Accuracy Of Shear Wave Elastography Research Articles

The deep abdominal ultrasound transducer (DAX) increases the success rate and diagnostic accuracy of shear wave elastography for liver fibrosis assessment in patients with obesity-A prospective biopsy-controlled study.

Obesity impacts the diagnostic accuracy of shear wave elastography (SWE). A deep abdominal ultrasound transducer (DAX) capable of point (pSWE) and two-dimensional (2D)-SWE has recently been introduced to address this issue. We performed a prospective study in a cohort of mostly patients with obesity undergoing liver biopsy with a high prevalence of metabolic dysfunction-associate steatotic liver disease (MASLD). Liver stiffness measurement (LSM) was measured using vibration-controlled transient elastography (VCTE), as well as pSWE and 2D SWE on the standard (5C1) and the DAX transducers. We included 129 patients with paired LSM and liver biopsy: median age 44.0 years, 82 (63.6%) women, median BMI: 43.2 kg/m2. Histologic fibrosis stages: F0: N = 55 (42.6%), F1: N = 14 (10.9%), F2: N = 50 (38.8%), F3: N = 2 (1.6%), F4: N = 8 (6.2%). VCTE-LSM failed (N = 13) or were unreliable (IQR/median ≤30% in ≥7.1 kPa, N = 14) in 20.9% of patients. The Pearson correlation of reliable VCTE-LSM with both pSWE and 2D SWE was strong (all >0.78). The diagnostic accuracy for all LSM techniques was poor for significant fibrosis (≥F2, AUC: 0.54-0.63); however, it was good to excellent for advanced fibrosis (≥F3, AUC: 0.87-0.99) and cirrhosis (F4, AUC: 0.86-1.00). In intention-to-diagnose analysis, pSWE on DAX was significantly superior to VCTE-LSM. pSWE- and 2D-SWE enable the non-invasive identification of advanced fibrosis and cirrhosis in patients with obese MASLD. The use of the DAX transducer for acoustic radiation force imaging (ARFI)-LSM avoids technical failures in an obese population and subsequently offers advantages over VCTE-LSM for the evaluation of fibrosis in an obese MASLD population at risk for fibrosis.

Diagnostic accuracy of shear wave elastography versus laboratory parameters as non-invasive screening tool for esophageal varices

BackgroundVariceal hemorrhage from the rupture of esophageal varices is accompanied by a substantial mortality rate. So, newly diagnosed cirrhotic patients are recommended to perform screening esophago-gastroduodenoscopy (EGD) for identifying varices. The primary objective of the present research was to ascertain the most precise biochemical and ultrasonographic variables that have the potential to non-invasively forewarn the occurrence of varices in cirrhotic patients. The study evaluated different parameters such as aspartate aminotransferase-to-platelet ratio index (APRI), platelet count/splenic diameter (PC/SD), portal vein velocity (PVV), and splenic and hepatic stiffness in prediction of EV.MethodsThis is a cross-sectional study that was conducted on 100 cirrhotic patients based on clinical, laboratory, and radiological assessments. All patients were subjected to thorough clinical examinations; laboratory tests were conducted to assess liver function and calculate Child–Pugh score and non-invasive tests for detecting esophageal varices such as APRI, PC/SD, Doppler ultrasonography for assessment of PV Doppler, and hepatic and splenic elastography. All patients got an endoscopic assessment in order to examine and classify the esophageal varices.ResultsBased on the current study, we found that predictors for EV among the studied patients were the following: PC/SD ratio with odds ratio (OR) was 2.20, PVV with OR was 4.68, liver stiffness with OR was 1.99, and splenic stiffness with OR was 3.55.With ROC curve analysis, PVV has the best overall accuracy (85.4%) for prediction of EV with an area under the curve of 0.79 at cutoff point < 7.09 (cm/s) followed by splenic stiffness that has 82.6% overall accuracy with an area under the curve of 0.71 at cutoff point > 62.22 kPa.ConclusionPVV and splenic stiffness measurement hold potential as non-invasive markers for predicting the presence of esophageal varices in individuals with liver cirrhosis. Moreover, these markers can also aid in predicting the occurrence of advanced esophageal varices.

