Acoustic Radiation Force Impulse Imaging Research Articles

Point Shear-Wave Elastography Using Acoustic Radiation Force Impulse Imaging for the Prediction of Liver-Related Events in Patients With Chronic Viral Hepatitis.

Chronic viral hepatitis is associated with substantial morbidity and mortality worldwide. The aim of our study was to assess the ability of point shear-wave elastography (pSWE) using acoustic radiation force impulse imaging for the prediction of the following liver-related events (LREs): new diagnosis of HCC, liver transplantation, or liver-related death (hepatic decompensation was not included as an LRE). pSWE was performed at study inclusion and compared with liver histology, transient elastography (TE), and serologic biomarkers (aspartate aminotransferase to platelet ratio index, Fibrosis-4, FibroTest). The performance of pSWE and TE to predict LREs was assessed by calculating the area under the receiver operating characteristic curve and a Cox proportional-hazards regression model. A total of 254 patients with a median follow-up of 78 months were included in the study. LRE occurred in 28 patients (11%) during follow-up. In both patients with hepatitis B virus and hepatitis C virus (HCV), pSWE showed significant correlations with noninvasive tests and TE, and median pSWE and TE values were significantly different between patients with LREs and patients without LREs (both P<0.0001). In patients with HCV, the area under the receiver operating characteristic curve for pSWE and TE to predict LREs were comparable: 0.859 (95% confidence interval [CI], 0.747-0.969) and 0.852 (95% CI, 0.737-0.967) (P=0.93). In Cox regression analysis, pSWE independently predicted LREs in all patients with HCV (hazard ratio, 17.9; 95% CI, 5.21-61-17; P<0.0001) and those who later received direct-acting antiviral therapy (hazard ratio, 17.11; 95% CI, 3.88-75.55; P=0.0002). Conclusion: Our study shows good comparability between pSWE and TE. pSWE is a promising tool for the prediction of LREs in patients with viral hepatitis, particularly those with chronic HCV. Further studies are needed to confirm our data and assess their prognostic value in other liver diseases.

Role of acoustic radiation force impulse imaging and contrast enhanced ultrasound in characterization CT indeterminate pancreatic cystic lesion

Role of acoustic radiation force impulse imaging and contrast enhanced ultrasound in characterization CT indeterminate pancreatic cystic lesion

Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Using Acoustic Radiation Force Impulse

Background: The clinical importance of NAFLD and the limitations of liver biopsy have increased the need for accurate and noninvasive imaging methods to evaluate NAFLD. 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. Aim of study: Assess the reliability of acoustic radiation force impulse (ARFI) for diagnosis of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) compared with NAFLD-fibrosis score and FIB-4 Index. Methods: This study was conducted on 100 patients diagnosed with NAFLD and 30 healthy subjects referred from Damanhour Medical National Institute outpatient clinics, from June 2018 to December 2018. Results: The degree of agreement between ARFI and FIB-4 index is 80%. The ROC curve for the performance of ARFI in prediction of F3 or more (taking FIB-4 as a gold standard) shows sensitivity of 100% and specificity of 79.5%. It also showed that the degree of agreement between ARFI and NAFLD fibrosis score is 87.1%. The ROC curve for the performance of ARFI in prediction of F3 or more (taking NAFLD Fibrosis Score as a gold standard) shows sensitivity of 71.4% and specificity of 83.3%. Conclusion: The degree of agreement between ARFI on one hand and FIB-4 score and NAFLD fibrosis score on the other hand is acceptably high and is statistically significant.

Multiparametric Ultrasound for Targeting Prostate Cancer: Combining ARFI, SWEI, QUS and B-Mode

Diagnosing prostate cancer through standard transrectal ultrasound (TRUS)-guided biopsy is challenging because of the sensitivity and specificity limitations of B-mode imaging. We used a linear support vector machine (SVM) to combine standard TRUS imaging data with acoustic radiation force impulse (ARFI) imaging data, shear wave elasticity imaging (SWEI) data and quantitative ultrasound (QUS) midband fit data to enhance lesion contrast into a synthesized multiparametric ultrasound volume. This SVM was trained and validated using a subset of 20 patients and tested on a second subset of 10 patients. Multiparametric US led to a statistically significant improvements in contrast, contrast-to-noise ratio (CNR) and generalized CNR (gCNR) when compared with standard TRUS B-mode and SWEI; in contrast and CNR when compared with MF; and in CNR when compared with ARFI. ARFI, MF and SWEI also outperformed TRUS B-mode in contrast, with MF outperforming B-mode in CNR and gCNR as well. ARFI, although only yielding statistically significant differences in contrast compared with TRUS B-mode, captured critical qualitative features for lesion identification. Multiparametric US enhanced lesion visibility metrics and is a promising technique for targeted TRUS-guided prostate biopsy in the future.

