Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome

Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.

Research progress of real-time sonoelastography to evaluate testicular spermatogenic function in non-obstructive azoospermia

Objective: The azoospermia is increasingly becoming prevalent year by year,which has been plaguing a great number of infertile couples. Testes biopsy is a gold index to evaluate the testicular spermatogenesis in patients with anspermia. However, it is more invasive and may not accurately reflect the whole spermatogenic function of the testes. In recent years, with the continuous development of ultrasound and assisted reproductive technology, real-time sonoelastography has been widely applied in the evaluation of spermatogenic function in patients with azoospermia. It is still at the initial stage, but shows good application prospects. In this paper, we will summarize and review the present status of male infertility and the clinical application and research progress of real-time sonoelastography in the evaluation of the testicular spermatogenic function of non-obstructive azoospermia patients.

Comparison of resistive index and shear-wave elastography in the evaluation of chronic kidney allograft dysfunction

BACKGROUND Detection of early chronic changes in the kidney allograft is important for timely intervention and long-term survival.Conventional and novel ultrasound-based investigations are being increasingly used for this purpose with variable results.AIM To compare the diagnostic performance of resistive index(RI)and shear wave elastography(SWE)in the diagnosis of chronic fibrosing changes of kidney allograft with histopathological results.METHODS This is a cross-sectional and comparative study.A total of 154 kidney transplant recipients were included in this study,which was conducted at the Departments of Transplantation and Radiology,Sindh Institute of Urology and Transplantation,Karachi,Pakistan,from August 2022 to February 2023.All consecutive patients with increased serum creatinine levels and reduced glomerular filtration rate(GFR)after three months of transplantation were enrolled in this study.SWE and RI were performed and the findings of these were evaluated against the kidney allograft biopsy results to determine their diagnostic utility.RESULTS The mean age of all patients was 35.32±11.08 years.Among these,126(81.8%)were males and 28(18.2%)were females.The mean serum creatinine in all patients was 2.86±1.68 mg/dL and the mean estimated GFR was 35.38±17.27 mL/min/1.73 m2.Kidney allograft biopsy results showed chronic changes in 55(37.66%)biopsies.The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of SWE for the detection of chronic allograft damage were 93.10%,96.87%%,94.73%,and 95.87%,respectively,and the diagnostic accuracy was 95.45%.For RI,the sensitivity,specificity,PPV,and NPV were 76.92%,83.33%,70.17%,and 87.62%,respectively,and the diagnostic accuracy was 81.16%.CONCLUSION The results from this study show that SWE is more sensitive and specific as compared to RI in the evaluation of chronic allograft damage.It can be of great help during the routine follow-up of kidney transplant recipients for screening and early detection of chronic changes and selecting patients for allograft biopsy.

Impact of nodular size on the predictive values of gray-scale,color-Doppler ultrasound,and sonoelastography for assessment of thyroid nodules

Objective:To define the roles of gray-scale,color-Doppler ultrasound,and sonoelastography for the assessment of thyroid nodule to determine whether nodule size affects the differential diagnosis of benign and malignant.Methods:A total of 243 consecutive subjects(214 women,29 men) with 329 thyroid nodules were examined by gray-scale,color-Doppler ultrasound,and sonoelastography in this prospective study.All patients underwent surgery and the final diagnosis was obtained from histopathological examination.Results:Three hundred and twenty-nine nodules(208 benign,121 malignant) were divided into small(SNs,5-10 mm,n=137) and large(LNs,>10 mm,n=192) nodules.Microcalcifications were more frequent in malignant LNs than in malignant SNs,but showed no significant difference between benign LNs and SNs.Poorly-circumscribed margins were not significantly different between malignant SNs and LNs,but were less frequent in benign LNs than in benign SNs.Among all nodules,marked intranodular vascularity was more frequent in LNs than in SNs.By comparison,shape ratio of anteroposterior to transverse dimensions(A/T) ≥1 was less frequent in LNs than in SNs.Otherwise,among all nodules,marked hypoechogenicity and elasticity score of 4-6 showed no significant difference between LNs and SNs.Conclusions:The predictive values of microcalcifications,nodular margins,A/T ratio,and marked intranodular vascularity depend on nodule size,but the predictive values of echogenicity and elastography do not.

Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy

Background Conventional ultrasonography or magnetic resonance （MR） imaging is commonly performed to obtain information about the severity of the disease,location of the injury,and differential diagnosis.The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.Methods A single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients （9 men,19 women; mean age,48.5 years; age range,36-67 years） with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls.Greyscale images were described as normal,tendinosis,partialthickness tear,and full-thickness tear.Sonoelastographic images of the common extensor tendon were analyzed qualitatively （scoring of the elastic spectrum） and quantitatively （based on a color histogram）.Results Both the imaging methods had high sensitivity,specificity,and accuracy for diagnosing lateral elbow tendinopathy.Considering the clinical diagnosis of lateral elbow tendinopathy,sonoelastography showed significantly higher diagnostic accuracy （96.4％） than ultrasonography （89.5％,P ＜0.01）.Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows （P ＜0.01）.Conclusion Sonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.

Acoustic radiation force impulse of the liver

Acoustic radiation force impulse(ARFI)imaging is a new and promising ultrasound-based diagnostic technique that,evaluating the wave propagation speed,allows the assessment of the tissue stiffness.ARFI is implemented in the ultrasound scanner.By short-duration acoustic radiation forces(less than 1 ms),localized displacements are generated in a selected region of interest not requiring any external compression so reducing the operator dependency.The generated wave scan provides qualitative or quantitative(wave velocity values)responses.Several non-invasive methods for assessing the staging of fibrosis are used,in order to avoid liver biopsy.Liver function tests and transient elastography are non-invasive,sensitive and accurate tools for the assessment of liver fibrosis and for the discrimination between cirrhotic and non-cirrhotic liver.Many published studies analyse ARFI performance and feasibility in studying diffuse liver diseases and compare them to other diagnostic imaging modalities such as conventional ultrasonography and transient elastography.Solid focal liver lesions,both benign and malignant,are common findings during abdominal examinations.The accurate characterization and differential diagnosis are important aims of all the imaging modalities available today.Only few papers describe the application of ARFI technology in the study of solid focal liver lesions,with different results.In the present study,the existing literature,to the best of our knowledge,about ARFI application on diffuse and focal liver pathology has been evaluated and results and statistical analyses have been compared,bringing to the conclusion that ARFI can be used in the study of the liver with similar accuracy as transient elastography in diagnosing significant fibrosis or cirrhosis and has got some advantages in respect to transient elastography since it does not require separate equipment,better displays anatomical structures and measurements can be successfully carried out almost in every patient.

Prediction of liver cirrhosis, using diagnostic imaging tools

Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography(US), computed tomography, and magnetic resonance imaging(MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed.

Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases

Background Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades,but its use has only recently been explored by pediatric rheumatologists.The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases.Data sources We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far,on the applications of ultrasound in juvenile idiopathic arthritis(JIA),systemic lupus erythematosus,dermatomyositis,enthesitis,Sjogren's syndrome,and other rheumatic diseases.In addition,articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed.Results In JIA,ultrasound can be used to detect subclinical synovitis,to improve the classification of patients in JIA subtypes,to capture early articular damage,to monitor treatment response,and to guide intraarticular injections.Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms,assessment of parotid gland pathology,and measurement of skin thickness and pathology.Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders.Conclusions Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders.However,standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.