ACCURACY OF SHEAR WAVE ELASTOGRAPHY IN THE DIAGNOSIS OF HEPATIC FOCAL LESIONS

This study aimed to evaluate the accuracy of Shear Wave Elastography (SWE) in diagnosing hepatic focal lesions using triphasic CT as the gold standard. The study was conducted prospectively at the Department of Radiology, Nishtar Medical Hospital, from January 2022 to January 2023. Patients with at least one hepatic focal lesion ranging from 1 to 5 cm in diameter were included in the study. All patients underwent SWE scanning and ultrasound examination. The segment of focal lesions was evaluated, and 5-8 measurements were taken for quantitative analysis of stiffness. In patients with multiple focal lesions, the pathology of all lesions was confirmed by MRI and CT, and the most accessible lesion was analyzed. The mean of all measurements was compared with the findings of triphasic CT and tumor markers to estimate SWE's accuracy, specificity, and sensitivity. The study was conducted on 100 patients, of which 85 were males and 17 were females. The mean stiffness in benign lesions was 10.4 ± 6.32 kPa, and in malignant lesions was 16.3 ± 9.24 kPa. This difference was statistically significant (P&lt;.002). A cutoff value 13.25 was used to differentiate between malignant and benign lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SWE were 78.05%, 71.43%, 88.9%, 52.3%, and 64.3%, respectively. The mean tissue stiffness in focal fatty infiltration was 12.7 ± 8.9 kPa, and in hemangioma lesions was 9.6 ± 4.3 kPa. The mean stiffness in HCC was 15.5 ± 7.1 kPa, in cholangiocarcinoma was 32.6 ± 8.26 kPa, and in metastatic lesions was 22.2 ± 0.5 kPa. In conclusion, SWE has a high sensitivity, specificity, and accuracy for differentiating malignant and benign hepatic focal lesions. The study shows that the stiffness of benign and malignant lesions differs significantly.

Body Composition and Demographic Features Do Not Affect the Diagnostic Accuracy of Shear Wave Elastography.

Shear-wave elastography (SWE) is an imaging method that can be used to estimate shear wave speed and the Young's modulus based on the measured shear wave speed under certain conditions. Up to date, no research has analyzed whether body composition factors contribute to ultrasound attenuation, refraction, reflection, and, consequently, SWE measurement errors. Therefore, this study aimed to analyze the association between demographic and body composition features with SWE errors for assessing the anterior scalene stiffness (which is a key structure in patients with neck pain and nerve compressive syndromes). Demographic (sex, age, height, weight, and body mass index), body composition (water volume, fat mass, and lean mass), and anterior scalene muscle stiffness (Young's modulus and shear wave speed) data were collected from a sample of asymptomatic subjects. After calculating the absolute SWE differences between trials and the reliability estimates, a correlation matrix was generated to quantify the association among all the variables. A total of 34 asymptomatic subjects (24 males) were included in the analyses. Test-retest reliability was excellent for assessing the Young's modulus and shear wave velocity (ICC = 0.912 and 0.923, respectively). No significant associations were found between age, height, weight, body mass index, body fat, lean mass, or water volume with SWE errors (p > 0.05). However, the Young's modulus error was associated with the stiffness properties (p < 0.01), whereas shear wave speed was associated with none of them (all, p > 0.05). A detailed procedure can reliably assess the AS muscle stiffness. None of the sociodemographic or body composition features assessed were correlated with SWE errors. However, baseline stiffness seems to be associated with Young's modulus error.

Diagnostic accuracy of shear wave elastography in evaluating renal fibrosis in children with chronic kidney disease: a comparative study with nuclear scan