Quantifying Skin Stiffness in Graft-Versus-Host Disease, Morphea, and Systemic Sclerosis Using Acoustic Radiation Force Impulse Imaging and Shear Wave Elastography

There is a need for objective, sensitive, and reproducible methods of assessing skin sclerosis. We successfully adapted ultrasound-based, noninvasive methods for quantifying tissue stiffness for use on the skin: acoustic radiation force impulse (ARFI) imaging and shear wave elasticity imaging (SWEI) (Lee et al., 2015). ARFI imaging generates images of micron-scale tissue displacement, whereas SWEI measures the speed at which sound waves travel across target tissue (shear wave speed [SWS]) in meters per second (Palmeri and Nightingale, 2011).

Improved Acoustic Radiation Force Impulse Imaging Using Split-Focused Ultrasound Transducer With Phase Inversion Technique

Echo decorrelation artifacts decrease the resolution of the acoustic radiation force impulse (ARFI) images. Reducing echo decorrelation requires that the lateral and the elevational beamwidths of the pushing beam are broad compared to the detection beam. In this study, we propose the split-focused ultrasound based on phase inversion technique to achieve this goal. The proposed technique can be implemented with a cross-segmented transducer composed of four rectangular elements driven by signals having different phases. Four independent focal lobes were generated in the lateral and elevational directions, extending the beamwidths in both directions. A finite element analysis (FEA) simulation was conducted to verify the performance of the proposed technique, and an experimental demonstration was performed using the fabricated prototype transducer and a tissue-mimicking gelatin phantom. Compared to the conventional model, the proposed method reduced the jitter by up to 4.7 times at the peak mean displacement, improving the accuracy of the measured displacement, and increased the peak contrast-to-noise ratio by 2.1 times. Thus, the proposed technique can contribute to improve the resolution of the ARFI imaging.

Diagnosis of Acute Rejection of Liver Grafts in Young Children Using Acoustic Radiation Force Impulse Imaging.

OBJECTIVE. Frequency of acute rejection (AR) after pediatric liver transplant remains high despite progress in immunosuppression. Liver biopsy (LB) is the reference standard for the diagnosis of AR despite its potential for morbidity. The purpose of our study was to evaluate the ability of acoustic radiation force impulse (ARFI) imaging to distinguish AR from other causes of short- and medium-term liver dysfunction and to identify liver transplant cases with normal liver function. MATERIALS AND METHODS. ARFI imaging was used to evaluate shear wave velocity (SWV) after liver transplant in young children. All pediatric liver grafts that had LB and ARFI examination between January 2014 and December 2017 were included in this retrospective study. Results of LB were compared with those of SWV. Collected data included age at biopsy and transplant, sex, weight, height, body mass index, interval between liver transplant and shear wave elastography and LB, kind of graft, type of donor, and diagnosis at transplant. ROC curve analysis was performed to assess the diagnostic performance of SWV. Optimal cutoff of SWV using ARFI imaging in predicting AR was identified using the Youden index. RESULTS. Statistical analysis was performed on 54 children; six of the original 60 were excluded because of confounding alterations or changes in outcome. Median SWV was higher in patients with AR (2.03 m/s; interquartile range [IQR], 1.80-2.45 m/s) compared with those with idiopathic hepatitis (1.33 m/s; IQR, 1.12-1.53 m/s), portal hypertension (1.42 m/s; IQR, 1.32-1.72 m/s), cholangitis (1.56 m/s; IQR, 1.07-1.62 m/s) or normal liver function (1.23 m/s; IQR 1.12-1.29 m/s) at protocol biopsies (all comparisons, p < 0.01). SWV higher than 1.73 m/s was predictive for AR (AUC, 0.966). SWV also showed good diagnostic accuracy in normal liver function (AUC, 0.791). ARFI imaging was not predictive for hepatitis (AUC, 0.402), portal hypertension (AUC, 0.556), or cholangitis (AUC, 0.420). CONCLUSION. ARFI imaging could be routinely used in place of LB in pediatric patients with liver dysfunction after liver transplant, restricting indication and risks of biopsy to selected cases.

