retrospective analysis of 884 patients who underwent liver resection and pathology evaluation from February 2021 to August 2023 was conducted at the Oriental Hepatobiliary Surgery Hospital.The patients were divided into the modeling group(n=720)and the control group(n=164).The study included conventional ultrasound,2D-SWE,and preoperative laboratory tests.Multiple logistic regression was used to identify independent predictive factors for RESULTS In the modeling group analysis,maximal elasticity(Emax)of tumors and their peripheries,platelet count,cirrhosis,and blood flow were independent risk indicators for malignancies.These factors yielded an area under the curve of 0.77(95%confidence interval:0.73-0.81)with 84%sensitivity and 61%specificity.The model demonstrated good calibration in both the construction and validation cohorts,as shown by the calibration graph and Hosmer-Lemeshow test(P=0.683 and P=0.658,respectively).Additionally,the mean elasticity(Emean)of the tumor periphery was identified as a risk factor for microvascular invasion(MVI)in malignant liver tumors(P=0.003).Patients receiving antiviral treatment differed significantly in platelet count(P=0.002),Emax of tumors(P=0.033),Emean of tumors(P=0.042),Emax at tumor periphery(P<0.001),and Emean at tumor periphery(P=0.003).CONCLUSION 2D-SWE’s hardness value serves as a valuable marker for enhancing the preoperative diagnosis of malignant liver lesions,correlating significantly with MVI and antiviral treatment efficacy.

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.

Toward Improved Accuracy in Quasi-Static Elastography Using Deep Learning

Elastography is a non-invasive medical imaging technique to map the spatial variation of elastic properties of soft tissues.The quality of reconstruction results in elastography is highly sensitive to the noise induced by imaging measurements and processing.To address this issue,we propose a deep learning(DL)model based on conditional Generative Adversarial Networks(cGANs)to improve the quality of nonhomogeneous shear modulus reconstruction.To train this model,we generated a synthetic displacement field with finite element simulation under known nonhomogeneous shear modulus distribution.Both the simulated and experimental displacement fields are used to validate the proposed method.The reconstructed results demonstrate that the DL model with synthetic training data is able to improve the quality of the reconstruction compared with the well-established optimization method.Moreover,we emphasize that our DL model is only trained on synthetic data.This might provide a way to alleviate the challenge of obtaining clinical or experimental data in elastography.Overall,this work addresses several fatal issues in applying the DL technique into elastography,and the proposed method has shown great potential in improving the accuracy of the disease diagnosis in clinical medicine.

Transient elastography and diffusion-weighted magnetic resonance imaging for assessment of liver fibrosis in children with chronic hepatitis C

BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.

Algebraic processing technique for extracting frequency-dependent shear-wave splitting parameters in an anisotropic medium

Based on the dual source cumulative rotation technique in the time-domain proposed by Zeng and MacBeth（1993）,a new algebraic processing technique for extracting shear-wave splitting parameters from multi-component VSP data in frequency-dependent medium has been developed.By using this dual source cumulative rotation technique in the frequency-domain（DCTF）,anisotropic parameters,including polarization direction of the shear-waves and timedelay between the fast and slow shear-waves,can be estimated for each frequency component in the frequency domain.It avoids the possible error which comes from using a narrow-band filter in the current commonly used method.By using synthetic seismograms,the feasibility and validity of the technique was tested and a comparison with the currently used method was also given.The results demonstrate that the shear-wave splitting parameters frequency dependence can be extracted directly from four-component seismic data using the DCTF.In the presence of larger scale fractures,substantial frequency dependence would be found in the seismic frequency range,which implies that dispersion would occur at seismic frequencies.Our study shows that shear-wave anisotropy decreases as frequency increases.

Shear-wave splitting in the crust:Regional compressive stress from polarizations of fast shear-waves

When propagating through anisotropic rocks in the crust, shear-waves split into faster and slower components with almost orthogonal polarizations. For nearly vertical propagation the polarization of fast shear- wave （PFS） is parallel to both the strike of the cracks and the direction of maximum horizontal stress, therefore it is possible to use PFS to study stress in the crust. This study discusses several examples in which PFS is applied to deduce the compressive stress in North China, Longmenshan fault zone of east edge of Tibetan plateau and Yunnan zone of southeast edge of Tibetan plateau, also discusses temporal variations of PFS orientations of 1999 Xiuyan earthquake sequences of northeastern China. The results are consistent to those of other independent traditional stress measurements. There is a bridge between crustal PFS and the crustal principal compressive stress although there are many unclear disturbance sources. This study suggests the PFS results could be used to deduce regional and in situ principal compressive stress in the crust only if there are enough seismic stations and enough data. At least, PFS is a useful choice in the zone where there are a large number of dense seismic stations.

Variational characteristics of shear-wave splitting on the 2001 Shidian earthquakes in Yunnan, China

In 2001 three earthquakes occurred in Shidian in Yunnan Province, which were the MS=5.2 on April 10, the MS=5.9 on April 12 and the MS=5.3 on June 8. Based on the data from the station Baoshan of Yunnan Telemetry Digital Seismograph Network, the variational characteristics of shear-wave splitting on these series of strong earthquakes has been studied by using the systematic analysis method (SAM) of shear-wave splitting. The result shows the time delays of shear-wave splitting basically increase with earthquake activity intensifying. However the time delays abruptly decrease immediately before strong aftershocks. It accords with the stress relaxation before earthquakes, which was found recently in study on shear-wave splitting. The result suggests it is significant for reducing the harm degree of earthquakes to develop the stress-forecasting on earthquake in strong active tectonic zones and economic developed regions or big cities under the danger of strong earthquakes.