BackgroundChronic kidney disease (CKD) is a significant health issue in pediatric patients due to fibrosis progression. Shear wave elastography (SWE) is a noninvasive technique used to assess fibrosis in CKD, but its efficacy needs to be better established. This study aimed to compare SWE with nuclear scan in assessing fibrosis in pediatric CKD patients.AimTo determine the area of scarring/fibrosis of each kidney using shear wave elastography in chronic kidney disease and compare it with technetium-99m dimercaptosuccinic acid (DMSA) results.MethodsA prospective study included 39 chronic kidney disease patients who underwent shear wave elastography and grayscale ultrasound. DMSA scans were performed to identify scar areas of the kidneys. Young modulus was recorded for each pole of both kidneys and compared with scar areas on DMSA. Thirty-nine age-matched controls underwent shear wave elastography to estimate the average elasticity value in the normal population.ResultsThirty-nine CKD patients underwent this study, with 10 females and 29 males. The median age was 6.5 years. The cutoff value of cortical thickness ≤ 10.2 predicted scar on DMSA with a sensitivity of 79% and a specificity of 77%. The cutoff value of elasticity value ≥ 5.57 kPa predicted scar on DMSA with a sensitivity of 87% and a specificity of 96%. Median SWE values were significantly higher with the scar on DMSA (12.6 kPa) compared to no scar on DMSA (4.1 kPa). The controls mean values and standard deviation were 2.42 kPa and 0.45 kPa, respectively.ConclusionsShear wave elastography has revealed that patients with chronic kidney disease exhibit higher values in the areas where scarring has occurred, compared to non-scarred areas. Fortunately, integrating shear wave elastography into routine ultrasonography assessments is a straightforward and painless process that requires no additional preparation from the patient. Not only is this method time efficient, but it also eliminates the need for potentially risky radiation exposure from radionuclide tests in the future.

Diagnostic accuracy of shear wave elastography for endometrial cancer: A meta-analysis.

This meta-analysis aimed to identify the accuracy of shear wave elastography (SWE) in the diagnosis of endometrial cancer (EC). We searched the PubMed, Cochrane Library, and chinese biomedical literature database from inception to September 30, 2022. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 software. We calculated summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratio (LR+/LR-), diagnostic odds ratio (DOR), and receiver operating characteristic (SROC) curves. Eight studies that met all the inclusion criteria were included in this meta-analysis. A total of 432 patients with EC and 548 with benign endometrial lesions were assessed. All endometrial lesions were histologically confirmed by SWE. The pooled Sen was 0.91 (95% confidence interval [CI] = 0.83-0.95); the pooled Spe was 0.90 (95% CI = 0.86-0.93); the pooled LR+ was 9.10 (95% CI = 6.20-13.35); the pooled negative LR- was 0.10 (95% CI = 0.05-0.20); the pooled DOR of SWE in the diagnosis of EC was 90.73 (95% CI = 36.62-804.5). The area under the SROC curve was 0.95 (95% CI = 0.93-0.97). No evidence of publication bias was found (t = 0.98, P = .37). Our meta-analysis indicates that SWE may have high diagnostic accuracy in the differential diagnosis of benign and malignant endometrial lesions. Thus, SWE may be a useful tool for the diagnosis of EC.

Diagnostic accuracy of shear wave elastography in the evaluation of solid breast lesions and its correlation with histopathology

Title: Diagnostic accuracy of shear wave elastography in evaluation of solid breast lesions & its correlation with histopathology. Background: To assess role of shear wave elastography in diagnosis of solid breast lesions with histopathological correlation. Materials and Methods: This cross-sectional analytical study was conducted in 50 patients from January 2021 to June 2022 in Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Results: Study group consisted of 50 individuals who presented to Department of Radiology for examination of breast for a solid tumor, ranging in age from 26 to 68 years. There were 27 malignant lesions among which 9 were Ductal Carcinoma insitu which is highest number seen in this study, 7 were Invasive ductal carcinoma, 6 were mucinous adenocarcinoma and 5 were Invasive lobular Carcinoma. Among 23 benign lesions, 47% were fibro adenomas followed by Mastitis (26%), Intraductal papilloma (17%), Adenosis (3%) and Intramammary lymph node. In this study sensitivity of shear wave elastography combined with USG was 95.24% & specificity was 97.37%. PPV & NPV values were 97.56% & 94.87% respectively. Mean elasticity value for predicting malignancy was 102.15 kpa & for benign was 41.12 kpa. Conclusion: A thorough grasp of the characteristics of each elastography technique enables accurate imaging and diagnosis, proving that elastography is a clinically valuable tool.

Evaluation of Accuracy of Shear Wave Elastography and Superb Microvascular Imaging Methods in Diagnosis of Piriformis Syndrome: A Preliminary Study.