Increased liver stiffness by transient elastography and acoustic radiation force impulse imaging in patients with extrahepatic cholestasis.

Transient elastography and acoustic radiation force impulse (ARFI) imaging are noninvasive tools for liver stiffness measurement (LSM), which may be influenced by cholestasis. The aim of the study was to evaluate the performance of transient elastography and ARFI in extrahepatic cholestasis and correlate changes in LSM with biochemical activity. A total of 38 patients with extrahepatic cholestasis prospectively underwent transient elastography and ARFI. Changes in LSM by transient elastography/ARFI were evaluated after 1 week of ERCP and correlated with biochemical parameters. The optimal ARFI cutoffs according to stages of clinical interest were analyzed. Biliary obstruction was calcular in 21 (55.3%) and noncalcular in 17 (44.7%) (benign n = 15, malignant n = 2). After 1 week, adequate biliary drainage reduced total bilirubin from 7.7 to 2.2 mg/dL (P < 0.001) which significantly correlated with reduction of LSM by transient elastography from 12.38 ± 6.68 kPa to 8.08 ± 3.21 kPa (P < 0.001), and by ARFI from 1.73 ± 0.51 m/s to 1.56 ± 0.70 m/s (P = 0.014). The LSM percentage change showed a decrease (nonsignificant, P = 0.843) by 25.83% using transient elastography and a significant decrease (P < 0.001) by 18.42% using ARFI in the improved patients. At initial visit, transient elastography positively correlated with ARFI, bilirubin and platelets, also, transient elastography had a positive correlation with ARFI, bilirubin, alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT) in follow-up visit. LSM by ARFI (visit 1) negatively correlated with ALT, while in (visit 2), ARFI positively correlated with bilirubin, ALP, GGT and negatively correlated with albumin. The increased LSM in patients with extrahepatic cholestasis is reduced after adequate biliary drainage, implying that increased values are not solely due to liver fibrosis, but due to biliary congestion leading temporarily to increased elasticity.

Can acoustic radiation force impulse imaging (ARFI) accurately diagnose renal masses?: A protocol of systematic review and meta-analysis.

Background:Renal masses are increasingly being discovered because of the wide accessibility of modern high resolution imaging procedures. Previous clinical studies have reported that acoustic radiation force impulse imaging (ARFI) is used for diagnosis of renal masses. However, no study has investigated this topic systematically. Therefore, this study will evaluate the diagnostic value of ARFI for the diagnosis of renal masses.Methods:A systematic search using the databases of Cochrane Library, EMBASE, Pubmed, WANGFANG, and China National Knowledge Infrastructure will be performed to identify studies in which patients with renal masses are assessed by ARFI. Two investigators will independently screen the literature and extract the data. Any discrepancies will be resolved via discussion with the senior author. Study quality will be assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various ARFI findings for the diagnosis of renal masses will be determined. Summary receiver operating characteristic curve will be used to assess the overall performance of ARFI.Results:This study will evaluate the diagnostic value of ARFI for the diagnosis of renal masses through sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio.Conclusion:This study will summarize the most recent evidence that focusing on the diagnosis of ARFI for renal masses.Study registration:INPLASY202060105.

Comparative Efficacy of Ultrasonography and Acoustic Radiation Force Impulse (ARFI) Elastography in Prediction of Malignancy in Thyroid Nodules

Objective: The incidence of malignancy in thyroid nodules is infrequent, but this trend may be reversing. The present study was conducted to emphasize the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging, in addition to conventional gray-scale ultrasonography (US), for differentiating benign and malignant thyroid nodules. Methods: A total of 141 patients with thyroid nodules (≥10 mm) were included in the study and were evaluated with US, Doppler, and ARFI elastography using Siemens S2000 Acuson ultrasound equipment. Results: The sonographic patterns most predictive and indicative of malignancy included irregular margins and presence of microcalcifications. The Doppler findings in isolation were not extremely sensitive in the detection of malignancy. The shear wave velocity cutoff value on ARFI imaging using receiver operating characteristic curves for differentiation of benign and malignant nodules were noted at 2.87 m/s. ARFI imaging performed better than US and Doppler with sensitivity of 75%, specificity of 96%, and accuracy of 94%. Conclusion: ARFI elastography could be utilized as a reliable initial screening test for detection of malignancy in thyroid nodules.