Seismic anisotropy of the crust in Yunnan,China:Polarizations of fast shear-waves

Using seismic data recorded by Yunnan Telemetry Seismic Network from January 1, 2000 to December 31, 2003, the dominant polarization directions of fast shear-waves are obtained at 10 digital seismic stations by SAM technique, a systematic analysis method on shear-wave splitting, in this study. The results show that dominant directions of polarizations of fast shear-waves at most stations are mainly at nearly N-S or NNW direction in Yunnan. The dominant polarization directions of fast shear-waves at stations located on the active faults are consistent with the strike of active faults, directions of regional principal compressive strains measured from GPS data, and basically consistent with regional principal compressive stress. Only a few of stations.show complicated polarization pattern of fast shear-waves, or are not consistent with the strike of active faults and the directions of principal GPS compressive strains, which are always located at junction of several faults. The result reflects complicated fault distribution and stress field. The dominant polarization direction of fast shear-wave indicates the direction of the in-situ maximum principal compressive stress is controlled by multiple tectonic aspects such as the regional stress field and faults.

Preliminary analysis of the shear-wave splitting observations from the Qiaojia seismic array

A total of 351 shear-wave splitting results at 25 stations were obtained from the seismic data recorded in period of January,2013 to December,2016,by a broadband seismic array deployed in the northern segment of Xiaojiang Fault Zone(n-XJFZ).Meanwhile,the stress field of the n-XJFZ was determined by inverting 140 focal mechanism solutions of the small earthquakes within the study area which were recorded in the same period.This determination confirmed a compressive stress in NW-SE orientation and an extensional stress in the NE-SW orientation,with little difference from those released by previous studies.The shear-wave splitting results show a spatial complexity in polarization orientation,different from one site to another.How-ever,the polarization orientations integrated for the subareas suggest that the fault trends seemingly played important roles.All the subareas bear two dominant orientations,N10°E and N90°E,both of which are different from the azimuths of the principal compressive stress,due to the fault distribution.The time delay averaged over the entire region is 4.56 ms/km,close to that of the upper boundary of the generally accepted interval worldwide but larger than those in most of the investigated regions in the Chinese mainland,which probably implies an alignment of more micro-cracks in the n-XJFZ.Interestingly,the 2014 Ms6.5 Ludian earthquake was found to have caused a variation in the time delays of the slow shear waves within the study area though its epicenter was outside.This earthquake resulted in an evident drop of the time delays remaining for 4 months,however,lifted a bit the time-delay level with respect to that prior to the earthquake.

Systematic Analysis Method of Shear-Wave Splitting:SAM Software System

In order to make a more effective use of the data from regional digital seismograph networks and to promote the study on shear wave splitting and its application to earthquake stress-forecasting, SAM software system, i.e., the software on systematic analysis method of shear wave splitting has been developed. This paper introduces the design aims, system structure, function and characteristics about the SAM software system and shows some graphical interfaces of data input and result output. Lastly, it discusses preliminarily the study of shear wave splitting and its application to earthquake forecasting.

The Character of Shear-wave Splitting in Marble in the Critical State of Rupture

This paper mainly observed and analyzed the character of shear-wave splitting in rock specimens while they were in the critical state of rupture. The rock specimens for study are made of Laizhou marble from Shandong, China. A series of records were obtained from two rock specimens when they were in the critical state of rupture. The result shows that, in the critical state just before rock rupture, there may be the phenomenon of rise and fall in the time delay of shear-wave splitting, even though the load was kept constant. That is to say, the time delay of shear-wave splitting may have a falling process before rock rupture.

A seismological evidence for the northwestward movement of Africa with respect to Iberia from shear-wave splitting

Seismic anisotropy and its main features along the convergent boundary between Africa and Iberia are detected through the analysis of teleseismic shear-wave splitting. Waveform data generated by 95 teleseismic events recorded at 17 broadband stations deployed in the western Mediterranean region are used in the present study. Although the station coverage is not uniform in the Iberian Peninsula and north- west Africa, significant variations in the fast polarization directions and delay times are observed at stations located at different tectonic domains. Fast polarization directions are oriented predominantly NW-SE at most stations which are close to the plate boundary and in central Iberia; being consistent with the absolute plate motion in the region. In the northern part of the Iberian Peninsula, fast velocity direc- tions are oriented nearly E--W; coincident with previous results. Few stations located slightly north of the plate boundary and to the southeast of lberia show E--W to NE-SW fast velocity directions, which may be related to the Alpine Orogeny and the extension direction in lberia. Delay times vary significantly between 0.2 and 1.9 s for individual measurements, reflecting a highly anisotropic structure beneath the recording stations. The relative motion between Africa and lberia represents the main reason for the observed NW-SE orientations of the fast velocity directions. However, different causes of anisotropy have also to be considered to explain the wide range of the splitting pattern observed in the western Mediterranean region. Many geophysical observations such as the low Pn velocity, lower lithospheric Q values, higher heat flow and the presence of high conductive features support the mantle flow in the western Mediterranean, which may contribute and even modify the splitting pattern beneath the studied region.