Piriformis syndrome is a neuromuscular disease resulting from sciatic nerve compression caused by an abnormal condition in the piriformis muscle. Superb microvascular imaging (SMI) is a new ultrasound imaging technique that visualizes low-velocity and small-diameter blood vessel flow. In our prospectively designed study, we aimed to evaluate the accuracy of diagnosis of piriformis syndrome with innovative methods such as shear wave elastography (SWE) and SMI. Thirty-two patients diagnosed with unilateral piriformis syndrome were accepted to the statistical stage. The side without symptoms was considered the "unaffected side." Bilateral piriformis muscles were examined by ultrasonography. Muscle thickness was determined on gray scale, stiffness on SWE and vascularity characteristics on power Doppler and SMI by two independent radiologists. Piriformis muscle stiffness on the non-pathological (unaffected) side was measured by SWE as 18.27 ± 7.301 kPa, and the mean stiffness on the pathological side was 29.70 ± 10.095 kPa. Pathological side muscle stiffness was significantly higher (p < 0.05). Using innovative methods such as SWE and SMI in addition to conventional ultrasonography as much as possible in our daily practice and research helps us in making the correct diagnosis in piriformis syndrome.

Comparing the accuracy of shear wave elastography and strain elastography in the diagnosis of breast tumors: A systematic review and meta-analysis.

Shear wave elastography (SWE) and strain elastography (SE) are 2 new ultrasonic technologies which have developed rapidly in recent years. Elastography transforms the elastic information of tissue into optical information for display, thus more intuitive display of tissue elasticity. Conflicting results have been obtained in different scholars' studies on the accuracy comparison of the 2 elastography technologies in the diagnosis of breast tumors. This meta-analysis aims to compare the accuracy of the 2 elastography technologies in the diagnosis of breast tumors, and provide a reference for clinical decision making. We have searched Chinese and English literatures on the accuracy of SWE and SE in the diagnosis of breast tumors from PubMed, Web of Science, China national knowledge infrastructure and Wanfang databases, and the time was up to December30, 2020. Two literature reviewers screened the literatures according to the screening criteria, and Quality Assessment of Diagnostic Accuracy Study tool was used to evaluate the quality of included literatures. Meta Disc1.4 and Stata14.0 softwares were used to perform heterogeneity test, sensitivity analysis and publication bias test. Ten literatures included 1599 patients and 1709 breast lesions. The final results in the SWE as follow: The pooled sensitivity was 0.852 (95% confidence interval [CI] [0.826-0.874]), the pooled specificity (Spe) was 0.799 (95% CI [0.776-0.820]), the pooled positive likelihood ratio was 4.758 (95% CI [3.443-6.576]), the pooled negative likelihood ratio was 0.192 (95% CI [0.147-0.250]), the pooled diagnostic odds ratio was 29.071 (95% CI [16.967-49.811]), and the area under the summary receiver operating characteristic curve was 0.9159. The final results in the SE as follow: The pooled sensitivity was 0.843 (95% CI [0.817-0.866]), the pooled Spe was 0.766 (95% CI [0.743-0.789]), the pooled positive likelihood ratio was 4.387 (95% CI [3.088-6.233]), the pooled negative likelihood ratio was 0.216 (95% CI [0.179-0.261]), the pooled diagnostic odds ratio was 22.610 (95% CI [15.622-32.724]), and the area under the summary receiver operating characteristic curve was 0.8987. The sensitivity and Spe of SWE were higher than those of SE, suggesting that SWE may have a higher accuracy in the diagnosis of breast tumors. PROSPERO. Registration number: CRD42021251110.

Accuracy and reproducibility of shear wave elastography according to the size and elasticity of lesions: A phantom study.

While the extrinsic factors affecting reproducibility of shear wave elastography (SWE) have been well documented, there are few resources assessing intrinsic characteristics of the lesion affecting the reproducibility and accuracy of SWE. In this regard, this study aimed to evaluate the accuracy of measured elasticity and the reproducibility of SWE according to the lesion size and stiffness. Two breast radiologists examined 20 targets of 4 different levels of stiffness and 5 different sizes (2.5, 4, 7, 11, and 18 mm) in a customized elasticity phantom. The B-mode image, color elastography image, and kPa measurement were obtained twice by each examiner with a 1-week interval. Inter- and intra-observer reproducibility and the accuracy of measured kPa were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Subgroup analysis was run to evaluate the effect of lesion size and stiffness on the reproducibility and accuracy of measured kPa. Inter- and intraobserver reproducibility for measuring kPa showed excellent agreement (ICC: 0.9742 and 0.9582; ICC: 0.9932 and 0.9294). The size and stiffness of the targets did not affect reproducibility. The overall accuracy of measured kPa was very high (ICC: 0.8049). In the subgroup analysis, targets that were ≤4 mm in size showed lower accuracy (ICC: 0.542), whereas targets that were 7 and 11 mm in size showed higher accuracy (ICC: 0.9832 and 0.9656, respectively). SWE shows excellent reproducibility regardless of lesion size or stiffness in phantom targets. The accuracy of measured kPa is high in lesions that are 7 and 11 mm in size but is low in lesions that are ≤4 mm in size.