Virtual Touch Quantification using Acoustic Radiation Force Impulse Imaging Technology versus Transient Elastography for the Noninvasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B or C using Liver Biopsy as the Gold Standard.

Our aim was to assess the diagnostic performance of transient elastography (TE) and Virtual Touch Quantification (VTQ), a point Shear Wave Elastography (pSWE) technique, using Acoustic Radiation Force Impulse (ARFI) technology, for liver fibrosis assessment, as compared to percutaneous liver biopsy (LB), in patients with chronic hepatitis B or C. We analyzed 157 patients (80 with chronic hepatitis B and 77 with chronic hepatitis C) with reliable liver stiffness (LS) measurements, in whom we compared TE and VTQ to the LB performed during the same session (evaluated according to the Metavir scoring system: F0-F4). LS was assessed by TE (FibroScan, EchoSens, Paris, France) and VTQ using the Siemens Acuson S2000TM ultrasound system (Siemens AG, Erlangen, Germany). We defined reliable LS measurements as the median value of 10 measurements with an IQR/M <30% for both TE (obtained using the M probe) and VTQ. The areas under receiver operating characteristic curves (AUROCs) were used to assess the diagnostic performance of TE and VTQ. Correlation analysis determined the relationship between LSM values and liver histology. On LB 31 (19.7%) patients had no fibrosis, 35 (22.3%) had F1, 43 (27.4%) had F2, 28 (17.8%) had F3 and 20 (12.7%) had cirrhosis. The mean size of the liver specimen in LB was 27 mm. A strong, linear correlation (Spearman ρ=0.826; p<0.001) with 95% confidence interval for rho (0.769- 0.870), was found between the TE and VTQ measurements. By comparing the AUROC curves, TE and VTQ had similar predictive values for the presence of F≥1 Metavir: AUROC TE=0.876, AUROC VTQ=0.832, p=0.358, for F≥2 Metavir: AUROC TE=0.826, AUROC VTQ=0.862, p=0.313, for F≥3 Metavir: AUROC TE=0.907, AUROC VTQ=0.880, p=0.434 and for F=4 Metavir: AUROC TE=0.981, AUROC VTQ=0.974, p= 0.423. Both methods, TE and VTQ (pSWE) offer excellent diagnostic accuracy for liver fibrosis assessment in patients with chronic hepatitis B or C with similar performance.

How Much Liver Tissue Is Required for Sufficient Histological Staging in Patients with Primary Biliary Cholangitis?

Introduction: Histological alterations in primary biliary cholangitis (PBC) are heterogeneously distributed throughout the liver. Thus, the quality of histological staging is probably dependent on the available amount of liver tissue. The goals of this study were to test this hypothesis and to define biopsy conditions for obtaining sufficient tissue. Methods: In this retrospective analysis, we investigated 34 patient cases who fulfilled the criteria of the European Association for the Study of the Liver (EASL) for PBC and underwent a mini-laparoscopic liver biopsy between 2011 and 2018 using 16 or 18G needles. For histological assessment of fibrosis, we used the Ishak score, and the amount of tissue was measured by the number of portal fields. Histological staging was compared with the macroscopic mini-laparoscopic fibrosis score (MLFS), and non-invasive liver stiffness measurements using acoustic radiation force impulse (ARFI) imaging and the FIB-4 score. Results: Biopsy was successful in 33 of 34 patients (97%). Fibrosis assessment by MLFS and ARFI correlated strongly with each other (r = 0.7088, p = 0.000017). However, the correlation of both methods with the histological staging was weaker (MLFS vs. histology: r = 0.4231, p = 0.0142; ARFI vs. histology: r = 0.3564, p = 0.0577). The correlation of ARFI and MLFS with the histological staging was better in the subgroup of biopsies with at least 10 portal fields (= SG_≥10PF) (MLFS vs. histology: r = 0.6369, p = 0.006; ARFI vs. histology: r = 0.7538, p = 0.0012). FIB-4 correlated weakly with the histological staging, which was statistically not significant (all samples: r = 0.2693, p = 0.1296; SG_≥10PF: r = 0.2244, p = 0.3866). The number of portal fields correlated well with the length of the samples (r = 0.6436, p = 0.00012). The probability to attain at least 10 portal fields depended on the needle diameter and number of samples (1 × 16G or 18G [n = 10]: 30.0%; 2 × 18G [n = 15]: 53.3%; 2 × 16G [n = 5]: 100%; p = 0.0414). Conclusion: ARFI and MLFS are probably well suited for the assessment of liver fibrosis in patients with PBC. A minimum of 10 portal fields could improve the histological assessment in PBC and can probably be achieved by obtaining two 16G biopsies.