Comparison of the diagnostic performance of shear wave elastography with shear wave dispersion for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma

PurposeThis prospective study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic fibrosis in patients with hepatocellular carcinoma before resection. MethodA total of 210 consecutive patients with hepatocellular carcinoma (HCC) who were scheduled to undergo hepatectomy were prospectively enrolled, pre-operative SWE and SWD examinations were performed. Fibrosis staging and necroinflammatory activity were determined histopathologically according to the Scheuer standard. Multivariate linear regression analysis was used to identify factors associated with SWE and SWD values. The performance of SWE and SWD were determined by receiver operating characteristic (ROC) analysis. ResultsBoth SWE and SWD values of liver were highly correlated with liver fibrosis stage and necroinflammatory activity (p < 0.05). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (p < 0.001). ROC analysis revealed that SWE that predicted substantial fibrosis (S ≥ 2), severe fibrosis (S ≥ 3) and cirrhosis (S = 4) were 0.895, 0.877 and 0.854, the SWD that predicted substantial fibrosis (S ≥ 2), severe fibrosis (S ≥ 3) and cirrhosis (S = 4) were 0.857, 0.815 and 0.791. SWE had better diagnostic performance than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4). ConclusionsBoth SWE and SWD are useful, accurate and non-invasive methods for evaluating hepatic fibrosis in patients with hepatocellular carcinoma adapted to hepatectomy, SWE is a more accurate imaging modality than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4).

Clinical Application of Shear Wave Elastography With Shear Wave Dispersion Imaging in the Preoperative Evaluation of Hepatic Parenchyma in Patients With Liver Tumors.

This study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic parenchyma in patients with liver tumors before resection. A total of 174 patients with liver tumors were prospectively enrolled. SWE and SWD examinations were performed. Fibrosis stage and necroinflammatory activity were determined histopathologically according to the Scheuer standard. We compared the diagnostic accuracy of SWE and SWD. Both SWE and SWD values of the liver were highly correlated with liver fibrosis stage (P < .05, respectively). Both SWE and SWD values of the liver were moderately correlated with necroinflammatory activity (P < .05, respectively). Both SWE and SWD values of the liver were not correlated with steatosis (P > .05, respectively). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (P < .001, respectively). The area under the receiver operating characteristic (ROC) curve of SWE value was 0.982, 0.977, 0.969, and 0.984 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S=4, respectively. The optimal cutoff SWE values were 6.9, 7.9, 8.7, and 10.6kPa for S ≥ 1, S ≥ 2, S ≥ 3, and S=4, respectively. The area under the ROC curve of SWD value was 0.967, 0.960, 0.925, and 0.954 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S=4, respectively. The optimal cutoff SWD values were 11.2, 12.0, 13.2, and 16.0 m/s/kHz for S ≥ 1, S ≥ 2, S ≥ 3, and S=4, respectively. SWE and SWD could be noninvasive and accurate for predicting the stage of liver fibrosis in patients with liver tumors before surgery. SWE was more accurate than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S=4).

Comparing the accuracy between shear wave elastography and strain elastography in the diagnosis of breast tumors: Systematic review and meta-analysis.