Diagnostic Performance Evaluation of Practice Guidelines, Elastography and Their Combined Results for Thyroid Nodules: A Multicenter Study

The purpose of this multicenter study was to compare the differential diagnostic value of the 2015 American Thyroid Association (ATA) and 2017 American College of Radiology (ACR) practice guidelines and elastography in thyroid nodules. This study also investigated whether the diagnostic value of practice guidelines can be improved, and the unnecessary biopsy rate decreased in combination with elastography. A total of 498 thyroid nodules were evaluated using the ATA and the ACR guidelines. Strain elastography, acoustic radiation force impulse imaging and point-shear wave elastography were used to assess the nodules. The suspicious levels were downgraded or upgraded after combination and unnecessary biopsy rates were calculated, respectively. The diagnostic performance of the practice guidelines was better than that of elastography. The ACR guidelines had a lower unnecessary biopsy rate and similar diagnostic performance compared with the ATA guidelines. The unnecessary biopsy rates significantly decreased when the ACR guidelines were combined with elastography, but the rates did not decrease when the ATA guidelines were combined with elastography.

Effect of shear wave propagation on estimation of heating distribution by high-intensity focused ultrasound using acoustic radiation force imaging

In a high-intensity focused ultrasound (HIFU) treatment, to predict a HIFU heat source is important for the safety and efficiency. Acoustic radiation force impulse imaging using a HIFU burst is known as a method for the prediction from the distribution of the tissue displacement in a homogeneous tissue. However, the distribution induced by HIFU radiation force expands as the shear wave propagates. In this study, the effect of the shear wave propagation on the estimation of the heat source distribution was investigated by changing the burst duration and intensity of HIFU. The results showed that a shorter HIFU burst provided the higher accuracy of the prediction, improving the spatial resolution. It is concluded that the estimation method has the potential to estimate in a wide range of HIFU energy and requires one to obtain the distribution of displacements immediately after the start of HIFU burst exposure.

Acoustic radiation force impulse imaging of pancreas in patients with early onset idiopathic recurrent acute pancreatitis.

Patients with recurrent acute pancreatitis (RAP) may progress to chronic pancreatitis (CP). A critical step in this progression is the development of fibrosis. Elastography has been used to assess degree of fibrosis by measurement of shear wave velocity (SWV). The aim of this study was to measure the stiffness of pancreas as a surrogate for pancreatic fibrosis in patients with RAP and compare it with a group of individuals without any history of pancreatic disorders. Using acoustic radiation force impulse (ARFI) imaging SWV was calculated in 31 patients with idiopathic RAP having disease onset ≤30 years. A control group of 31 individuals with no history pancreatic disorder and no features of CP on endosonography was selected for comparison. ARFI imaging was done by a single radiologist who was blinded to the cases and controls RESULTS:: Mean age of patients with RAP was 24.8 (SD 9.86) years, disease duration was 3.45 (interquartile range 1-5) years, mean number of episodes 4.9 (SD 2.72). There was a significant difference in SWV between patients (1.27 ± 0.50 m/s) and controls (1.00 ± 0.17 m/s) (P = 0.001)). There was a positive correlation between SWV and number of pain episodes (P = 0.026) and negative correlation with BMI (P = 0.002). SWV was high in patients with RAP indicating a stiff pancreas. The stiffness increases with the number of episodes of pancreatitis.

Role of Ultrasound Acoustic Radiation Force Impulse in Differentiating Benign from Malignant Superficial Lymph Nodes.

Objective:The purpose of this study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) imaging in differentiating benign from malignant peripheral lymphadenopathy.Materials and Methods:This was a prospective study approved by the Institutional Review Board with financial grant for the same. Ultrasound and ARFI imaging of peripheral lymph nodes were performed and correlated with pathological results, which were used as the reference standard. The virtual touch tissue imaging and virtual touch tissue quantification parameters of ARFI were analyzed in 86 lymph nodes, of which 78 were included in the study. Using receiver operating characteristic curve analysis, the diagnostic usefulness of ARFI values were evaluated with respect to their sensitivity, specificity, and area under the curve.Results:The mean area ratio of benign lymph nodes was 0.88 (±0.2) and that of malignant lymph nodes was 1.17 (±0.14). The mean shear wave velocities (SWV) of benign and malignant lymph nodes were 2.02 m/s (±0.94) and 3.7 m/s (±2.27), respectively. The sensitivity and specificity of virtual touch imaging area ratio in differentiating benign from malignant lymph nodes was 97% and 77%, of SWV was 71% and 70%, and of SWV ratio was 68% and 79%, respectively.Conclusion:As ARFI was found to have a superior diagnostic performance over conventional ultrasound and color Doppler in the characterization of lymph nodes, we recommend its routine use in differentiating benign from malignant nodes.

Evaluation of Liver Fibrosis and Portal Hypertension in Chronic Hepatitis B Patients by Acoustic Radiation Force Impulse Elastography

Background: Accurate evaluation of the degree of fibrosis and cirrhosis is crucial for determining treatment strategies, surveillance, and prognosis in patients with chronic hepatitis B (CHB). Objectives: To explore the value of acoustic radiation force impulse (ARFI) elastography in assessing the stage of liver fibrosis and the severity of cirrhosis based on portal hypertension. Patients and Methods: One hundred ninety-six consecutive CHB patients who underwent partial hepatectomy and sixty-four advanced cirrhosis patients who underwent hepatic vein pressure gradient (HVPG) measurement were examined with ARFI imaging. Liver stiffness measurements (LSMs) were obtained and compared with the hepatic histological findings by using Scheuer scoring system and with the value of HVPG, respectively. A spleen stiffness measurement (SSM) and spleen index were also performed, and the values were compared with HVPG measurements. Results: Areas under the receiver operating characteristics curve (AUROCs) were 0.952 and 0.976, respectively for the diagnosis of significant fibrosis (S ≥ S2) and cirrhosis (S4), with the corresponding values of 1.26 m/s and 1.58 m/s for optimal LSM cutoff points. For advanced cirrhotic patients (n = 64), the correlation coefficient between LSM and HVPG was 0.637 (P < 0.001). The cutoff values for predicting HVPG ≥ 10 mm Hg and HVPG ≥ 12 mm Hg were 1.79 m/s and 1.90 m/s, respectively (AUROC: 0.665 and 0.859). Neither the value of SSM nor the spleen index showed a statistical relationship with HVPG in the advanced cirrhosis group, but they were significantly correlated with each other (ρ = 0.604, P < 0.05). Conclusion: As a noninvasive elastosonography for the evaluation of liver stiffness, ARFI imaging could not only be used to stage liver fibrosis in CHB patients, but also to evaluate the severity of cirrhosis based on portal hypertension.

Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation.