Background:Shear wave elastography and strain elastography are two new ultrasonic techniques developed rapidly in recent years. Changes in tissue elasticity occur after normal tissue changes. Elastography technique transforms the elastic information of tissue into optical information for display. Thus more intuitive display of tissue elasticity. Due to the differences in principles and related imaging parameters between the two elastic imaging methods, and the acquisition and interpretation of image data in strain elastic imaging method largely depends on the experience of inspectors, and due to the significant differences between the techniques of inspectors, As a result, conflicting results have been obtained in different scholars’ studies on the accuracy comparison of the two elastography techniques in the diagnosis of breast tumors. This meta-analysis aims to compare the accuracy of the two elastography methods in the diagnosis of breast tumors, so as to provide more accurate diagnostic means for patients with breast tumors. The final results will show which elastography method is more accurate in the diagnosis of breast tumors, reduce unnecessary biopsies and provide a reference for clinical decision making.Methods:We will examine published and unpublished randomized controlled trials, observational studies and abstracts without publication type or language restrictions, and search relevant literatures in PubMed, Web of Science, Wanfang Database, CNQI and other databases until December 30, 2020. The authors will independently search relevant literature records, scan titles and abstracts, full text, collect data and assess the risk of bias. Data will be analyzed by using Meta Disc1.4 software and Stata14.0 software. Heterogeneity tests and combined sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve will be performed by using Meta Disc1.4 software. Stata14.0 software will be used for sensitivity analysis and publication bias test.Results:The results of this systematic review will demonstrate the accuracy of the two elastography methods in the diagnosis of breast tumors.Discussion:The results will provide useful evidence for the comparison of the diagnostic accuracy of shear wave elastography and strain elastography in breast tumors.Other:This study was not funded. Register name: PROSPERO. Registration number: CRD42021251110.

Comparison of diagnostic value of SWE, FNA and BRAF gene detection in ACR TI-RADS 4 and 5 thyroid nodules.

To compare the diagnostic value of shear wave elastography (SWE), fine needle aspiration (FNA) and BRAF gene detection (BRAFV600E gene mutation detection) in ACR TI-RADS 4 and 5 thyroid nodules. SWE images, FNA cytological results and BRAF detection results of ACR TI-RADS 4 and 5 thyroid nodules confirmed by pathology were analyzed retrospectively. The receiver operating characteristic (ROC) curve was drawn to determine the best cutoff value of SWE Emax. In the combined diagnosis of SWE, FNA and BRAF, firstly, the nodules with BRAF gene mutation were included in the positive ones, secondly, the nodules with benign and malignant FNA were included in the FNA + SWE or FNA + SWE + BRAF negative and positive ones respectively, finally, for FNA uncertain nodules: those whose SWE Emax were less than or equal to the cutoff value were included in FNA + SWE or FNA + SWE + BRAF negative ones, and those whose SWE Emax were greater than the cutoff value were included in positive ones. The diagnostic efficacy of SWE, FNA, SWE + FNA, FNA + BRAF and their combination in ACR TI-RADS 4 and 5 thyroid nodules were compared. The ROC curve showed that the best cutoff value of SWE Emax was 40.9 kpa, and the area under ROC curve (AUC) was 0.842 (0.800∼0.885). The sensitivity, specificity and accuracy of SWE were 76.3% (270/354), 75.5% (80/106) and 76.1% (350/460), respectively. The sensitivity, specificity and accuracy of FNA were 58.2% (206/354), 88.7% (94/106) and 65.2(300/460), respectively. The sensitivity, specificity and accuracy of FNA + BRAF were 95.5% (338/354), 88.7% (94/106) and 93.9% (432/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA were 85.9% (304/354), 98.1% (104/106) and 88.7% (408/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA + BRAF were 98.3% (348/354), 98.1% (104/106) and 98.3% (452/460), respectively. For the diagnostic accuracy, SWE + FNA + BRAF > FNA + BRAF > FNA + SWE > SWE > FNA, the difference was statistically significant (all P > 0.05). For ACR TI-RADS 4 and 5 thyroid nodules, SWE and FNA have high diagnostic efficiency. For the diagnostic accuracy, FNA + BRAF is better than FNA + SWE. FNA combination with BRAF gene detection further improves the diagnostic sensitivity and accuracy of FNA. The combined application of the three is the best.

Comparison of p63 immunohistochemistry and shear wave elastography in the diagnosis of indeterminate breast lesions: A prospective study.