Purpose: To investigate the value of US and elastography for predicting prognostic factors of papillary thyroid cancer (PTC) in the positive BRAFV600E Mutation group.Materials and Methods: A total of 116 BRAFV600E Mutation patients with PTCs were enrolled in this prospective study, who were preoperatively evaluated by US, US elasticity imaging (EI), and Virtual Touch tissue imaging (VTI) and Virtual Touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging. Multivariate logistic regression analysis was performed to assess 23 independent variables for predicting prognostic factors. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis.Results: Forty-two (36.2%) of 116 PTC patients with BRAFV600E Mutation had central lymph node metastasis (LNM). Nine (7.8%) and fifty-six (48.3%) had lateral LNM and extra-thyroidal extension (ETE), respectively. In multivariate logistic regression analyses, rich internal flow [odds ratio [OR]: 6.66] was the best predictor for central LNM, followed by male sex (OR: 4.22), halo sign absence (OR: 2.78) (all P < 0.05). VTQ ratio (OR: 1.57) was the only predictor for lateral LNM (P = 0.02). Rich internal flow (OR: 6.33) was the strongest predictor for ETE, followed by male sex (OR: 3.29), halo sign absence (OR: 2.90), and VTQ ratio (OR: 1.63) (all P < 0.05).Conclusion: VTQ ratio on ARFI imaging, rich internal flow and halo sign absence on US are the predicting prognostic factors in PTC patients with BRAFV600E Mutation. The specificities were significantly increased by combining ARFI imaging and US features, which has a potential to avoid unnecessary therapeutic neck dissection in the high-risk PTC patients.

The diagnostic accuracy of liver fibrosis in non-viral liver diseases using acoustic radiation force impulse elastography: A systematic review and meta-analysis.

BackgroundAcoustic radiation force impulse (ARFI) imaging is an ultrasound-based elastography method that has been studied in the staging of hepatic fibrosis, especially in chronic hepatitis. However, the diagnostic accuracy of ARFI in non-viral hepatopathies, such as autoimmune hepatitis and non-alcoholic fatty liver disease, has not been systematically determined.AimTo systematically assess the diagnostic accuracy of ARFI in non-viral hepatopathies.MethodsThe databases of PubMed, Embase, Cochrane Library and clinicaltrials.gov were systematically searched for candidate studies reporting the diagnostic accuracy of ARFI for hepatic fibrosis. The pooled estimates of the sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios were calculated with the summary receiver operating curve (sROC) performed using STATA software.ResultsIn detail, a total of 29 diagnostic studies were included for further analysis. The quality of the included studies was relatively high using QUADAS method. The pooled sensitivity and specificity were 0.79 (0.73, 0.83) and 0.81 (0.75, 0.86), with AUROC 0.87 (0.83, 0.89) for the staging of significant fibrosis (F≥2). Meanwhile, for the staging of severe fibrosis (F≥3), the pooled sensitivity and specificity were 0.92 (0.87, 0.95) and 0.85 (0.80, 0.89), with AUROC 0.94 (0.92, 0.96). Furthermore, the pooled sensitivity and specificity were 0.89 (0.79, 0.95) and 0.89 (0.85, 0.92), with AUROC 0.94 (0.92, 0.96) for ARFI in staging cirrhosis (F = 4), which were similar to the data for severe fibrosis. No significant publication bias was present in this study.ConclusionThis meta-analysis demonstrated that ARFI exerted satisfactory diagnostic performance in staging non-viral hepatic fibrosis, especially severe fibrosis (F≥3) and cirrhosis (F = 4).

Comparison of hepatic and splenic stiffness in chronic hepatitis C infection with and without schistosomal infection; correlation with hepatic histopathological changes.

Aim of the studyTo assess the degree of liver and spleen stiffness in chronic hepatitis C virus (HCV) patients co-infected with schistosomiasis, and chronic HCV mono-infected patients.Material and methodsThe present study was conducted on 50 Egyptian chronic HCV patients, categorized into two groups: group A (25 patients with chronic HCV mono-infection) and group B (25 patients with chronic HCV and schistosomiasis coinfection). Also, 25 age- and sex-matched healthy subjects with no evidence of liver disease were included in the study as a control group. Stage of fibrosis was assessed invasively by histopathological examination of liver biopsies (patients only) and non-invasively by acoustic radiation force impulse imaging (ARFI) (all subjects).ResultsARFI of liver (ARFI L) and ARFI of spleen (ARFI S) in group A patients who had significant fibrosis were 1.82 ±0.24 and 2.72 ±0.26, respectively, while in group B, ARFI L and ARFI S in patients with significant fibrosis was 1.99 ±0.53 and 3.10 ±0.57, respectively.ConclusionsThe current study demonstrated insignificantly higher values of liver stiffness and significantly higher values of spleen stiffness assessed by ARFI in patients co-infected with HCV and schistosomiasis than mono-infected with HCV.