To evaluate the accuracy of breast shear wave elastography (SWE) and p63 immunohistochemistry (IHC) in the diagnosis of indeterminate breast lesions. Based on detailed clinical examination and a combination of X-ray mammography/B-mode ultrasound with SWE, a total of 40 patients with breast lumps (BI-RADS 4) were included. Patients with previous diagnosis of breast cancer and a previous history of surgery, chemotherapy, or radiotherapy in the same breast as the present lesion were excluded. Core needle biopsy of the breast lesion was performed, and p63 IHC staining was performed. A final histopathological report of the definitive procedure was considered as the gold standard. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy were calculated for each modality. The mean age of the patients included in the study was 50.85 ± 13.53 years. Of the 40 patients recruited, 23 were clinically malignant and 17 were benign. The sensitivity, specificity, PPV, NPV, and accuracy of SWE were 91.3%, 94.1%, 95.5%, 88.9%, and 92.5% and those of p63 IHC were 95.7%, 100%, 100%, 94.4%, and 97.5%, respectively. Overall, the parametric values were higher for p63 IHC as compared to clinical examination and elastography. The area under the ROC curve (AUC) for p63 IHC (.978) was higher than those for SWE (.927) and clinical examination (.898). SWE and p63 IHC are highly reliable novel modalities that demonstrate enhanced diagnostic accuracy of indeterminate breast lesions aiding in the early initiation of appropriate treatment and reducing the number of women subjected to biopsy or short-term follow-up for benign-appearing solid breast lesions.

Non Invasive Assessment of Fibrosis in Non Alcoholic Fatty Liver Disease by Shear Wave Elastography and NAFLD Fibrosis Score: A Cross-sectional Study

Introduction: The major consequence of Non Alcoholic Fatty Liver Disease (NAFLD) is the inflammation and fibrosis of hepatic tissue resulting in cirrhosis, portal hypertension, and eventually hepatocellular carcinoma. Presently, the distinction between simple steatosis, steatohepatitis, and cirrhosis stages of NAFLD is largely dependent on liver biopsy. Since, liver biopsy is invasive, it not suitable for screening purposes. To overcome this limitation, elastography and NAFLD fibrosis score have been studied as non invasive objective substitutes for liver biopsy. Aim: To evaluate the diagnostic accuracy of Shear Wave Elastography (SWE) as a method to diagnose significant-advanced fibrosis in patients with NAFLD by using NAFLD fibrosis score as a reference standard. Materials and Methods: This hospital based cross-sectional study was conducted at JSS Hospital, Mysuru, Karnataka, India over a period of 18 months from September 2018 to November 2019. Total 154 participants underwent ultrasound abdomen to assess the presence and grade the degree of Steatosis. All patients underwent 2D shear wave elastography and the values were compared with NAFLD fibrosis scores. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) statistics version 23.0. Results: The age of this study group ranged from 20 to 76 years, mean age was 42.8± 10.8 years including 51 (33.1%) females and 103 (66.9%) males. The level of agreement for assessment of fibrosis between SWE and NAFLD fibrosis score was good (score of 0.71). Using a predictive shear stiffness threshold of 6.1 kPa, shear stiffness distinguished low (fibrosis stage 0-2) from high (fibrosis stage 3-4) fibrosis stages with a sensitivity of 83% and a specificity of 92.7% (area under the curve of 0.879). Conclusion: Two-dimensional shear wave elastography showed a good diagnostic performance for detection of fibrosis.

A Comparison of Shear Wave Elastography between Normal Myometrium, Uterine Fibroids, and Adenomyosis: A Cross-Sectional Study.

BackgroundThe differential diagnosis between uterine fibroid and adenomyosis is sometimes difficult; a precise diagnosis is required in women with infertility because of the different choice of treatments. Ultrasound elastography (UE) is a novel technique to evaluate the elasticity or the stiffness of the tissue of interest. The present study aims to compare UE shear wave velocity (SWV) among normal uterine myometrium, uterine fibroid, and adenomyosis, and assess the accuracy of shear wave elastography in the diagnosis of adenomyosis.Materials and MethodsThis cross-sectional study recruited 25 subjects for each group (control, adenomyosis, and fibroid) from April 2019 to April 2020. Transvaginal UE using an Aplio 500 (Toshiba Medical Systems, Japan) with ultrasound mapping for point of tissue biopsy was performed for all subjects. The diagnosis was confirmed by histology. Masson’s trichrome staining for collagen was performed and quantifiedResultsThe mean ± standard deviation (SD) for SWV was 3.44 ± 0.95 m/seconds (control group), 4.63 ± 1.45 m/seconds (adenomyosis group), and 4.53 ± 1.07 m/seconds (fibroid group). The mean SWV differed when comparing normal myometrium and adenomyosis after adjustments for age and endometrial pathology (P=0.019). The cut-off point of SWV at 3.465 m/seconds could differentiate adenomyosis from the normal uterus with an 80% sensitivity, 80% specificity, and an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.68-0.93) (P<0.001). No significant difference in SWV between the adenomyosis and fibroid groups was detected.ConclusionShear wave elastography could be an alternative tool to distinguish between normal myometrium and adenomyosis; however, it could not differentiate adenomyosis from uterine fibroid or uterine fibroid from normal myometrium.

Diagnostic performance of quantitative and qualitative elastography for the differentiation of benign and malignant cervical lymph nodes: A protocol for systematic review and meta-analysis.

Background:Studies have shown inconsistent results regarding the diagnostic performance of quantitative and qualitative elastography for the differentiation of benign and malignant cervical lymph nodes. This meta-analysis aimed to estimate the diagnostic performance of ultrasound elastography in patients with cervical lymphadenopathy.Methods:We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the May 30, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.Results:This systematic review will determine the accuracy of shear wave elastography and strain elastography in the differential diagnosis between benign and malignant cervical lymph nodes.Conclusion:Its findings will provide helpful evidence for the accuracy of shear wave elastography and strain elastography in the differential diagnosis between benign and malignant cervical lymph nodes.Systematic review registration:INPLASY202150109.

Accuracy of shear wave elastography in characterization of thyroid nodules in children and adolescents

BackgroundThyroid nodules are an important health problem in children and adolescents. They possess a higher risk of malignancy in comparison to adults. This fact forms a great dilemma for clinicians. The aim of this study was to evaluate the reliability of shear wave elastography (SWE) as a non-invasive technique in the characterization of thyroid nodules in children and adolescents.MethodsThis prospective study included 56 patients with thyroid nodules. All the patients underwent clinical assessment, laboratory investigations, ultrasound, and Doppler examination, followed by an SWE assessment. Statistical analysis was performed and the best cut-off value to differentiate benign from malignant nodules was determined using the ROC curve and AUC.ResultsSeventy-two nodules were detected in the examined patients (ages ranged from 11 to 19 years, with mean age of 14.89 ± 2.3 years). Fifty-eight nodules (80.6%) were benign, and fourteen nodules (19.4%) were malignant (histopathologically proved). Highly suspicious criteria for prediction of malignancy by ultrasound and Doppler were hypoechoic echopattern, internal or internal and peripheral vascularity, microcalcifications, taller-than-wide dimensions, irregular outlines, and absence of halo (p < 0.05). The diagnostic performance for their summation was 70.69% sensitivity, 82.8% specificity, 80.45% accuracy, a 63.79% positive predictive value (PPV), and 87.9% negative predictive values (NPV). Regarding SWE, our results showed that 42.2 kPa was the best cut-off value, with AUC = 0.921 to differentiate malignant from benign nodules; the diagnostic performance was 85.71% sensitivity, 94.83% specificity, 93.06% accuracy, 76.9% PPV, and 93.2% NPV.ConclusionShear wave elastography is a non-invasive technique that can assist in the diagnosis of malignant thyroid nodules among children and adolescents.

The Accuracy of Shear Wave Elastography in the Assessment of Placental Invasion in Women with Placenta Previa

Background: Placenta accreta spectrum is a term which describes abnormal invasion of the placenta into the uterine myometrium. The first line in diagnosis is ultrasonography and magnetic resonance imaging may complement the diagnosis. Aim: The aim of the work is to assess the accuracy of shear wave elastography in predication of placental invasion in women with placental previa.Materials and Methods: This is a prospective cohort study which was conducted in Ain Shams University on 50 women with a diagnosis of anterior placenta previa and history of previous cesarean section who were pregnant at 32 weeks or more and were planned for delivery by elective cesarean section. They were subjected to ultrasonography and elastography study and the diagnosis of placenta accreta spectrum was confirmed/ excluded intraoperatively.Results: Placental separation was normal in 36% of cases, delayed in 46 % of cases, partial in 6% of cases only whereas non separation occurred in 12% of cases. elastrgraphy had a sensitivity of 73.7%, specificity of 90.3%, positive predicting value of 82.4% and negative predictive value of 84.8% in diagnosing cases with abnormal placental invasion while sensitivity, specificity positive and negative predictive value of ultrasonography in diagnosing abnormal placental invasion was 89.5%, 96.8%, 94.4% and 93.8% respectively.Conclusion: Elastography is sensitive and specific but inferior to ultrasonography in evaluating women with suspected placenta accreta spectrum but it may be useful in diagnosis of focal invasion.